Surgical Pathology Cancer Case Summary

OVARY:             Report

OVARY: Oophorectomy, Salpingo-oophorectomy, Subtotal oophorectomy or removal of tumor in fragments, Hysterectomy with Salpingo-oophorectomy

MACROSCOPIC (check all that apply)

SPECIMEN TYPE

___ Right oophorectomy

___ Left oophorectomy

___ Right salpingo-oophorectomy

___ Left salpingo-oophorectomy

___ Subtotal right oophorectomy

___ Subtotal left oophorectomy

___ Removal of tumor in fragments

___ Hysterectomy with salpingo-oophorectomy

PRIMARY TUMOR SITE (check all that apply)

___ Right ovary

___ Parenchymal growth

___ Growth on surface

___ Rupture

___ Left ovary

___ Parenchymal growth

___ Growth on surface

___ Rupture

TUMOR INVOLVEMENT OF BROAD LIGAMENT

___ Not applicable

___ Right broad ligament

___ None

___ Direct extension

___ Separate metastasis

___ Left broad ligament

___ None

___ Direct extension

___ Separate metastasis

TUMOR SIZE: ___ x ___ x ___ cm

___ Single tumor

___ Tumor fragments in aggregate

OTHER ORGANS (if applicable, see optional Extended Synopsis)

___ None

___ Right ovary

___ Left ovary

___ Uterine cervix

___ Uterine corpus

___ Vagina

___ Vulva

___ Right fallopian tube

___ Left fallopian tube

___ Urinary bladder

___ Rectum

___ Other(s) (specify: ______________)

HISTOLOGIC TYPE

___ Serous

___ Borderline

___ Carcinoma

___ Mixed (specify proportions: _________)

___ Mucinous

___ Borderline

___ Carcinoma

___ Mixed (specify proportions: _________)

___ Endometrioid

___ Borderline

___ Carcinoma

___ Mixed (specify proportions: _________)

___ Clear cell

___ Borderline

___ Carcinoma

___ Mixed (specify proportions: _________)

___ Transitional cell

___ Borderline

___ Carcinoma

___ Mixed (specify proportions: _________)

___ Mixed epithelial

___ Borderline

___ Carcinoma

___ Mixed (specify proportions: _________)

___ Undifferentiated

___ Granulosa cell

___ Germ cell (specify type(s): ________________)

___ Other(s) (specify type(s) and proportions if mixed: ______________________)

HISTOLOGIC GRADE

___ Not applicable

___ GX: Cannot be assessed

___ G1: Well differentiated

___ G2: Moderately differentiated

___ G3: Poorly differentiated

___ G4: Undifferentiated

EXTENT OF INVASION

TNM (FIGO)

___ TX (--): Cannot be assessed

___ T0 (--): No evidence of primary tumor

___ T1 (--): Tumor limited to ovaries (one or both)

___ T1a (IA): Tumor limited to one ovary: capsule intact, no tumor on ovarian surface. No malignant cells in ascites or peritoneal washings

___ T1b (IB): Tumor limited to both ovaries: capsule intact, no tumor on ovarian surface. No malignant cells in ascites or peritoneal washings

___ T1c (IC): Tumor limited to one or both ovaries with any of the following: capsule ruptured, tumor on ovarian surface, malignant cells in ascites or peritoneal washings

___ T2: Tumor involves one or both ovaries with pelvic extension

___ T2a (IIA): Extension and/or implants on uterus and/or tube(s). No malignant cells in ascites or peritoneal washings

___ T2b (IIB): Extension to other pelvic tissues. No malignant cells in ascites or peritoneal washings

___ T2c (IIC): Pelvic extension (T2a or b) with malignant cells in ascites or peritoneal washings

___ T3 and/or N1 (III): Tumor involves one or both ovaries with microscopically confirmed peritoneal metastasis outside the pelvis and/or regional lymph node metastasis

___ T3a (IIIA): Microscopic peritoneal metastasis beyond pelvis

___ T3b (IIIB): Macroscopic peritoneal metastasis beyond pelvis < 2 cm in greatest dimension

___ T3c (IIIC): Peritoneal metastasis beyond pelvis > 2 cm in greatest dimension and/or regional lymph node metastasis

MARGIN(S), IF APPLICABLE

___ Uninvolved by tumor

Distance of tumor from closest margin: ___ cm

(Specify margin: _________________________)

___ Involved by tumor

(Specify margin(s):_______________________)

BLOOD/LYMPHATIC VESSEL INVASION

___ Absent

___ Present

___ Indeterminate

REGIONAL LYMPH NODES

___ NX: Cannot be assessed

___ N0: No regional lymph node metastasis

Number examined: ___

___ N1: Regional lymph node metastasis

Number examined: ___

Number involved: ___

DISTANT METASTASIS

___ MX: Cannot be assessed

___ M0: No distant metastasis

___ M1 (IV): Distant metastasis (site(s):_________

_________________________________________)

ADDITIONAL PATHOLOGIC FINDINGS

___ None identified

___ Endometriosis

___ Ovarian

___ Extraovarian

___ Endosalpingiosis

___ Other(s):

(specify site(s) and type(s):________________

________________________________________

________________________________________)

COMMENT

___________________________________________

___________________________________________

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