Specimen Laterality:

Tumor Size:

Patient Age:

Histologic Type:

Note: For nodular (composite) ganglioneuroblastomas with more than 1 nodule, degree of differentiation and mitotic-karyorrhectic index (MKI) must be given for each nodule. Please indicate the differentiation and MKI for the least favorable nodule in the checklist below. Classification of additional nodules can be described in the Comment.

Degree of Differentiation (neuroblastic component):

Mitotic-Karyorrhectic Index (MKI) (neuroblastic component):

Treatment History:

International Neuroblastoma Pathology Classification (INPC):

Note: INPC applies to untreated primary tumors and tumors in metastatic sites provided that there is sufficient material to classify histologically. Bone marrow biopsy is useful only for evaluation of degree of neuroblastic differentiation, but not eligible for MKI determination.


Extent of Tumor:

Primary Tumor:

Regional Lymph Nodes:

Distant Metastasis:

International Neuroblastoma Staging System (INSS):

Multifocal primary tumors (eg, bilateral adrenal primary tumors) should be staged according to the greatest extent of disease, as defined above, and followed by a subscript “M” (eg, 3M).
The midline is defined as the vertebral column. Tumors originating on one side and crossing the midline must infiltrate to or beyond the opposite side of the vertebral column.
Marrow involvement in stage 4S should be minimal (ie, less than 10% of total nucleated cells identified as malignant on bone marrow biopsy or marrow aspirate). More extensive marrow involvement would be considered stage 4. The meta-iodobenzylguanidine (MIBG) scan (if performed) should be negative in the marrow.