Surgical Pathology Cancer Case Summary (Checklist)
Protocol revision date: January 2005
Applies to invasive carcinomas only
Based on AJCC/UICC TNM, 6th edition
PANCREAS (EXOCRINE): Resection
Patient name:
Surgical pathology number:
Note: Check 1 response unless otherwise indicated.
MACROSCOPIC
Specimen Type
___ Pancreaticoduodenectomy (Whipple resection), partial pancreatectomy
___ Pancreaticoduodenectomy (Whipple resection), total pancreatectomy
___ Pylorus sparing pancreaticoduodenectomy, partial pancreatectomy
___ Pylorus sparing pancreaticoduodenectomy, total pancreatectomy
___ Partial pancreatectomy, pancreatic body
___ Partial pancreatectomy, pancreatic tail
___ Other (specify): ____________________________
___ Not specified
Tumor Site (check all that apply)
___ Pancreatic head
___ Uncinate process
___ Pancreatic body
___ Pancreatic tail
___ Not specified
Tumor Size
Greatest dimension: ___ cm
*Additional dimensions: ___ x ___ cm
___ Cannot be determined (see Comment)
*Other Organs Resected
*___ None
*___ Spleen
*___ Gallbladder
*___ Other(s) (specify): _________________________
MICROSCOPIC
Histologic Type
___ Ductal adenocarcinoma
___ Mucinous noncystic carcinoma
___ Signet-ring cell carcinoma
___ Adenosquamous carcinoma
___ Undifferentiated (anaplastic) carcinoma
___ Undifferentiated carcinoma with osteoclast-like giant cells
___ Mixed ductal-endocrine carcinoma
___ Serous cystadenocarcinoma
___ Mucinous cystadenocarcinoma – invasive
___ Invasive papillary-mucinous carcinoma
___ Acinar cell carcinoma
___ Acinar cell cystadenocarcinoma
___ Mixed acinar-endocrine carcinoma
___ Other (specify): ____________________________
___ Carcinoma, type cannot be determined
Histologic Grade (ductal carcinoma only)
___ Not applicable
___ GX: Cannot be assessed
___ G1: Well differentiated
___ G2: Moderately differentiated
___ G3: Poorly differentiated
___ G4: Undifferentiated
___ Other (specify): ____________________________
Pathologic Staging (pTNM)
Primary Tumor (pT)
___ pTX: Cannot be assessed
___ pT0: No evidence of primary tumor
___ pTis: Carcinoma in situ
___ pT1: Tumor limited to the pancreas, 2 cm or less in greatest dimension
___ pT2: Tumor limited to the pancreas, more than 2 cm in greatest dimension
___ pT3: Tumor extends beyond the pancreas but without involvement of the celiac axis or the superior mesenteric artery
___ pT4: Tumor involves the celiac axis or the superior mesenteric artery
Regional Lymph Nodes (pN)
___ pNX: Cannot be assessed
___ pN0: No regional lymph node metastasis
___ pN1: Regional lymph node metastasis
*___ N1a: Metastasis in single regional lymph node
*___ N1b: Metastasis in multiple regional lymph nodes
Specify: Number examined ___
Number involved: ___
Distant Metastasis (pM)
___ pMX: Cannot be assessed
___ pM1: Distant metastasis
*Specify site(s), if known: ____________________________
Margins (check all that apply)
___ Cannot be assessed
___ Margins uninvolved by invasive carcinoma
Distance of invasive carcinoma from closest margin: ___ mm
*Specify margin (if possible): ____________________________
___ Carcinoma in situ absent at ductal margins
___ Carcinoma in situ present at common bile duct margin
___ Carcinoma in situ present at pancreatic parenchymal margin
___ Margin(s) involved by invasive carcinoma
___ Posterior retroperitoneal (radial) margin: posterior surface of pancreas
___ Uncinate process margin (non-peritonealized surface of the uncinate process)
___ Distal pancreatic margin
___ Common bile duct margin
___ Proximal pancreatic margin
___ Other (specify): ____________________________
*Venous/Lymphatic (Large/Small Vessel) Invasion (V/L)
*___ Absent
*___ Present
*___ Indeterminate
*Perineural Invasion
*___ Absent
*___ Present
*Additional Pathologic Findings (check all that apply)
*___ None identified
*___ Pancreatic intraepithelial neoplasia (highest grade: PanIN ___)
*___ Chronic pancreatitis
*___ Acute pancreatitis
*___ Other (specify): ____________________________
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