Colon Polyp 

Colon Polyp   AJCC 6th Edition; CAP 2005
Benign or Malignant 2007-05-31 Cancer Case Summary
Diagnosis Example: Sigmoid biopsy at 15 cm - Tubular Adenoma This Synoptic is for Biopsies & Polypectomies.
  - 1 cm head diameter For Segmental Resections, use Colon Synoptic.
  - 0.5 cm stalk  
  - no stalk invasion Use term "carcinoma" only for polyps with
  - no high grade dysplasia invasive tumour below muscularis mucosa.
    - completely excised Avoid "CIS" or "Intramucosal Ca" as terms.
HNPCC Amsterdam Criteria for Genetic Testing  
Dysplasia / Adenoma in UC    
Microscopic (If the Diagnosis is formatted as above, a Microscopic is not needed)    
# Report Header Dictation Options Note
Surgical Pathology Case Summary  
1 Specimen Type Polypectomy/Biopsy For Segmental Resection, use Colon Synoptic
2 Polyp Location Not stated or Specify Cecum, Ascending colon, Hepatic Flexure, Transverse, Splenic Flex, Descending, Sigmoid, Rectosigmoid, Rectum
3 Polyp Type Tubular Adenoma < 1/3 villous
    Villous adenoma > 2/3 villous
    Tubulo-villous adenoma 1/3 - 2/3 villous
    Sessile Serrated Polyp SSP Features
    Invasive Carcinoma arising in a Tubular Adenoma Specify Ca type: Adenoca, Mucinous, Signet ring, Small cell
    Invasive Carcinoma arising in a Villous Adenoma  
    Invasive Carcinoma arising in a Tubulo-villous adenoma  
    Polypoid carcinoma  
4 Polyp Size __ cm diameter  
    Cannot be determined (fragmented or biopsy)  
5 Polyp Configuration Stalk present ___ cm long "Pedunculated"
6 High Grade Dysplasia Present/Absent This is of no clinical importance, but some endoscopists want to know about it.
7 Stalk Invasion Absent (Benign Polyp)  
    Absent with misplaced epithelium in stalk (Pseudo-invasion; Benign Polyp)  
    Stalk invasion present with: The risk of metastatic disease is only about 2% for all levels of invasion. Colectomy indications:  (1) margin <2 mm (2) anaplastic Ca in polyp (3)lymphatic inv.
    Ca confined to head of polyp Haggitt Level I
    Ca invading to junction of head and stalk Haggitt Level II
    Ca invading stalk below junction of head & stalk Haggitt Level III
    Ca invading submucosa of bowel below the stalk of the polyp but above the muscularis propria Haggitt Level IV
    Sessile Polyp with Ca invading muscularis mucosa of polyp,  but above musc. mucosa of adjacent normal bowel (minimal invasion)  
    Sessile Polyp with Ca invading below the muscularis mucosa of adjacent normal bowel  
8 Resection Margin Negative Margin Margin is defined as cauterized edge. Negative margin is tumour more than 2 mm distant from margin
    Cannot be assessed accurately (explain why) Cautery artifact, tangential section, etc
    Adenoma / Tumour present at margin  
    Adenoma / Tumour present near margin (<1 mm) Defined as within 1mm or 1 HPF of margin
9 Lcode L864  
Omit the following for Benign Polyps  
10 Histologic Type Adenocarcinoma NOS WHO classification
    Mucinous Carcinoma > 50% mucinous
    Signet Ring Carcinoma >50% signet ring
    Small cell, undifferentiated ca Oat cell
    Undifferentiated ca < 5% composed of glands
    Other (specify)  
11 Histologic Grade Low Grade 50-100% glands
    High Grade 0-49% glands
12 Lymphatic / Vascular Invasion Present / Absent  
    Cannot be assessed accurately Cautery artifact, tangential section, etc
13 Associated Lesions NA or [list]  
14 Internal Consultation Pathologist name  
15 Comments Risk of metastatic disease in LN Higher risk:  Poorly differentiated;  Lymphatic invasion; close to venous or lymphatic channel;  less than 1 mm from margin;  Haggitt Level III / IV
16 pTNM AJCC 6th Ed This Synoptic is for biopsies / polypectomies, so detailed TNM classification is not shown  
17 Lcode L864