COLON AND RECTUM: Resection, Including Transanal Disk Excision of Rectal Neoplasms

Specimen:
Terminal ileum
Cecum
Appendix
Ascending colon
Transverse colon
Descending colon
Sigmoid colon
Rectum
Anus
Other (specify):
Not specified

Procedure Type:
Right hemicolectomy
Transverse colectomy
Left hemicolectomy
Sigmoidectomy
Rectal/rectosigmoid colon (low anterior resection)
Total abdominal colectomy
Abdominoperineal resection
Transanal disk excision (local excision)
Other (specify):
Not specified

Specimen Length (if applicable)
Specimen length: cm

Tumor Site:
Cecum
Right (ascending) colon
Hepatic flexure
Transverse colon
Splenic flexure
Left (descending) colon
Sigmoid colon
Rectosigmoid
Rectum
Colon, not otherwise specified
Cannot be determined (see Comment)

Tumor Size:
Greatest dimension (cm):
Additional dimensions: x cm
Cannot be determined (see Comment)

Macroscopic Tumor Perforation:
Present
Not identified
Cannot be determined

Macroscopic Intactness of Mesorectum:
Not applicable
Complete
Near complete
Incomplete
Cannot be determined

Histologic Type:
Adenocarcinoma
Mucinous adenocarcinoma
Signet-ring cell carcinoma
Small cell carcinoma
Squamous cell carcinoma
Adenosquamous carcinoma
Medullary carcinoma
Undifferentiated carcinoma
Other (specify):
Carcinoma, type cannot be determined

Histologic Grade:
Not applicable
Cannot be assessed
Low-grade (well-differentiated to moderately differentiated)
High-grade (poorly differentiated to undifferentiated)
Other (specify):

Histologic Features Suggestive of Microsatellite Instability:
       Intratumoral Lymphocytic Response (tumor-infiltrating lymphocytes):
        None
        Mild to moderate (0-2 per high-power (X400) field)
        Marked (3 or more per high-power field)
       Peritumor Lymphocytic Response (Crohn-like response):
        None
        Mild to moderate
        Marked
       Tumor Subtype and Differentiation:
           Mucinous tumor component (specify percentage: ):
           Medullary tumor component
           High histologic grade (poorly differentiated)

Microscopic Tumor Extension:
Cannot be assessed
No evidence of primary tumor
Intramucosal carcinoma, invasion of lamina propria
Tumor invades submucosa
Tumor invades muscularis propria
Tumor invades through the muscularis propria into the subserosal adipose tissue or the nonperitonealized pericolic or perirectal soft tissues but does not extend to the serosal surface
Tumor penetrates to the surface of the visceral peritoneum (serosa)
Tumor is adherent to other organs or structures(specify: ):
Tumor directly invades adjacent structures(specify: ):
Tumor penetrates to the surface of the visceral peritoneum (serosa) and directly invades adjacent structures(specify: ):

Margins:
Proximal Margin:
Cannot be assessed
Uninvolved by invasive carcinoma
Involved by invasive carcinoma
Intramucosal carcinoma /adenoma not identified at proximal margin
Intramucosal carcinoma/adenoma present at proximal margin

Distal Margin:
Cannot be assessed
Uninvolved by invasive carcinoma
Involved by invasive carcinoma
Intramucosal carcinoma/adenoma not identified at distal margin
Intramucosal carcinoma /adenoma present at distal margin

Circumferential (Radial) or Mesenteric Margin:
Not applicable
Cannot be assessed
Uninvolved by invasive carcinoma
Involved by invasive carcinoma (tumor present 0-1 mm from margin)

If all margins uninvolved by invasive carcinoma:
Distance of invasive carcinoma from closest margin: at

Lateral Margin (for non-circumferential transanal disk excision):
    Cannot be assessed
    Uninvolved by invasive carcinoma: Distance of invasive carcinoma from closest lateral margin: mm at specify o'clock if possible
    Involved by invasive carcinoma at specify o'clock if possible
    Uninvolved by adenoma
    Involved by adenoma

Treatment Effect (applicable to carcinomas treated with neoadjuvant therapy)

No prior treatment
Present:
    No residual tumor (complete response, grade 0)
    Moderate response (grade 1, minimal residual cancer)
    Minimal response (grade 2)
No definite response identified (grade 3, poor response)
Not known

Lymph-Vascular Invasion:
Not identified
Present
Indeterminate

Perineural Invasion:
Not identified
Present
Indeterminate

Tumor Deposits (discontinuous extramural extension)

Not identified
Present
Indeterminate

Type of Polyp in Which Invasive Carcinoma Arose:
    None identified
    Tubular adenoma
    Villous adenoma
    Tubulovillous adenoma
    Traditional serrated adenoma
    Sessile serrated adenoma
    Hamartomatous polyp
    Indeterminate

Pathologic Staging (pTNM):
TNM Descriptors (required only if applicable) (select all that apply)
m (multiple primary tumors)
r (recurrent)
y (post-treatment)

Primary Tumor (pT):
pTX: Cannot be assessed
pT0: No evidence of primary tumor
pTis: Carcinoma in situ, intraepithelial (no invasion)
pTis: Carcinoma in situ, invasion of lamina propria
pT1: Tumor invades submucosa
pT2: Tumor invades muscularis propria
pT3: Tumor invades through the muscularis propria into pericolorectal tissues
pT4a: Tumor penetrates the visceral peritoneum
pT4b: Tumor directly invades or is adherent to other organs or structures

Regional Lymph Nodes (pN):
pNX: Cannot be assessed
pN0: No regional lymph node metastasis ( 0 / )
pN1a: Metastasis in 1 regional lymph node ( 1 / )
pN1b: Metastasis in 2 to 3 regional lymph nodes ( / )
pN1c: Tumor deposit(s) in the subserosa, or non-peritonealized pericolic or perirectal tissues without regional lymph node metastasis ( 0 / )
pN2a: Metastasis in 4 to 6 regional lymph nodes ( / )
pN2b: Metastasis in 7 or more regional lymph nodes ( / )

Distant Metastasis (pM):
Not applicable
pM1: Distant metastasis at
pM1a: Metastasis to single organ or site (eg, liver, lung, ovary, nonregional lymph node)
pM1b: Metastasis to more than one organ/site or to the peritoneum

Additional Pathologic Findings:
None identified
Adenoma(s)
Chronic ulcerative proctocolitis
Crohn disease
Dysplasia arising in inflammatory bowel disease
Other polyps (types):
Other (specify):

Ancillary Studies:
       Microsatellite instability:
        Stable
        Low
        High
       Immunohistochemistry Studies for Mismatch Repair Proteins:
           MLH1:
            Intact nuclear positivity, tumor cells
            Loss of nuclear positivity, tumor cells
            Pending
            Other (specify):
           MSH2:
            Intact nuclear positivity, tumor cells
            Loss of nuclear positivity, tumor cells
            Pending
            Other (specify):
           MSH6:
            Intact nuclear positivity, tumor cells
            Loss of nuclear positivity, tumor cells
            Pending
            Other (specify):
           PMS2:
            Intact nuclear positivity, tumor cells
            Loss of nuclear positivity, tumor cells
            Pending
            Other (specify):

Mutational Analysis:
       BRAF V600E mutational analysis, testing method:
        Mutant BRAF detected
        No mutant BRAF detected (wild type BRAF allele)
        Other (specify):
       KRAS mutational analysis, testing method:
        Mutant KRAS detected (specify mutation)
        No mutant KRAS detected (wild type KRAS allele)
        Other (specify):
       Other, specify:
       Not performed

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