Protocol for Thymoma and Thymic Carcinoma Specimen Examination

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.