Surgical Pathology Cancer Case Summary

UTERINE CERVIX:             Report

UTERINE CERVIX: Cytology/Biopsy

MACROSCOPIC (check all that apply)

SPECIMEN TYPE

___ Cytology

___ Incisional biopsy

___ Excisional biopsy (cone biopsy)

TUMOR SITE

___ Right superior quadrant

___ Right inferior quadrant

___ Left superior quadrant

___ Left inferior quadrant

TUMOR SIZE (cone biopsy only)

___ x ___ x (___) cm

MICROSCOPIC (check all that apply)

HISTOLOGIC TYPE

___ Squamous intraepithelial neoplasia (CIN)

___ Mild dysplasia (CIN 1)

___ Moderate dysplasia (CIN 2)

___ Severe dysplasia (CIN 3)

___ Carcinoma in situ (CIN 3)

___ Squamous cell carcinoma

___ Keratinizing

___ Nonkeratinizing

___ Other (specify: __________________)

___ Glandular intraepithelial lesions

___ Dysplasia

___ Adenocarcinoma in situ

___ Adenocarcinoma

___ Mucinous

___ Endocervical type

___ Intestinal type

___ Endometrioid

___ Clear cell

___ Other (specify: __________________)

___ Other (specify: ______________________)

HISTOLOGIC GRADE

___ Not applicable

___ GX: Cannot be assessed

___ G1: Well differentiated

___ G2: Moderately differentiated

___ G3: Poorly differentiated

___ G4: Undifferentiated

EXTENT OF INVASION

___ Cannot be assessed

___ Epithelium only (no invasion)

___ Stromal invasion

Depth (cone biopsy only): ___ cm

MARGINS

___ Not applicable

___ Indeterminate

___ Uninvolved by tumor

Distance of tumor from closest margin: ___ cm

(Specify margin: __________________________)

___ Involved by tumor (specify site:_____________)

ADDITIONAL PATHOLOGIC FINDINGS

___ None identified

___ Koilcytosis

___ Inflammation

___ Microorganisms present (specify: ____________)

___ Other (specify: ____________________________)

COMMENT

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