Liver Tumor Resection for Hepatocellular carcinoma Checklist

Pathology No: ______

PATHOLOGY DIAGNOSIS:

Liver, right / left / segment______, (extended) lobectomy / segmentectomy/ wedge resection,

MACROSCOPIC EXAMINATION

1.Specimen Type:

Right lobectomyExtended right lobectomy Left lobectomy Atypical hepatectomy

Segmentectomy Wedge resectionExplanted liver

Other: ______

2.Specimen Size: x x cm; Weight: gm.

3.Focality

Solitary (specify location): Segment , well / ill-defined (with extracapsular extension.)

cm beneath the liver capsule and cm away from the nearest resection margin, grossly

Solitary, confluent multinodular: Segment , well / ill-defined (with extracapsular extension.)

cm beneath the liver capsule and cm away from the nearest resection margin, grossly.

Multiple (specify locations): Segments , ,and

cm beneath the liver capsule, grossly. (the nearest one)

cm away from the nearest resection margin, grossly. (the nearest one)

4.Tumor Size: x x cm, x x cm, and x x cm (I f multiple)

Cannot be determined (see Comment)

5.Satellite nodules:None / in number, cm away fromthe main tumor, up to cm in diameter.

6.Tumor necrosis:absent / mild / moderate / marked ( %)

7.Venous (Large Vessel) Invasion: Absent / Present grossly

8.Non-tumoral Liver Tissue

Cirrhotic, mixed macronodular and micronodular/ micronodular

Non-cirrhotic

  1. Gallbladder:

Not included.

Size: x x cm.

Gallstone: Not identified

Present: Number: . Size: up to cm in diameter. Color: black/brown/yellow

MICROSCOPICEXAMINATION

1.Histologic Type

Hepatocellular carcinoma: compact solid / trabecular / pseudoglandular / scirrhous / clear cell/ sarcomatoid/ steatohepatitic

Fibrolamellar hepatocellular carcinoma variant

Undifferentiated carcinoma

Other (specify): ______

Carcinoma, type cannot be determined

2.Histologic Grade: (According to the Edmondson and Steiner System)

GI: Well differentiated

GII: Moderately differentiated

GIII: Poorly differentiated

GIV: Undifferentiated/anaplastic

Other (specify): ______

  1. Tumor necrosis:absent / mild / moderate / marked
  2. Tumor capsule:

Well encapsulated

Partially encapsulated with focal infiltrative border

Non-encapsulated with infiltrative border

5.Satellite nodule: Absent / Present (number: )

6.Tumor Extension (select all that apply)

Tumor confined to liver

Microscopic (Small Vessel) Invasion

Macroscopic Venous (Large Vessel) Invasion

Tumor directly invades gallbladder

Tumor directly invades other adjacent organs (specify):______

7.Bile duct Invasion: Absent / Present / Indeterminate

  1. For post-TAE or TACE tumor: % of residual viable tumor

9.Margins (check all that apply)

Parenchymal Margin

Cannot be assessed

Uninvolved by invasive carcinoma

Distance of invasive carcinoma from closest margin: mm

Involved by invasive carcinoma

Hepatic capsule

Cannot be assessed

Uninvolved by invasive carcinoma

Involved by invasive carcinoma

Other Margin

Specify margin: ______

Cannot be assessed

Uninvolved by invasive carcinoma

Involved by invasive carcinoma

10.Pathologic Staging (pTNM): (According to AJCC system, version 7)

Primary tumor (T)
TX / Primary tumor cannot be assessed
T0 / No evidence of primary tumor
T1 / Solitary tumor without vascular invasion
T2 / Solitary tumor with vascular invasion or multiple tumors, none > 5 cm
T3a / Multiple tumors > 5 cm
T3b / Single tumor or multiple tumors of any size involving a major branch of the portal or hepatic vein
T4 / Tumor(s) with direct invasion of adjacent organs other than gallbladder or with visceral peritoneum
Regional lymph nodes (N)
NX / Regional lymph nodes cannot be assessed
N0 / No regional lymph node metastasis
N1 / Regional lymph node metastasis
Distant metastasis (M)
MX Distant metastasis cannot be assessed
M0 / No distant metastasis
M1 / Distant metastasis

11.Additional Pathologic Findings in nontumorous liver parenchyma (check all that apply)

None identified

Hepatitis (specify type): due to hepatitis B and / C virus infection

Large cell change

Small cell change

Dysplastic nodule: low-grade/high grade

Ishak modified staging: architectural changes, fibrosis and cirrhosis

(0) no fibrosis

(1) fibrous expansion of some portal areas, with or without short fibrous septa

(2) fibrous expansion of most portal areas, with or without short fibrous septa

(3) fibrous expansion of most portal areas with occasional portal to portal bridging

(4) fibrous expansion of portal areas with marked bridging (portal to portal as well as portal to central

(5) marked bridging with occasional nodules (incomplete cirrhosis)

(6) cirrhosis (probable or definite)

