Surgical Pathology Cancer Case Summary
SMALL INTESTINE: Report
MACROSCOPIC (check all that apply)
SPECIMEN TYPE
___ Cytology
___ Biopsy
___ Polypectomy
TUMOR SITE
___ Unknown
___ Duodenum
___ Jejunum
___ Ileum
TUMOR CONFIGURATION:
___ Exophytic (polypoid)
___ Infiltrative
___ Ulcerating
___ Annular
___ Other (specify: ___________________________)
TUMOR SIZE: ___ x ___ x ___ cm
OTHER ORGANS
___ Stomach
___ Pancreas
___ Spleen
___ Colon
___ Other (specify: ____________________________)
ADDITIONAL PATHOLOGIC FINDINGS
___ None identified
___ Polyps (number: ___)
___ Active Crohn’s disease
MICROSCOPIC (check all that apply)
HISTOLOGIC TYPE
___ Adenocarcinoma in situ/severe dysplasia
___ Adenocarcinoma
___ Mucinous adenocarcinoma (>50% mucinous)
___ Signet ring cell carcinoma (>50% signet ring cells)
___ Squamous cell carcinoma
___ Adenosquamous carcinoma
___ Small cell carcinoma
___ Undifferentiated carcinoma
___ Other:___________________
HISTOLOGIC GRADE (if applicable to tumor type)
___ Not applicable
___ GX: Cannot be assessed
___ G1: Well differentiated (>95% gland forming)
___ G2: Moderately differentiated (50-95% gland forming)
___ G3: Poorly differentiated
___ G4: Undifferentiated
EXTENT OF INVASION
___ TX: Cannot be assessed
___ T0: No evidence of primary tumor
___ Tis: Carcinoma in situ
___ T1: Tumor invades lamina propria or submucosa
___ T2: Tumor invades muscularis propria
___ T3: Tumor invades through the muscularis propria into the subserosa or the nonperitonealized perimuscular tissue with extension of 2 cm or less
___ T4: Tumor perforates the visceral peritoneum or directly invades other organs or structures
MARGINS
Proximal margin
___ Uninvolved
___ Involved by tumor
Distal margin
___ Uninvolved
___ Involved by tumor
Deep (radial) margin
___ Not applicable
___ Uninvolved
___ Involved by tumor
BLOOD/LYMPHATIC (SMALL) VESSEL INVASION
___ Absent
___ Present
___ Indeterminate
PERINEURAL INVASION
___ Not applicable
___ Absent
___ Present
TUMOR BORDER CONFIGURATION
___ Pushing
___ Infiltrating
REGIONAL LYMPH NODES
___ NX: Cannot be assessed
___ N0: No regional lymph node metastasis
Number examined: ___
___ N1: Metastasis in lymph nodes
Number examined: ___
Number involved: ___
DISTANT METASTASIS
___ MX: Cannot be assessed
___ M0: No distant metastasis
___ Distant metastasis (site(s): _________________
_________________________________________)
ADDITIONAL PATHOLOGIC FINDINGS
___ None identified
___ Adenoma(s)
___ Crohn’s disease
___ Celiac disease
___ Epithelial dysplasia
___ Other polyps (type(s): _____________________)
___ Other (specify: ___________________________)
COMMENT
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