Surgical Pathology Cancer Case Summary

UTERINE CERVIX:             Report

Surgical Pathology Cancer Case Summary

UTERINE CERVIX: Hysterectomy/Pelvic Exenteration

MACROSCOPIC (check all that apply)

SPECIMEN TYPE

___ Hysterectomy

___ Radical hysterectomy

___ Pelvic exenteration

TUMOR SITE (check all that apply)

___ Right superior quadrant

___ Right inferior quadrant

___ Left superior quadrant

___ Left inferior quadrant

TUMOR SIZE: ___ x ___ x ___ cm

OTHER ORGANS (if applicable, see optional Extended Synopsis)

___ None

___ Right ovary

___ Left ovary

___ Uterine corpus

___ Vagina

___ Vulva

___ Right fallopian tube

___ Left fallopian tube

___ Urinary bladder

___ Rectum

___ Other(s) (specify: ______________)

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 TNM (FIGO)

___ TX (--): Cannot be assessed

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

___ Tis (--): Carcinoma in situ

___ T1 (I): Cervical carcinoma confined to uterus

___ T1a (IA): Invasive carcinoma diagnosed by microscopy only

___ T1a1 (IA1): Stromal invasion < 3.0 mm in depth and horizontal spread < 7.0 mm

___ T1a2 (IA2): Stromal invasion > 3.0 mm but < 5.0 mm in depth and horizontal spread < 7.0 mm

___ T1b (IB): Clinically visible lesion confined to the cervix or microscopic lesion greater than T1a2/IA2

___ T1b1 (IB1): Clinically visible lesion < 4.0 cm in greatest dimension

___ T1b2 (IB2): Clinically visible lesion > 4.0 cm in greatest dimension

___ T2 (II): Tumor invades beyond the uterus but not to pelvic wall or to lower third of vagina

___ T2a (IIA): T2 without parametrial invasion

___ T2b (IIB): T2 with parametrial invasion

___ T3 (III): Tumor extends to the pelvic wall and/or involves the lower third of the vagina and/or causes hydronephrosis or nonfunctioning kidney

___ T3a (IIIA): Tumor involves lower third of vagina, but not pelvic wall

___ T3b (IIIB): Tumor extends to pelvic wall and/or causes hydronephrosis or nonfunctioning kidney

___ T4 (IVA): Tumor invades the mucosa of bladder or rectum and/or extends beyond true pelvis

___ M1(IVB): Distant metastasis

MARGINS

___ Uninvolved by tumor

Distance of tumor from closest margin: ___ cm

(Specify margin: __________________________)

___ Indeterminate for involvement by tumor

(Specify margin:__________________________)

___ Involved by tumor

(Specify margin:__________________________)

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 (IVB): Distant metastasis

(Site(s):_________________________________)

ADDITIONAL PATHOLOGIC FINDINGS

___ None identified

___ Cervical koilcytosis

___ Cervical Inflammation

___ Microorganisms present in cervix

(Specify:________________________________)

___ Other(s):

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

________________________________________

________________________________________)

COMMENT

___________________________________________

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