Vulva Cancer Histopathology Reporting Proforma Mandatory questions (i.e. protocol standards) are in bold (e.g. S1.01). S1.01 Identification Family name Given name(s) Ethnicity Unknown AboriginalTorres Strait Islander ethnicity: Date of birth DD MM YYYY Date of request Mandatory questions (i.e. protocol standards) are in bold (e.g. S1.01). Requesting doctor - name and contact details DD MM YYYY Patient identifiers e.g. MRN, IHI or NHI (please indicate which) S1.03 Accession number Clinical diagnosis New primary, recurrence, precancer (VIN) or other previous cancer New primary cancer Details Precancer (VIN) Local recurrence (vulva) Regional recurrence (groin) Distant metastasis previous cancer diagnosis Lymph nodes None received OR Select all that apply: Right inguinal Left inguinal Right femerol Left femerol Accompanying specimens Right pelvic Left pelvic Right sentinel Left Sentinel Specimen site Method of treatment Number of tumours Surgical orientation markers Operative specimen Local resection Total radical vulvectomy Part of vulva, radically resected Describe below Type: Not stated Right Left Anterior Posterior S1.04 Principal clinician G1.01 clinical information Version 1.0 Proforma: Vulva Cancer Structured Reporting Protocol 1st Edition Page 1 of 9
Macroscopic findings features (shape, colour, demarcation): S2.01 Specimen orientation markers S2.05 Tumour dimensions G2.01 Surface anatomical structures (eg clitoris, urethralvaginal orifice etc) Type of surface: Hair bearing skin Hairless skinmucosa Both hair bearing and hairless skinmucosa Cannot determine S2.02 Specimen measurements length x width x thickness TUMOUR 3 S2.04 Macro. appearance of tumour Type of growth: Fungating Ulcerative features (shape, colour, demarcation): length x width x thickness S2.03 Number of macroscopically visible tumour(s) S2.05 Tumour dimensions length x width x thickness TUMOUR 1 S2.04 Macro. appearance of tumour Type of growth: Fungating Ulcerative S2.06 Margins Not assessable peripheral margin features (shape, colour, demarcation): Site(s) of involved margins S2.05 Tumour dimensions length x width x thickness S2.07 Adjacent skin abnormality No Yes Describe (eg. white, thickened) TUMOUR 2 S2.04 Macro. appearance of tumour Type of growth: Fungating Ulcerative S2.08 Macroscopic depth of invasion OR Not assessable Version 1.0 Proforma: Vulva Cancer Structured Reporting Protocol 1st Edition Page 2 of 9
S2.09 LYMPH NODES RIGHT INGUINAL LN RIGHT FEMORAL LN to LEFT INGUINAL LN to LEFT FEMORAL LN to to Version 1.0 Proforma: Vulva Cancer Structured Reporting Protocol 1st Edition Page 3 of 9
LEFT FEMORAL LN (cont.) LEFT PELVIC LN (cont.) RIGHT PELVIC LN RIGHT SENTINEL INGUINOFEMORAL LN to LEFT PELVIC LN to LEFT SENTINEL INGUINOFEMORAL LN to to Version 1.0 Proforma: Vulva Cancer Structured Reporting Protocol 1st Edition Page 4 of 9
LEFT SENT. INGUINOFEMORAL LN (Cont.) Microscopic findings S3.01 Number of primary tumours G3.01 Microscopic description S2.10 Block code Repeat the following set of information for each primary tumour identified in S3.01. TUMOUR 1 S3.02 Tumour type (of primary tumour) Squamous cell carcinoma S3.03 Depth of invasion G3.02 Superficial reference point for depth of invasion measurement From point of origin From most superficial epithelial-stromal interface (exophytic tumours only) From top of adjacent dermal papilla (for ulcerated tumours and where the point of origin is not known) S3.04 Size of microscopic tumour(s) (for each microscopic tumour identified that has not been identified previously in the macroscopic) S3.05 Lymphvascular space invasion S3.06 Perineural invasion Version 1.0 Proforma: Vulva Cancer Structured Reporting Protocol 1st Edition Page 5 of 9