Fatty change: %, mixed macro- and micro-vesicular

Other (specify): ______

  1. Gallbladder:

No pathologic change

Chronic cholecystitis

Cholelethiasis

Others: ______

13.Comment(s):

Liver Tumor Resection for Intrahepatic cholangiocarcinoma and mixed Hepatocellular-cholangiocarcinoma carcinoma Checklist

Pathology No: ______

PATHOLOGY DIAGNOSIS:

Liver, right / left / segment , (extended) lobectomy / segmentectomy/ wedge resection

MACROSCOPIC EXAMINATION

1.Specimen Type

Right lobectomy Extended right lobectomy Left lobectomy Atypical hepatectomy

Segmentectomy Wedge resection Explanted liver

Other: ______

2.Specimen Size: x x cm; Weight: gm.

3.Tumor Size: x x cm

Cannot be determined (see Comment)

4.Tumor Focality

Solitary (specify location):

Multiple (specify locations):

5.Non-tumoral Liver Tissue

Cirrhotic

Non-cirrhotic

  1. Gallbladder:

Not included.

Size: x x cm.

Gallstone: Not identified

Present: Number: . Size: up to cm in diameter. Color: black/brown/yellow

MICROSCOPIC EXAMINATION

1.Histologic Type

Cholangiocarcinoma

Combined hepatocellular and cholangiocarcinoma

Bile duct cystadenocarcinoma

Other (specify): ______

2.Histologic Grade

Grade XGrade cannot be assessed

Grade 1Well differentiated (more than 95% of tumor composed of glands)

Grade 2Moderately differentiated (50% to 95% of tumor composed ofglands)

Grade 3Poorly differentiated (5% to 49% of tumor composed of glands)

Grade 4Undifferentiated (less than 5% of tumor composed of glands)

Other (specify): ______

3.Tumor Growth Pattern

Mass-forming

Periductal infiltrating

Mixed mass-forming and periductal infiltrating

Cannot be determined

4.Microscopic Tumor Extension

Cannot be assessed

No evidence of primary tumor

Tumor confined to the intrahepatic bile ducts histologically (carcinoma in situ)

Tumor confined to hepatic parenchyma

Tumor involves visceral peritoneal surface

Tumor directly invades gallbladder

Tumor directly invades adjacent organs other than the gallbladder (specify):______

5.Margins (check all that apply)

Hepatic Parenchymal Margin

Cannot be assessed

Uninvolved by invasive carcinoma

Distance of invasive carcinoma from closest margin: mm

Involved by invasive carcinoma

Bile Duct Margin

Cannot be assessed

Uninvolved by invasive carcinoma

Biliary intraepithelial neoplasm not identified

Biliary intraepithelial neoplasm present

Involved by invasive carcinoma

Other Margin

Specify margin: ______

Cannot be assessed

Uninvolved by invasive carcinoma

Involved by invasive carcinoma

6.Lymph-Vascular Invasion: Not identified/Present/Indeterminate

  1. Perineural Invasion: Not identified/Present/Indeterminate
  2. Precursor lesion

Biliary intraepithelial neoplasm, grade: _____

Intraductal papillary neoplasm of the bile duct

9.Pathologic Staging (pTNM):

Primary Tumor (pT)

pTX:Cannot be assessed

pT0: No evidence of primary tumor

pTis: Carcinoma in situ (intraductal tumor)

pT1: Solitary tumor without vascular invasion

pT2a:Solitary tumor with vascular invasion

pT2b:Multiple tumors, with or without vascular invasion

pT3:Tumor perforating the visceral peritoneum or involving the local extrahepatic structures by direct invasion

pT4: Tumor with periductal invasion

Regional Lymph Nodes (pN)

pNX: Cannot be assessed

pN0: No regional lymph node metastasis

pN1: Regional lymph node metastasis

Specify:Number examined: , Number involved:

Distant Metastasis (pM)

pMX: Cannot be assessed

pM0: No distant metastasis

pM1:Distant metastasis

*Specify site(s), if known: ______

10.Additional Pathologic Findings (select all that apply)

None identified

Hepatitis (specify type): due to hepatitis B and / C virus infection

Large cell change

Small cell change

Dysplastic nodule: low-grade/high grade

Primary sclerosing cholangitis

Intrahepatic lithiasis

Ishak modified staging: architectural changes, fibrosis and cirrhosis

(0) no fibrosis

(1) fibrous expansion of some portal areas, with or without short fibrous septa

(2) fibrous expansion of most portal areas, with or without short fibrous septa

(3) fibrous expansion of most portal areas with occasional portal to portal bridging

(4) fibrous expansion of portal areas with marked bridging (portal to portal as well as portal to central

(5) marked bridging with occasional nodules (incomplete cirrhosis)

(6) cirrhosis (probable or definite

Fatty change: %, mixed macro- and micro-vesicular

Other (specify): ______

  1. Gallbladder:

No pathologic change

Chronic cholecystitis

Cholelethiasis

Others: ______

12.Comment(s):

1