Surgical Pathology Cancer Case Summary

ANUS:             Report

ANUS: Local excision (Transanal disk excision)

MACROSCOPIC (check all that apply)

SPECIMEN TYPE

Transanal disk excision

___ Intact

___ Fragmented (number of pieces: ___)

TUMOR SITE

___ Unknown

___ Anterior wall

(Distance from anal verge: ___ cm)

___ Distance from anal verge unknown

___ Posterior wall

(Distance from anal verge: ___ cm)

___ Distance from anal verge unknown

___ Right wall

(Distance from anal verge: ___ cm)

___ Distance from anal verge unknown

___ Left wall

(Distance from anal verge: ___ cm)

___ Distance from anal verge unknown

___ Anal margin

TUMOR CONFIGURATION:

___ Exophytic (polypoid)

___ Infiltrative

___ Ulcerating

___ Other (specify: ______________________)

TUMOR SIZE: ___ x ___ x ___ cm

MICROSCOPIC (check all that apply)

HISTOLOGIC TYPE

___ Squamous cell carcinoma

___ Large cell keratinizing

___ Large cell nonkeratinizing

___ Basaloid

___ Carcinoma in situ (Bowen’s disease)

___ Adenocarcinoma

___ Rectal type

___ Of anal glands

___ Within anorectal fistula

___ Paget’s disease

___ Small cell carcinoma

___ Giant condyloma (verrucous carcinoma)

___ Basal cell carcinoma

___ Undifferentiated carcinoma

___ Other:___________________

HISTOLOGIC GRADE (if applicable to tumor type)

___ Not applicable

___ GX: Cannot be assessed

___ G1: Well differentiated

___ G2: Moderately differentiated

___ G3: Poorly differentiated

___ G4: Undifferentiated

EXTENT OF INVASION

___ TX: Cannot be assessed

___ T0: No evidence of primary tumor

___ Tis: Carcinoma in situ

___ Intraepithelial (no invasion)

___ Invasion of lamina propria

___ Invasion of muscularis mucosae

___ T1: Tumor < 2 cm in greatest dimension

___ T2: Tumor > 2 cm but < 5 cm in greatest dimension

___ T3: Tumor > 5 cm in greatest dimension

___ T4: Tumor of any size with invasion of adjacent organ(s); e.g., vagina, urethra, bladder (involvement of sphincter muscles alone is not classified as T4).

MICROSCOPIC, CONTINUED (check all that apply)

MARGINS

___ Margins cannot be assessed

___ Margins uninvolved by tumor

Distance of tumor from closest margin: ___ cm

(Specify margin:

___________________________)

___ Lateral margin involved by tumor

___ Location unknown (specimen unoriented)

___ Superior

___ Left lateral

___ Inferior

___ Right lateral

___ Deep margin involved by tumor

___ Focal

___ Multifocal

BLOOD/LYMPHATIC (SMALL) VESSEL INVASION

___ Absent

___ Present

___ Indeterminate

PERINEURAL INVASION

___ Absent

___ Present

REGIONAL LYMPH NODES

___ NX: Cannot be assessed

___ N0: No regional lymph node metastasis

Number examined: ___

___ N1: Metastasis in perirectal lymph nodes

Number examined: ___

Number involved: ___

___ N2: Metastasis in unilateral internal iliac and/or inguinal lymph node(s)

___ N3: Metastasis in perirectal and inguinal lymph nodes and/or bilateral internal iliac and/or inguinal lymph nodes

ADDITIONAL PATHOLOGIC FINDINGS

___ None identified

___ Crohn’s disease

___ Condyloma accuminatum

___ Dysplasia

___ Associated rectal carcinoma (Paget’s disease)

___ Other (specify: _____________________)

COMMENT

___________________________________________

___________________________________________

___________________________________________

___________________________________________