Protocol for the Examination of Specimens from Patients with Carcinoma of the Endometrium

Gynecologic • Endometrium

Endometrium 3.3.0.0

Protocol for the Examination of Specimens From Patients With Carcinoma of the Endometrium

Based on AJCC/UICC TNM, 7th edition, and FIGO 2014 Annual Report

Protocol web posting date: January 2016

Procedure

• Hysterectomy

Authors

Saeid Movahedi-Lankarani, MD*

Department of Pathology, Abbott Northwestern Hospital, Minneapolis, MN

C. Blake Gilks, MD

Department of Pathology, Vancouver General Hospital, Vancouver, Canada

Christopher N. Otis, MD

Department of Pathology, Baystate Medical Center, Springfield, Massachusetts

Robert Soslow, MD

Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY

Esther Oliva, MD†

Department of Pathology, Massachusetts General Hospital, Boston, MA

For the Members of the Cancer Committee, College of American Pathologists

* Denotes primary author. † Denotes senior author. All other contributing authors are listed alphabetically.

Previous lead contributors: Philip A. Branton, MD; William F. Moore, MD; Steven G. Silverberg, MD

The College does not permit reproduction of any substantial portion of these protocols without its written authorization. The College hereby authorizes use of these protocols by physicians and other health care providers in reporting on surgical specimens, in teaching, and in carrying out medical research for nonprofit purposes. This authorization does not extend to reproduction or other use of any substantial portion of these protocols for commercial purposes without the written consent of the College.

The CAP also authorizes physicians and other health care practitioners to make modified versions of the Protocols solely for their individual use in reporting on surgical specimens for individual patients, teaching, and carrying out medical research for non-profit purposes.

The CAP further authorizes the following uses by physicians and other health care practitioners, in reporting on surgical specimens for individual patients, in teaching, and in carrying out medical research for non-profit purposes: (1) Dictation from the original or modified protocols for the purposes of creating a text-based patient record on paper, or in a word processing document; (2) Copying from the original or modified protocols into a text-based patient record on paper, or in a word processing document; (3) The use of a computerized system for items (1) and (2), provided that the protocol data is stored intact as a single text-based document, and is not stored as multiple discrete data fields.

Other than uses (1), (2), and (3) above, the CAP does not authorize any use of the Protocols in electronic medical records systems, pathology informatics systems, cancer registry computer systems, computerized databases, mappings between coding works, or any computerized system without a written license from the CAP.

Any public dissemination of the original or modified protocols is prohibited without a written license from the CAP.

The College of American Pathologists offers these protocols to assist pathologists in providing clinically useful and relevant information when reporting results of surgical specimen examinations of surgical specimens. The College regards the reporting elements in the “Surgical Pathology Cancer Case Summary” portion of the protocols as essential elements of the pathology report. However, the manner in which these elements are reported is at the discretion of each specific pathologist, taking into account clinician preferences, institutional policies, and individual practice.

The College developed these protocols as an educational tool to assist pathologists in the useful reporting of relevant information. It did not issue the protocols for use in litigation, reimbursement, or other contexts. Nevertheless, the College recognizes that the protocols might be used by hospitals, attorneys, payers, and others. Indeed, effective January 1, 2004, the Commission on Cancer of the American College of Surgeons mandated the use of the required data elements of the protocols as part of its Cancer Program Standards for Approved Cancer Programs. Therefore, it becomes even more important for pathologists to familiarize themselves with these documents. At the same time, the College cautions that use of the protocols other than for their intended educational purpose may involve additional considerations that are beyond the scope of this document.

The inclusion of a product name or service in a CAP publication should not be construed as an endorsement of such product or service, nor is failure to include the name of a product or service to be construed as disapproval.

CAP Endometrium Protocol Revision History

Version Code

The definition of version control and an explanation of version codes can be found at www.cap.org
(search: cancer protocol terms).

Version: Endometrium 3.3.0.0

Summary of Changes

The following changes have been made since the October 2013 release.

The following data elements were modified:

Specimen Integrity

Tumor Site

Tumor Size (changed from required to optional)

Histologic Type

Myometrial Invasion

Tumor Involvement of Cervix

Peritoneal Ascitic Fluid

Lymph-Vascular Invasion

Regional Lymph Nodes

Distant Metastasis (changed to required only if confirmed pathologically)

Additional Pathologic Findings

The following data element was added:

FIGO Stage (not required)

CAP Approved Gynecologic • Endometrium

Endometrium 3.3.0.0

Surgical Pathology Cancer Case Summary

Protocol web posting date: January 2016

ENDOMETRIUM: Hysterectomy, With or Without Other Organs or Tissues

Select a single response unless otherwise indicated.

Specimen (select all that apply)

___ Uterine corpus

___ Cervix

___ Right ovary

___ Left ovary

___ Right fallopian tube

___ Left fallopian tube

___ Right parametrium

___ Left parametrium

___ Vaginal cuff

___ Omentum

___ Other (specify): ___________________________

___ Not specified

Procedure (select all that apply) (Note A)

___ Supracervical hysterectomy

___ Simple hysterectomy

___ Radical hysterectomy

___ Right oophorectomy

___ Left oophorectomy

___ Right salpingectomy

___ Left salpingectomy

___ Right salpingo-oophorectomy

___ Left salpingo-oophorectomy

___ Bilateral salpingo-oophorectomy

___ Omentectomy

___ Peritoneal biopsies

___ Peritoneal washing

___ Other (specify): ____________________________

___ Not specified

Lymph Node Sampling (select all that apply)

___ Performed

___ Pelvic lymph nodes

___ Para-aortic lymph nodes

___ Other (specify): ____________________________

___ Not performed

___ Not known

Specimen Integrity (Note A)

