Surgical Pathology Cancer Case Summary

GASTROINTESTINAL LYMPHOMA:             Report

GASTROINTESTINAL LYMPHOMA: Resection

MACROSCOPIC (check all that apply)

SPECIMEN TYPE

___ Stomach

___ Partial gastrectomy

___ Proximal stomach

___ Distal stomach

___ Other (specify: _____________)

___ Total gastrectomy

___ Small intestine

___ Duodenum (Whipple resection)

___ Jejunal segmental resection

___ Ileal segmental resection

___ Distal ileum (with right hemicolectomy)

___ Colon

___ Right hemicolectomy

___ Transverse colectomy

___ Left hemicolectomy

___ Sigmoidectomy

___ Rectal (low anterior) resection

___ Other (specify: _____________________)

TUMOR SITE(S)

___ Stomach

___ Cardia

___ Fundus

___ Body

___ Antrum

___ Small intestine

___ Duodenum

___ Jejunum

___ Ileum

___ Colon

___ Cecum

___ Right colon

___ Hepatic flexure

___ Transverse colon

___ Splenic flexure

___ Left colon

___ Sigmoid colon

___ Rectum

___ Other (specify: _____________________)

TUMOR CONFIGURATION

___ Single tumor

___ Ulcerating

___ Polypoid

___ Multiple tumors

___ Ulcerating

___ Polypoid

TUMOR SIZE(S)

Single tumor: ___ x ___ x ___ cm

Multiple tumors (range of diameters): ___ cm to ___ cm

MICROSCOPIC (check all that apply)

TUMOR

Immunophenotyping

___ Performed

___ Not performed

Histologic type

___ Hodgkin’s disease

___ Lymphocyte predominance, nodular

___ Nodular sclerosis

___ Mixed cellularity

___ Lymphocyte depletion

___ Unclassified

___ Non-Hodgkin’s lymphoma (REAL Classification)

___ B cell lymphoma

___ Extranodal marginal zone B-cell lymphoma (low grade B-cell lymphoma of MALT type)

___ Mantle cell lymphoma

___ Follicle center lymphoma

___ Diffuse large B-cell lymphoma

___ Burkitt’s lymphoma

___ Other: _____________________

___ T cell lymphoma

___ Intestinal T-cell lymphoma (gluten-sensitive enteropathy-associated)

___ Other: ______________________

Histologic grade

___ High grade

___ Low grade

___ Not applicable

EXTENT OF INVASION

___ Cannot be assessed

___ Confined to mucosa/submucosa

___ Involvement of muscular wall/subserosa

___ Penetration of serosa

___ Perforation present

___ Perforation absent

___ Direct extension to other organ(s) or structure(s): __________________

___ Noncontiguous tumor involvement of other organ(s) or structure(s)

___ Absent

___ Present (specify site(s): _____________)

MARGINS

___ Uninvolved by tumor

Distance of tumor from closest margin: ___ cm

(Specify margin:__________________________)

___ Involved by tumor

___ Proximal margin

___ Distal margin

___ Deep radial margin (if applicable)

REGIONAL LYMPH NODES

___ Cannot be assessed

___ No regional lymph node involvement

Number examined: ___

___ Regional lymph node involvement

Number examined: ___

Number involved: ___

NONREGIONAL LYMPH NODES (if applicable)

___ Not applicable

___ No nonregional lymph node involvement

Number present in specimen: ___

___ Nonregional lymph node involvement

Number present in specimen: ___

Number involved: ___

ADDITIONAL PATHOLOGIC FINDINGS

___ None identified

___ Helicobacter pylori gastritis

___ Celiac disease (sprue)

___ Other (specify: _____________________)

COMMENT

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