Surgical Pathology Cancer Case Summary
VAGINA: Report
Surgical
Pathology Cancer Case Summary
VAGINA: Resection
MACROSCOPIC (check all that apply)
SPECIMEN TYPE
___ Vaginectomy
___ Radical vaginectomy
TUMOR SITE (check all that apply)
___ Upper third
___ Circumferential
___ Anterior
___ Posterior
___ Left lateral
___ Right lateral
___ Middle third
___ Circumferential
___ Anterior
___ Posterior
___ Left lateral
___ Right lateral
___ Lower third
___ Circumferential
___ Anterior
___ Posterior
___ Left lateral
___ Right lateral
TUMOR SIZE: ___ x ___ x ___ cm
OTHER ORGANS (if applicable, see optional Extended Synopsis)
___ None
___ Right ovary
___ Left ovary
___ Uterine cervix
___ Uterine corpus
___ Vulva
___ Right fallopian tube
___ Left fallopian tube
___ Urinary bladder
___ Rectum
___ Other(s) (specify: _________________________)
MICROSCOPIC (check all that apply)
HISTOLOGIC TYPE
___ Squamous cell carcinoma
___ Adenosquamous carcinoma
___ Adenocarcinoma
___ Mucinous
___ Clear cell
___ Other (specify:_______________)
___ Not otherwise specified
HISTOLOGIC GRADE
___ GX: Cannot be assessed
___ G1: Well differentiated
___ G2: Moderately differentiated
___ G3: Poorly differentiated
___ G4: Undifferentiated
TNM (FIGO)
___ TX (--): Cannot be assessed
___ T0 (--): No evidence of primary tumor
___ Tis (0): Carcinoma in situ
___ T1 (I): Tumor confined to vagina
___ T2 (II): Tumor invades paravaginal tissues but not to pelvic wall
___ T3 (III): Tumor extends to pelvic wall
___ T4 (IVA ):Tumor invades mucosa of bladder or rectum and/or extends beyond true pelvis
MARGINS
___ Uninvolved by tumor
Distance of tumor from closest margin: ___ cm
(Specify margin: _________________________)
___ Involved by tumor (specify margin:_________)
REGIONAL LYMPH NODES
___ NX: Cannot be assessed
___ N0: No regional lymph node metastasis
Number examined: ___
___ N1: Pelvic or inguinal 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
___ Dysplasia
___ Condyloma acuminatum
___ Adenosis
___ Other (specify: ____________________)
COMMENT
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