Ureter, Renal Pelvis: Biopsy

Surgical Pathology Cancer Case Summary (Checklist)

^*Specimen

^*____ Renal pelvis

^*____ Ureter

^*____ Other (specify): ______________________________

^*____ Not specified

^*Specimen Laterality

^*____ Left

^*____ Right

^*____ Not specified

^*Histologic Type

^*____ Urothelial (transitional cell) carcinoma

^*____ Urothelial (transitional cell) carcinoma with squamous differentiation

^*____ Urothelial (transitional cell) carcinoma with glandular differentiation

^*____ Urothelial (transitional cell) carcinoma with other variant histology (specify): ______________________________

^*____ Squamous cell carcinoma, typical

^*____ Squamous cell carcinoma, variant histology (specify): ______________________________

^*____ Adenocarcinoma, typical

^*____ Adenocarcinoma, variant histology (specify): ______________________________

^*____ Small cell carcinoma

^*____ Undifferentiated carcinoma (specify): ______________________________

^*____ Mixed cell type (specify): ______________________________

^*____ Other (specify): ______________________________

^*____ Carcinoma, type cannot be determined

^*Associated Epithelial Lesions (select all that apply)

^*____ None identified

^*____ Urothelial (transitional cell) papilloma (World Health Organization [WHO]/International Society of Urologic Pathology [ISUP], 1998; WHO 2004)

^*____ Urothelial (transitional cell) papilloma, inverted type

^*____ Papillary urothelial (transitional cell) neoplasm, low malignant potential (WHO/ISUP 1998; WHO 2004)

^*____ Cannot be determined

^*Histologic Grade

^*____ Not applicable

^*____ Cannot be determined

*Urothelial carcinoma (WHO/ISUP 1998; WHO 2004)

^*____ Low grade

^*____ High grade

^*____ Other (specify): ______________________________

^*Adenocarcinoma and squamous cell carcinoma

^*____ GX: Cannot be assessed

^*____ G1: Well differentiated

^*____ G2: Moderately differentiated

^*____ G3: Poorly differentiated

^*____ Other (specify): ______________________________

^*Tumor Configuration (select all that apply)

^*____ Papillary

^*____ Solid/nodule

^*____ Flat

^*____ Ulcerated

^*____ Indeterminate

^*____ Other (specify): ______________________________

^*Adequacy of Material for Determining T Category

^*____ Muscularis propria not identified

^*____ Muscularis propria present

^*____ Indeterminate

Pathologic Staging (pTNM)

^*TNM descriptors (select all that apply)

^*____ None

^*____ m (multiple primary tumors)

^*____ r (recurrent)

^*____ y (post-treatment)

*Primary tumor (pT)

^*____ pTX: Cannot be assessed

^*____ PT0: No evidence of primary tumor

^*____ pTa: Noninvasive papillary carcinoma

^*____ pTis: Flat carcinoma in situ

^*____ pT1: Tumor invades subepithelial connective tissue (lamina propria)

^*____ pT2: Tumor invades muscularis propria

^*Additional Pathologic Findings (select all that apply)

^*____ Urothelial carcinoma in situ

^*____ Urothelial dysplasia (low-grade intraurothelial neoplasia)

^*____ Inflammation/regenerative changes

^*____ Therapy-related changes

^*____ Cautery artifact

^*____ Ureteritis or pyelitis cystica &/or glandularis

^*____ Keratinizing squamous metaplasia

^*____ Intestinal metaplasia

^*____ Other (specify): ______________________________

^* 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 Carcinoma of the Ureter and Renal Pelvis.” Web posting date October 2009, www.cap.org.