___ Morcellated hysterectomy specimen

___ Intact hysterectomy specimen

___ Other (specify): ____________________________

+ Tumor Site (select all that apply)

+ ___ Anterior endometrium

+ ___ Posterior endometrium

+___ Fundus

+___ Lower uterine segment

+ ___ Other (specify): ____________________________

+ Tumor Size

+ Greatest dimension: ___ cm

+ Additional dimensions: ___ x ___ cm

+ ___ Cannot be determined (explain): ____________________________

Histologic Type (select all that apply) (Note B)

___ Endometrioid adenocarcinoma

___ Endometrioid adenocarcinoma with squamous differentiation

___ Endometrioid adenocarcinoma, villoglandular

___ Endometrioid adenocarcinoma, secretory

___ Mucinous adenocarcinoma

___ Serous endometrial intraepithelial carcinoma

___ Serous carcinoma

___ Clear cell carcinoma

___ Carcinoid

___ Small cell carcinoma

___ Large cell neuroendocrine carcinoma

___ Mixed cell carcinoma (specify types and percentages): _______________________________

___ Undifferentiated carcinoma

___ Dedifferentiated carcinoma

___ Carcinosarcoma (malignant mixed Mullerian tumor)

___ Homologous type

___ Heterologous type (specify heterologous elements): __________________________________

___ Epithelial component(s) (specify epithelial cell types and percentages): ___________________
____________________________________________________________________________

___ Other (specify): ____________________________

Histologic Grade (Note C)

International Federation of Gynecology and Obstetrics (FIGO) Grading System
(applies to endometrioid and mucinous adenocarcinomas only):

___ FIGO grade 1

___ FIGO grade 2

___ FIGO grade 3

For other carcinomas:

___ G1: Well differentiated

___ G2: Moderately differentiated

___ G3: Poorly differentiated

___ Other (specify): ____________________________

___ Not applicable

Myometrial Invasion (select all that apply) (Note D)

___ Not identified

___ Present

Depth of invasion: ___ mm

OR, if exact depth of invasion cannot be determined, state:

___ Extent of myometrial invasion cannot be determined (explain): _______________________

___ <50% myometrial invasion

___ ≥50% myometrial invasion

Myometrial thickness: ___ mm

____ Myometrial thickness cannot be determined (explain): ________________________

Tumor Involvement of Cervix (Note E)

___ Not involved

___ Involves cervix without stromal invasion

___ Invasion of cervical stromal connective tissue

___ Cannot be determined (explain): ____________________________

Extent of Involvement of Other Organs (select all that apply)

___ Right ovary

___ Involved

___ Not involved

___ Other (explain): ____________________________

___ Left ovary

___ Involved

___ Not involved

___ Other (explain): ____________________________

___ Right fallopian tube

___ Involved

___ Not involved

___ Other (explain): ____________________________

___ Left fallopian tube

___ Involved

___ Not involved

___ Other (explain): ____________________________

+ ___ Vagina

+ ___ Involved

+ ___ Not involved

+ ___ Right parametrium

+ ___ Involved

+ ___ Not involved

+ ___ Left parametrium

+ ___ Involved

+ ___ Not involved

+ ___ Omentum

+ ___ Involved

+ ___ Not involved

+ ___ Rectal wall

+ ___ Involved

+ ___ Not involved

+ ___ Bladder wall

+ ___ Involved

+ ___ Not involved

+ ___ Pelvic wall

+ ___ Involved

+ ___ Not involved

+ ___ Bladder mucosa and/or bowel mucosa

+ ___ Involved

+ ___ Not involved

+ ___ Other (specify): _________________________________

+ Peritoneal Ascitic Fluid (Note F)

+ ___ Not performed/unknown

+ ___ Negative for malignancy (normal/benign)

+ ___ Atypical and/or suspicious (explain): ____________________

+ ___ Malignant (positive for malignancy)

+ ___ Unsatisfactory/nondiagnostic (explain): ______________________

+ Margins (Note G)

+ ___ Cannot be assessed

+ ___ Uninvolved by invasive carcinoma

+ Distance of invasive carcinoma from closest margin: ___ mm

+ Specify margin: _____________________________

+ ___ Involved by invasive carcinoma

+ Specify margin(s): ___________________________

Lymph-Vascular Invasion (Note H)

___ Not identified

___ Present

___ Cannot be determined

Pathologic Staging (pTNM) (Note I)

TNM Descriptors (required only if applicable) (select all that apply)

___ m (multiple primary tumors)

___ r (recurrent)

___ y (posttreatment)

Primary Tumor (pT)

___ pTX: Primary tumor cannot be assessed

___ pT0: No evidence of primary tumor

___ pT1a: Tumor limited to endometrium or invades less than one-half of the myometrium

___ pT1b: Tumor invades greater than or equal to one-half of the myometrium

___ pT2: Tumor invades stromal connective tissue of the cervix, but does not extend beyond uterus

___ pT3a: Tumor involves serosa and/or adnexa (direct extension or metastasis)

___ pT3b: Vaginal involvement (direct extension or metastasis) or parametrial involvement

___ pT4: Tumor invades bladder mucosa and/or bowel mucosa (bullous edema is not sufficient to classify a tumor as T4)

Regional Lymph Nodes (pN) (select all that apply) (Note I)

+ Modifier

+___ (sn)

Category (pN)

___ pNX: Cannot be assessed

___ pN0: No regional lymph node metastasis

___ pN1: Regional lymph node metastasis to pelvic lymph nodes

___ pN2: Regional lymph node metastasis to para-aortic lymph nodes, with or without positive pelvic lymph nodes

___ No nodes submitted or found

Pelvic lymph nodes:

___ No pelvic nodes submitted or found

Number of Pelvic Lymph Nodes Examined

Specify: ____