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Colon tumor

Other

Features to report for colonic carcinoma or other tumors


Reviewers: Charanjeet Singh, M.D. (see Reviewers page)
Revised: 2 May 2012, last major update May 2012
Copyright: (c) 2003-2012, PathologyOutlines.com, Inc.

General
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Editorial note
● Note: “mandatory” means for accreditation purposes by the American College of Surgeons Committee on Cancer
● “Recommended” means suggested by the literature
● Protocol may improve quality of pathology report (Colorectal Dis 2011;13:e33)

Diagrams
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Anatomic subsites


Margins

           
Staging related diagrams

Colonic biopsy - recommended features to report
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● Biopsy site
● Tumor size
● Histologic type
● Histologic grade (low grade: 50%+ gland formation; otherwise high grade)
● Depth of invasion (if identifiable)
● Angiolymphatic invasion (including extramural venous invasion)

Polypectomy - mandatory to report
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● Tumor site
● Polyp size
● Polyp configuration (pedunculated with or without stalk, sessile or fragmented)
● Histologic type
● Histologic grade (low grade: 50%+ gland formation; otherwise high grade)
● Depth of invasion
● Involvement of deep (stalk) margin by invasive carcinoma or distance of invasive carcinoma from margin
● Involvement of mucosal / lateral margin by invasive or in situ carcinoma
● Lymphatic invasion

Polypectomy - recommended but not required to report
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● Large vessel invasion
● Type of polyp in which invasive carcinoma arose
● Additional findings

Rectal tumor: local excision - mandatory to report
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● Specimen intact or fragmented
● Tumor size
● Histologic type
● Histologic grade (low grade: 50%+ gland formation; otherwise high grade)
● pT and pN staging
● Lateral margin involvement by invasive carcinoma or distance to margin
● Deep margin involvement by invasive carcinoma or distance to margin
● Focal or multifocal involvement of deep margin by invasive carcinoma
● Lymphatic invasion
● Large vessel invasion

Rectal tumor: local excision - recommended but not required to report
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● Distance of tumor from anal verge
● Lateral margin involvement by adenoma
● Perineural invasion
● Dysplasia present (high grade, low grade)
● Depth of invasion (part of staging)
● Additional findings

Colorectal resection for tumor - mandatory to report
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● Specimen type
● Tumor site
● Tumor size
● Macroscopic tumor perforation (present or not)
● Histologic type
● Histologic grade (low grade: 50%+ gland formation; otherwise high grade)
● pT, pN and pM staging
● Proximal margin involvement by invasive carcinoma or adenoma or distance to margin
● Distal margin involvement by invasive carcinoma or adenoma or distance to margin
● Radial margin involvement by invasive carcinoma or adenoma or distance to margin
● If all margins are negative, specify closest margin and distance of invasive carcinoma from this margin
● Lymphatic invasion
● Large vessel invasion
● Features suggestive of microsatellite instability (intratumoral lymphocytes, peritumoral lymphocytes, mucinous / medullary / poorly differentiated)
● Treatment effect (if relevant)
● Tumor deposits (discontinuous extramural extension)
● Ancillary studies performed (microsatellite instability, immunohistochemistry, mutational analysis)

Colorectal resection for tumor - recommended but not required to report
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● Specimen length
● Macroscopic intactness of mesorectum
● Gross tumor configuration (exophytic, infiltrative, ulcerative or other)
● Peritoneal (mesenteric) margin involvement by invasive carcinoma or adenoma or distance to margin
● Perineural invasion
● Depth of invasion (part of staging)
● Additional findings

Possible features to report (suggested by some authors)
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● Intra or peritumoral lymphocytic response
● Pattern of tumor at periphery (pushing, infiltrative)
● Intactness of mesorectum (incomplete, nearly complete or complete)
Checklists: Michigan Cancer Consortium
Additional references: Arch Pathol Lab Med 2009;133:1539

End of Colon tumor > Other > Features to report for colonic carcinoma or other tumors


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