Surgical Pathology Cancer Case Summary

TROPHOBLAST:             Report

TROPHOBLAST: Resection with or without other organs or tissues

MACROSCOPIC (check all that apply)

SPECIMEN TYPE

___ Hysterectomy

___ Radical hysterectomy

___ Pelvic exenteration

TUMOR SITE

___ Unspecified

___ Corpus

___ Fundus

___ Lower uterine segment

___ Right cornu

___ Left cornu

___ Isthmus

TUMOR SIZE: ___ x ___ x ___ cm

CLINICAL RISK FACTORS

Serum HCG level

___ Unknown

___ < 100,000 mIU/ml

___ > 100,000 mIU/ml

Duration of disease

___ Unknown

___ < 6 months from termination of antecedent pregnancy

___ > 6 months from termination of antecedent pregnancy

OTHER ORGANS (if applicable, see optional Extended Synopsis)

___ None

___ Right ovary

___ Left ovary

___ Vagina

___ Vulva

___ Right fallopian tube

___ Left fallopian tube

___ Urinary bladder

___ Rectum

___ Other(s) (specify: ______________)

MICROSCOPIC (check all that apply)

HISTOLOGIC TYPE

___ Hydatidiform mole

___ Complete

___ Partial

___ Invasive hydatidiform mole

___ Choriocarcinoma

___ Placental site trophoblastic tumor

___ Trophoblastic lesion

___ Exaggerated placental site

___ Placental site nodule and plaque

___ Unclassified trophoblastic lesion

EXTENT OF INVASION

Gestational Trophoblastic Tumors (GTTs)

TNM (FIGO)

___ T1 (I): Disease confined to uterus

___ T1 (IA): Disease confined to uterus with no risk factors

___ T1 (IB): Disease confined to uterus with one risk factor

___ T1 (IC): Disease confined to uterus with two risk factors

___ T2 (II): GTT extends outside of the uterus but is limited to the genital structures (adnexa, vagina, broad ligament)

___ T2 (IIA): GTT involving genital struture without risk factors

___ T2 (IIB): GTT extends outside of the uterus but limited to genital structures with one risk factor

___ T2 (IIC): GTT extends outside of the uterus but limited to genital structures with two risk factors

___ M1a (III): GTT extends to the lungs with or without genital tract involvement

___ M1a (IIIA): GTT extends to the lungs with or without genital tract involvement without risk factors

___ M1a (IIIB): GTT extends to the lungs with or without genital tract involvement with one risk factor

___ M1a (IIIC): GTT extends to the lungs with or without genital tract involvement with two risk factors

___ M1b (IV): All other metastatic sites

___ M1b (IVA): All other metastatic sites without risk factors

___ M1b (IVB): All other metastatic sites with one risk factor

___ M1b (IVC): All other metastatic sites with two risk factors

MARGINS

___ Uninvolved by tumor

Distance of tumor from closest margin: ___ cm

(Specify margin: __________________________)

___ Involved by tumor

___ Cervical/Vaginal margin

___ Right parametrial margin

___ Left parametrial margin

___ Other (specify:_____________________)

BLOOD/LYMPHATIC VESSEL INVASION

___ Absent

___ Present

___ Indeterminate

ADDITIONAL PATHOLOGIC FINDINGS

___ None identified

___ Implantation site

___ Fetal tissue(s)

___ Cord

___ Amnion

___ Chorion

___ Yolk sac

___ Fetal anomalies (specify: __________________)

___ Other (specify: ___________________________)

COMMENT

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