Surgical Pathology Cancer Case Summary

HODGKIN’S DISEASE:             Report

HODGKIN’S DISEASE: Cytology/Biopsy

MACROSCOPIC (check all that apply)

SPECIMEN TYPE

___ Cytology

___ Biopsy

TUMOR SITE

___ Lymph Node(s)

___ Site unknown

Site: _____________________________

Site: _____________________________

Site: _____________________________

___ Other tissue(s) or organ(s)*

Site: _____________________________

Site: _____________________________

Site: _____________________________

*non-gastrointestinal site (for primary gastrointestinal lymphoma, see Gastrointestinal Lymphoma protocol)

ADEQUACY OF SPECIMEN (if applicable)

___ Satisfactory

___ Limited (see COMMENT)

___ Unsatisfactory (see COMMENT)

COMMENT

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MICROSCOPIC (check all that apply)

IMMUNOPHENOTYPING

___ Performed (see COMMENT, if pertinent)

___ Not performed

HISTOLOGIC TYPE

___ Lymphocyte predominance, nodular

___ Nodular sclerosis

___ Mixed cellularity

___ Lymphocyte depletion

___ Lymphocyte-rich, classical Hodgkin’s disease (provisional category)

___ Indeterminate for type

ADDITIONAL PATHOLOGIC FINDINGS

Specify: ____________________________

COMMENT

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