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Urinary Bladder Cancer Checklist for Cystectomy

(Modified from CAP protocol, based on AJCC v. 8 and WHO 2016 Tumor Classification)

Diagnosis

Gross Description

  1. Procedure:

( ) Partial cystectomy

( ) Radical cystectomy

( ) Radical cystoprostatectomy

( ) Anterior exenteration

( ) Other, specify:

  1. Specimen size:

Urinary bladder: ( ) x ( ) x ( ) cm

Ureter stumps: right: ( ) cm; left: ( ) cm in length

Vaginal stump: ( ) cm in length

Prostate: ( ) x ( ) x ( ) cm

  1. Tumor size:( ) x ( ) x ( ) cm
  2. Tumor site:

( ) Trigone

( ) Right lateral wall

( ) Left lateral wall

( ) Anterior wall

( ) Posterior wall

( ) Dome

( ) Other, specify:

( ) Cannot be determined

  1. *Tumor appearance: *

( ) Papillary (cauliflower-like)

( ) Infiltrating

( ) Grossly invisible

( ) Other, specify:

  1. *Tumor focality:*

( ) Unifocal

( ) Multifocal

Sections are taken and labeled as:

Microscopic Description

  1. Histological type:

Urothelial:

( ) Papillary urothelial carcinoma, noninvasive

( ) Papillary urothelial carcinoma, invasive

( ) Urothelial carcinoma in situ (flat lesion)

( ) Urothelial carcinoma, invasive(Explanatory note A)

Squamous: (Explanatory note B)

( ) Pure squamous cell carcinoma

( ) Verrucous carcinoma

Glandular: (Explanatory note B)

( ) Adenocarcinoma, not otherwise specified

( ) Adenocarcinoma, enteric

( ) Adenocarcinoma, mucinous

( ) Adenocarcinoma, mixed

( ) Adenocarcinoma in situ (no invasive carcinoma identified)

Tumors of Müllerian type:

( ) Clear cell carcinoma

( ) Endometrioid carcinoma

Neuroendocrine tumors:

( ) Small cell (neuroendocrine) carcinoma

( ) Large cell neuroendocrine carcinoma

( ) Well-differentiated neuroendocrine tumor:

  1. Histological grade:

For urothelial carcinoma, other variants, or divergent differentiation:

( ) Low grade

( ) High grade

( ) Other, specify:

For squamous cell carcinoma or adenocarcinoma:

( ) G1: Well differentiated

( ) G2: Moderately differentiated

( ) G3: Poorly differentiated

( ) GX: Cannot be assessed

  1. Pathological staging (pTNM, AJCC 8th edition):

TNM Descriptors: (required only if applicable) (select all that apply)

( ) m (multiple primary tumors)

( ) r (recurrent)

( ) y (posttreatment)

Primary tumor (pT):

( ) pTX: Primary tumor cannot be assessed

( ) pT0: No evidence of primary tumor

( ) pTa: Papillary noninvasive carcinoma

( ) pTis: Urothelial carcinoma in situ (flat tumor)

( ) pT1: Tumor invades lamina propria (subepithelial connective tissue)

( ) pT2: Tumor invades the muscularis

( ) pT2a: Tumor invades superficial muscularis propria (inner half)

( ) pT2b: Tumor invades deep muscularis propria (outer half)

( ) pT3: Tumor invades perivesical soft tissue

( ) pT3a: Tumor invades perivesical soft tissue microscopically

( ) pT3b: Tumor invades perivesical soft tissue macroscopically (extravesical mass)

( ) pT4: Extravesical tumor directly invades any of the following: prostatic stroma, seminal vesicles, uterus, vagina, pelvic wall, abdominal wall

( ) pT4a: Extravesical tumor directly invades prostatic stroma, seminal vesicles, uterus, or vagina

( ) pT4b: Extravesical tumor invades pelvic wall or abdominal wall

Regional lymph nodes (pN):

( ) pNX: Regional lymph node cannot be assessed

( ) pN0: No lymph node metastasis

( ) pN1: Single lymph node metastasis in the true pelvis (perivesical, obturator, internal and external iliac or sacral lymph node)

( ) pN2: Multiple lymph node metastasis in the true pelvis

( ) pN3: Lymph node metastasis to the common iliac nodes

Note: Number of lymph nodes: total: ( ); involved: ( )

*Extranodal extension: ( ) Not identified / ( ) Present*

Distant metastasis (pM): (required only if confirmed pathologically in this case)

( ) pM1: Distant metastasis

( ) pM1a: Distant metastasis limited to lymph nodes beyond the common iliacs

( ) pM1b: Non-lymph node distant metastasis

Note: Site of metastasis:

  1. Section margins:

( ) Cannot be assessed (e.g. due to poor orientation of specimen, etc.)

( ) Uninvolved by invasive carcinoma

( ) Involved by invasive carcinoma, site:

( ) Right ureteral margin

( ) Left ureteral margin

( ) Urethral margin

( ) Soft tissue margin

( ) Other margin(s), specify:

( ) Involved by carcinoma in situ/ noninvasive high-grade urothelial carcinoma, site:

( ) Involved by noninvasive low-grade urothelial carcinoma/ urothelial dysplasia, site:

  1. *Lymphovascular invasion:*

( ) Not identified

( ) Present

( ) Cannot be determined

  1. *Additional pathologic findings: *

( ) Urothelial carcinoma in situ (flat lesion)

( ) Urothelial dysplasia (low-grade flat lesion)

( ) Adenocarcinoma of the prostate (see prostate cancer checklist)

( ) Inflammation/ regenerative changes

( ) Therapy-related changes (specify type):

( ) Cystitis cystica et glandularis

( ) Keratinizing squamous metaplasia

( ) Intestinal metaplasia

( ) Other (specify):

  1. *Comment(s): *

Explanatory note

  1. Variant histology may be commented, that includes

( ) with squamous differentiation

( ) with glandular differentiation

( ) with trophoblastic differentiation

( ) with Müllerian differentiation

( ) nested variant

( ) microcystic variant

( ) micropapillary variant

( ) lymphoepithelioma-like variant

( ) plasmacytoid/ signet ring/ diffuse variant

( ) giant cell variant

( ) lipid-rich variant

( ) clear cell (glycogen-rich) variant

( ) sarcomatoid variant

( ) poorly-differentiated variant

  1. Squamous cell carcinoma or adenocarcinoma should be in pure form. If urothelial carcinoma in situ or any conventional urothelial carcinoma component is identified, the tumor should be classified as urothelial carcinoma with squamous/glandular differentiation.