Surgical Pathology Cancer Case Summary
VULVA: Report
VULVA: Cytology/Biopsy/Resection
MACROSCOPIC (check all that apply)
SPECIMEN TYPE
___ Cytology
___ Biopsy
___ Local excision
___ Wide excision
___ Partial vulvectomy (specify type, if known: __
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___ Total vulvectomy (specify type, if known: __
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___ Radical vulvectomy
ADEQUACY OF SPECIMEN (if applicable)
___ Satisfactory
___ Limited (see COMMENT)
___ Unsatisfactory (see COMMENT)
LYMPHADENECTOMY
___ Not applicable
___ Inguinal-femoral nodes
___ Pelvic nodes
OTHER ORGANS OR TISSUES
___ None
___ Urethra
___ Vagina
___ Anus
___ Bladder
___ Rectum
___ Other
TUMOR SITE (check all that apply)
___ Unknown
___ Right vulva
___ Labia major
___ Labia minor
___ Left vulva
___ Labia major
___ Labia minor
___ Clitoris
TUMOR SIZE: ___ x ___ x ___ cm
COMMENT
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MICROSCOPIC (check all that apply)
HISTOLOGIC TYPE
___ Squamous cell carcinoma
___ Vulvar intraepithelial neoplasia 3 (VIN3: severe dysplasia/carcinoma in situ)
___ Keratinizing
___ Non keratinizing
___ Basaloid
___ Verrucous
___ Warty (condylomatous)
___ Other (specify): ______________________
___ Adenocarcinoma
___ Paget’s disease
___ Bartholin’s gland carcinoma
(specify type:________________________)
___ Carcinoma resembling breast carcinoma
___ Eccrine carcinoma
___ Other (specify): ______________________
___ Malignant melanoma
___ Superficial spreading
___ Nodular
___ Acrolentiginous
___ 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) (carcinomas only)
___ TX: Cannot be assessed
___ T0: No evidence of primary tumor
___ Tis: Carcinoma in situ
___ T1: Tumor confined to vulva or vulva and perineum ≤ 2cm in greatest dimension
___ T1a: with stromal invasion ≤ 1mm
___ T1b: with stromal invasion > 1mm
___ T2: Tumor confined to vulva or vulva and perineum > 2 cm in greatest dimension
___ T3: Tumor invades any of the following: lower urethra, vagina, anus
___ T4: Tumor invades any of the following: bladder mucosa, rectal mucosa, upper urethral mucosa; or is fixed to pubic bone
EXTENT OF INVASION (malignant melanoma only)
Clark Level
___ I: In situ
___ II: Invades superficial papillary dermis
___ III: Fills and expands papillary dermis
___ IV: Invades reticular dermis
___ V: Invades fat or deeper tissues
Breslow Measurement
___ Invasion < 0.75 mm from deep border of granular layer
___ Invasion 0.76 to 1.5 mm from deep border of granular layer
___ Invasion > 1.5 mm from deep border of granular layer
TUMOR BORDER (all tumors)
___ Pushing
___ Infiltrating
BLOOD/LYMPHATIC VESSEL INVASION (all tumors)
___ Absent
___ Present
___ Indeterminate
MARGINS (all tumors)
___ Uninvolved by tumor
Distance of tumor from closest margin: ___ cm
(specify margin: _________________________)
___ Involved by tumor (specify margin:_________)
REGIONAL LYMPH NODES (all tumors)
___ NX: Cannot be assessed
___ N0: No regional lymph node metastasis
Number examined: ___
___ N1: Unilateral lymph node metastasis
Number examined: ___
Number involved: ___
___ N2: Bilateral regional lymph node metastasis
Number examined: ___
Number involved: ___
DISTANT METASTASIS (all tumors)
___ MX: Cannot be assessed
___ M0: No distant metastasis
___ M1: Distant metastasis (site(s):_____________)
ADDITIONAL PATHOLOGIC FINDINGS
___ None identified
___ Dysplasia
___ Condyloma accuminatum
___ Other (specify: ____________________)
COMMENT
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