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Tumour involvement of distal margin of main specimen Yes No Tumour involvement by Tj0iyk

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									                                   National Minimum Dataset
                           Gastric Carcinoma Histopathology Report
Surname                         Forename                            Date of birth   Sex

Hospital                        Hospital No.                        NHS No.

Date of receipt                 Date of reporting                   Report No.

Pathologist                     Surgeon


Gross Description


Type of specimen:                          Total gastrectomy
                                           Subtotal gastrectomy
                                           Partial gastrectomy
                                           Oesophago-gastrectomy
Spleen included?                           Yes
                                           No
Pancreas included?                         Yes
                                           No
Length of specimen – lesser curve:                                                        mm
Length of specimen – greater curve:                                                       mm
Length of duodenum:                                                                       mm
Length of oesophagus:                                                                     mm
Site of tumour (anatomical):               Pylorus
                                           Antrum
                                           Body
                                           Oesophago-gastric junction


Site of tumour (topological):              Lesser curve
                                           Greater curve
                                           Anterior wall
                                           Posterior wall
Macroscopic type                           Ulcer like
                                           Diffusely infiltrating
                                           Fungating
                                           Polypoid
Length of tumour:                                                                         mm
Width of tumour:                                                                          mm



Gastric Carcinoma Proforma                                                           1 of 5
Thickness of tumour:                                                                    mm
Tumour edge to nearest distal margin:                                                   mm
Tumour edge to nearest proximal                                                         mm
margin:




Histology


Type of tumour:                         Adenocarcinoma (M81403)
                                        Other (specify)    (M           )


Differentiation by predominant area:    Other
                                        Poor


Character of invasive margin:           Expansive
                                        Infiltrative




Local invasion



Depth of invasion:                      T1 Invasion of lamina propria only (intra-mucosal)


                                        T1 Invasion of lamina propria and submucosa


                                        T2 Invasion of muscularis propria


                                        T2 Invasion of muscularis propria and subserosa


                                        T3 Penetration of peritoneum without invasion of
                                        adjacent structures


                                        T4 Invasion of adjacent structures
                                        (structure invaded =
                                        )




Gastric Carcinoma Proforma                                                            2 of 5
Lymph node spread



Total no. regional lymph nodes examined


Total no. regional lymph nodes involved                                 (N0 = no nodes involved
                                                                               N1 = 1-6 involved
                                                                             N2 = 7-15 involved
                                                                               N3 >15 involved)


Distant lymph nodes submitted?                 Yes
                                               No


Site of distant lymph nodes


No. distant lymph nodes examined


No. distant lymph nodes involved
                                                     (stage as M1 if any distant lymph nodes are
                                                                                        involved)




Spread to other sites



Histologically confirmed liver metastasis      Yes
                                               No


Histologically confirmed peritoneal deposits   Yes
                                               No




Gastric Carcinoma Proforma                                                                 3 of 5
Margins



Tumour involvement of proximal donut       Yes
                                           No
                                           Not applicable
Tumour involvement of distal donut         Yes
                                           No
                                           Not applicable
Tumour involvement of proximal margin of   Yes
main specimen
                                           No
Tumour involvement of frozen section of    Yes
proximal margin of main specimen
                                           No
                                           Not applicable
Tumour involvement of distal margin of     Yes
main specimen
                                           No
Tumour involvement of frozen section of    Yes
distal margin of main specimen
                                           No
                                           Not applicable




Other Pathology

Chronic gastritis                          Yes
                                           No
Atrophy                                    Yes
                                           No
Intestinal metaplasia                      Yes
                                           No
Helicobacter pylori                        Yes
                                           No
Other lesions                              No
                                           Yes (specify)
Synchronous carcinoma                      No
                                           Yes (if yes complete a separate proforma)




Gastric Carcinoma Proforma                                                             4 of 5
Pathology Staging

Complete resection at all margins                   Yes
                                                    No


                                              pT


                                              pN


                                             pM




Signature                           Date 10/2/2012               SNOMED codes T63000 M


    Adapted from Dixon M - Royal College of Pathologists Minimum Dataset for Gastric Carcinoma Histopathology Reports
                                                                          s.s.cross@sheffield.ac.uk 27/06/00 V1.1




Gastric Carcinoma Proforma                                                                                5 of 5

								
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