Thymus: Resection

Surgical Pathology Cancer Case Summary (Checklist)

Specimen

____ Thymus

____ Thymus and other (specify): ______________________________

____ Not specified

Procedure

____ Thymectomy

____ Partial thymectomy

____ Other (specify): ______________________________

____ Not specified

Specimen Integrity

____ Intact

____ Disrupted

____ Indeterminate

Specimen Weight

Specify: __________ grams

Tumor Size

Greatest dimension: __________ cm

^*Additional dimensions: __________ x __________ cm

____ Cannot be determined

Histologic Type

Thymoma (specify)

____ Type A thymoma

____ Type AB thymoma

____ Type B1 thymoma

____ Type B2 thymoma

____ Other (specify): ______________________________

Thymic carcinoma (specify)

____ Squamous cell carcinoma

____ Basaloid carcinoma

____ Mucoepidermoid carcinoma

____ Lymphoepithelioma-like carcinoma

____ Sarcomatoid carcinoma

____ Clear cell carcinoma

____ Adenocarcinoma

____ Well-differentiated neuroendocrine carcinoma, typical carcinoid

____ Well-differentiated neuroendocrine carcinoma, atypical carcinoid

____ Poorly differentiated neuroendocrine carcinoma, large cell neuroendocrine carcinoma

____ Poorly differentiated neuroendocrine carcinoma, small cell carcinoma, neuroendocrine type

____ Other (specify): ______________________________

____ Other (specify): ______________________________

Tumor Extension

____ Not applicable

____ Not identified

____ Cannot be assessed

____ Pulmonary parenchyma

^*Specify lobe(s) of lung: ______________________________

____ Pleura

^*Specify location: ______________________________

____ Pericardium

____ Diaphragm

____ Other (specify): ______________________________

Margins

____ Cannot be assessed

____ Margins uninvolved by tumor

Distance of tumor from closest margin: __________ mm

____ Margin(s) involved by tumor

Specify margin(s): ______________________________

Treatment Effect

____ Not applicable

____ Cannot be determined

____ Not identified

____ Present (specify: __________ % residual viable tumor)

Lymph-Vascular Invasion

____ Not identified

____ Present

____ Indeterminate

Regional Lymph Nodes

____ Cannot be assessed

____ No regional lymph node metastasis

____ Regional lymph node metastasis

____ No nodes submitted or found

Number of lymph nodes examined

Specify: __________

____ Number cannot be determined (explain): ______________________________

Number of lymph nodes involved

Specify: __________

____ Number cannot be determined (explain): ______________________________

Pathologic Staging for Thymomas (Modified Masaoka Stage) (applies only to thymomas)

____ Stage I: Grossly and microscopically encapsulated (includes microscopic invasion into, but not through, the capsule)

____ Stage IIa: Microscopic transcapsular invasion

____ Stage IIb: Macroscopic capsular invasion

____ Stage III: Macroscopic invasion of neighboring organs

____ Stage IVa: Pleural or pericardial dissemination

____ Stage IVb: Hematogenous or lymphatic dissemination

____ Cannot be determined

Implants/Distant Metastasis (select all that apply)

____ Cannot be assessed

____ Not identified

Specify site(s)

____ Pleura

____ Pericardium

____ Other (specify): ______________________________

Pathologic Staging for Thymic Carcinomas (pTNM) (does not apply to thymomas)

TNM descriptors (required only if applicable) (select all that apply)

____ m (multiple primary tumors)

____ r (recurrent)

____ y (post-treatment)

Primary tumor (pT)

____ pTX: Primary tumor cannot be assessed

____ pT0: No evidence of primary tumor

____ pT1: Tumor completely encapsulated

____ pT2: Tumor invades pericapsular connective tissue

____ pT3: Tumor invades neighboring structures, such as pericardium, mediastinal pleura, thoracic wall, great vessels, and lung

____ pT4: Tumor with pleural or pericardial dissemination

Regional lymph nodes (pN)

____ pNX: Regional lymph nodes cannot be assessed

____ pN0: No regional lymph node metastases

____ pN1: Metastasis in anterior mediastinal lymph nodes

____ pN2: Metastasis in other intrathoracic lymph nodes, excluding anterior mediastinal lymph nodes

____ pN3: Metastasis in scalene &/or supraclavicular lymph nodes

Distant metastasis (pM)

____ Not applicable

____ pM1: Distant metastasis

^*Specify site(s), if known: ______________________________

^*Additional Pathologic Findings (select all that apply)

^*____ Age-appropriate involution changes

^*____ Fibrosis

^*____ Cortical hyperplasia

^*____ Cystic changes in tumor

^*____ Cystic changes in adjacent thymus

^*____ Other (specify): ______________________________

^*Ancillary Studies

^*____ Immunohistochemical staining

^*Specify results: ______________________________

Protocol applies to thymic epithelial tumors located in any area of mediastinum.

^*Data elements with asterisks are not required. However, these elements may be clinically important but are not yet validated or regularly used in patient management. Adapted with permission from College of American Pathologists, “Protocol for the Examination of Specimens from Patients with Thymoma and Thymic Carcinoma.” Web posting date: February 2011, www.cap.org.