Surgical Pathology Cancer Case Summary

NON-HODGKIN’S LYMPHOMA:             Report

NON-HODGKIN’S LYMPHOMA: Cytology

MACROSCOPIC (check all that apply)

SPECIMEN TYPE

___ Cytology

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

___ 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 (Revised European-American

Lymphoma [REAL] Classification)

___ Histologic type cannot be assessed

___ B cell lymphoma

___ Subtype cannot be determined

___ Precursor B-lymphoblastic lymphoma/leukemia

___ B-cell chronic lymphocytic leukemia/prolymphocytic leukemia/small lymphocytic lymphoma

___ Mantle cell lymphoma

___ Lymphoplasmacytic/immunocytoma

___ Follicle center lymphoma

___ Follicular Grade I

___ Follicular Grade II

___ Follicular Grade III

___ Diffuse predominantly small cell

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

___ Nodal marginal zone B-cell lymphoma (monocytoid B-cell lymphoma) (provisional)

___ Splenic marginal zone B-cell lymphoma

___ Hairy cell leukemia

___ Plasmacytoma/plasma cell myeloma

___ Diffuse large B-cell lymphoma

___ Primary mediastinal B-cell lymphoma

___ Burkitt’s lymphoma

___ High grade B-cell lymphoma, Burkitt-like

___ T cell lymphoma

___ Subtype cannot be determined

___ Precursor T-lymphoblastic lymphoma/leukemia

___ T-cell chronic lymphocytic leukemia/prolymphocytic leukemia

___ Large granular lymphocytic leukemia

___ T-cell type

___ NK-cell type

___ Mycosis fungoides / Sézary’s syndrome

___ Peripheral T-cell lymphomas, unspecified

___ Hepatosplenic g-d T-cell lymphoma

___ Angioimmunoblastic T-cell lymphoma

___ Nasal / nasal type T/NK cell (angiocentric) lymphoma

___ Adult T-cell lymphoma/leukemia

___ Anaplastic large cell lymphoma

___ T-cell type

___ Null cell type

ADDITIONAL PATHOLOGIC FINDINGS

Specify: ___________________________________

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COMMENT

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