TUMOR OF URINARY BLADDER
List specimen(s), type of surgical procedure:
Tumor Characteristics:
1. Histologic type: (see page #2)
2. Histologic grade:
a. For urothelial carcinoma (WHO/ISUP, 1998) indicate whether low-grade or
high-grade.
b. For adenocarcinoma and squamous carcinoma specify if cannot be assessed, well
differentiated, moderately differentiated, poorly differentiated, or
undifferentiated.
3. Tumor configuration: (Indicate if tumor is papillary, solid/nodule, flat, ulcerated, or
indeterminate).
4. Tumor site: (Trigone, right lateral wall, left lateral wall, anterior wall, posterior wall, or
dome – specify all sites that are involved with tumor).
5. Tumor size (largest): _____ x _____ x _____ cm.
6. Extent of invasion: (See page #2 for information needed to perform TNM staging).
7. Lymphovascular space invasion (yes/no).
Surgical Margins, if Applicable:
1. Uninvolved by tumor: Distance of tumor from closest margin is __ cm. (specify margin)
2. Surgical margin involved by tumor: Specify margin involved such as (deep radial margin
(soft tissue), left or right ureteral margin, urethral margin, urachal margin, uterine margin,
vaginal margin, or other (specify)).
Lymph Node Status: (see page 2)
1. Total number of lymph nodes examined: (specify site)
2. Total number of lymph nodes containing metastatic carcinoma: (specify site)
3. Sise of largest metastasis to lymph node: ____cm. (specify site)
Other:
1. Correlation statement with intraoperative consult, frozen section
2. Additional pathologic findings: (urothelial dysplasia (low-grade intraurothelial
neoplasia) – focal or multifocal, inflammation/regenerative changes, therapy related
changes, cystitis cystica glandularis, keratinizing squamous metaplasia, intestinal
metaplasia, other (specify)).
3. Other organs: Indicate whether the other organs are involved with tumor or not
(possible other organs include urethra, ureters, prostate, seminal vesicals, uterine
corpus, vagina, or other (specify)).
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Histologic Type:
-Cannot be determined.
-Urothelial (transitional cell) papilloma (WHO/ISUP 1998; WHO 1973).
-Urothelial (transitional cell) papilloma, inverted type.
-Squamous cell papilloma.
-Papillary urothelial (transitional cell) neoplasm, low malignant potential (WHO/ISUP
1998)/Grade I (WHO, 1993).
-Urothelial transition (transitional cell) carcinoma in situ.
-Urothelial carcinoma.
-Urothelial (transitional cell) carcinoma with the following:
Squamous differentiation.
Glandular differentiation.
Variant histology (specify).
-Squamous cell carcinoma:
Typical:
Variant histology (specify)
-Adenocarcinoma:
Typical:
Variant histology (specify)
-Small cell carcinoma.
-Undifferentiated carcinoma.
-Other (specify).
-Mixed cell type (urothelial) transitional cell, squamous cell, adenocarcinoma, small cell
carcinoma, other (specify) – list all the cell types that apply.
TNM Staging:
-TX=cannot be assessed
-T0=no evidence of primary tumor
-Ta=non-invasive papillary carcinoma
-Tis=carcinoma in situ (flat tumor)
-T1=tumor invades subepithelial tissue
-T2=tumor invades muscularis propria
-T2A=tumor invades superficial muscle (inner half)
-T2B=tumor invades deep muscle
-T3=tumor invades perivesical tissue
-T3A=microscopically
-T3B=macroscopically (extravesicular mass)
T4=tumor invades any of the following: prostate, uterus, vagina, pelvic wall, abdominal
wall
-T4A=tumor invades prostate or uterus or vagina
-T4b=tumor invades pelvic wall or abdominal wall
REGIONAL LYMPH NODES
___ NX: Cannot be assessed
___ N0: No regional lymph node metastasis
___ N1: Metastasis in a single lymph node, 2 cm or less in greatest dimension
___ N2: Metastasis in a single lymph node, more than 2 cm but not more than 5 cm in
greatest dimension, or multiple lymph nodes, none more than 5 cm in greatest
dimension
___ N3: Metastasis in a lymph node more than 5 cm in greatest dimension
S:Dr. Draper Templates – Tumor of Urinary Bladder; TWD/slr
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