S3.07 Margin status (invasive tumour) peripheral margin List involved margin(s) medial (vaginal) urethral anal clitoral other TUMOUR 2 (cont.) S3.07 Margin status (invasive tumour) peripheral margin List involved margin(s) medial (vaginal) urethral anal clitoral other TUMOUR 2 S3.02 Tumour type (of primary tumour) Squamous cell carcinoma TUMOUR 3 S3.02 Tumour type (of primary tumour) Squamous cell carcinoma S3.03 Depth of invasion G3.02 Superficial reference point for depth of invasion measurement From point of origin From most superficial epithelial-stromal interface (exophytic tumours only) From top of adjacent dermal papilla (for ulcerated tumours and where the point of origin is not known) S3.04 Size of microscopic tumour(s) (Complete for each microscopic tumour identified that has not been identified previously in the macroscopic) S3.03 Depth of invasion G3.02 Superficial reference point for depth of invasion measurement From point of origin From most superficial epithelial-stromal interface (exophytic tumours only) From top of adjacent dermal papilla (for ulcerated tumours and where the point of origin is not known) S3.04 Size of microscopic tumour(s) (Complete for each microscopic tumour identified that has not been identified previously in the macroscopic) S3.05 Lymphvascular space invasion S3.05 Lymphvascular space invasion S3.06 Perineural invasion S3.06 Perineural invasion Version 1.0 Proforma: Vulva Cancer Structured Reporting Protocol 1st Edition Page 6 of 9
TUMOUR 3 (cont.) S3.07 Margin status (invasive tumour) S3.08 Intraepithelial Neoplasia eg VIN, EMPD VIN-Differentiated VIN-Warty-basaloid (usual, HPV-assoc d) S3.09 Margin status (VINEMPD) Uncertain peripheral margin Type medial (vaginal) urethral anal clitoral other List involved margin(s) medial (vaginal) urethral anal clitoral other EMPD List involved margin(s) Node 2 Node 3 Node 4 LEFT INGUINAL LN Node 2 Node 3 Node 4 RIGHT FEMORAL LN LYMPH NODES RIGHT INGUINAL LN Node 2 Node 3 Node 4 Version 1.0 Proforma: Vulva Cancer Structured Reporting Protocol 1st Edition Page 7 of 9
LEFT FEMORAL LN Node 2 Node 3 Node 4 LEFT PELVIC LN (cont.) RIGHT SENTINEL INGUINOFEMORAL LN Node 2 RIGHT PELVIC LN Node 2 Node 3 Node 4 Node 3 Node 4 LEFT SENTINEL INGUINOFEMORAL LN LEFT PELVIC LN Node 2 Node 3 Node 4 G3.03 OTHER DIAGNOSES Histopathological features of lesions other than cancers Node 2 Node 3 Node 4 Lichen sclerosus Version 1.0 Proforma: Vulva Cancer Structured Reporting Protocol 1st Edition Page 8 of 9
G3.04 relevant microscopic coent Synthesis and overview G5.01 Diagnostic suary Include: operative procedure; tumour type; tumour size; depth of invasion; lymphvascular space invasion; status of margins; lymph node status Ancillary test findings S4.01 IMMUNOHISTOCHEMICAL STAINS SENTINEL NODES Positive Abs Negative Abs Equivocal Abs G5.02 Overarching coent Interpretive coent G4.01 ancillary tests Not performed Performed Type of test 1 (eg FISH, cytogenetics) Result Interpretive coent Type of test 2 (eg FISH, cytogenetics) Result Interpretive coent Type of test 3 (eg FISH, cytogenetics) Result Interpretive coent Worksheet prepared by: On: DD MM YYYY Version 1.0 Proforma: Vulva Cancer Structured Reporting Protocol 1st Edition Page 9 of 9