THYROID GLAND: Resection

Procedure Type:
   Thyroid lobectomy:
    Right
    Left
   Partial thyroidectomy (anything less than a lobectomy):
    Right
    Left
   Hemithyroidectomy (lobe and part or all of isthmus):
    Right
    Left
   Total thyroidectomy
   Total thyroidectomy with central compartment dissection
   Total thyroidectomy with right neck dissection
   Total thyroidectomy with left neck dissection
   Total thyroidectomy with bilateral neck dissection
   Other (specify):
   Not specified

Received:
    Fresh
    In formalin
    Other

Specimen Integrity:
Intact
Fragmented

Specimen Size:
   Right lobe: x x cm
   Left lobe: x x cm
   Isthmus ± pyramidal lobe: x x cm
   Central compartment: x x cm
   Right neck dissection: x x cm
   Left neck dissection: x x cm
   Additional dimensions (specify): x x cm

Specimen Weight (g):
Tumor Focality:
    Unifocal
    Multifocal:
           Ipsilateral
           Bilateral
           Midline (isthmus)

Dominant Tumor:

Tumor Laterality:
   Right lobe
   Left lobe
   Isthmus
   Not specified

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

Histologic Type:
   Papillary carcinoma:
       Variant, specify:
           Classical (usual)
           Clear cell variant
           Columnar cell variant
           Cribriform-morular variant
           Diffuse sclerosing variant
           Follicular variant
           Macrofollicular variant
           Microcarcinoma (occult, latent, small, papillary microtumor)
           Oncocytic or oxyphilic variant
           Solid variant
           Tall cell variant
           Warthin-like variant
           Other, specify:
       Architecture:
           Classical (papillary)
           Cribriform-morular
           Diffuse sclerosing
           Follicular
           Macrofollicular
           Solid
           Other, specify:
       Cytomorphology:
           Classical
           Clear cell
           Columnar cell
           Oncocytic or oxyphilic
           Tall cell
   Follicular carcinoma:
       Variant, specify:
           Clear cell
           Oncocytic (Hürthle cell)
           Other, specify:
   Poorly differentiated thyroid carcinomas, including insular carcinoma
   Medullary carcinoma
   Undifferentiated (anaplastic) carcinoma
   Other (specify):
   Carcinoma, type cannot be determined

Histologic Grade:
    Not applicable
    GX: Cannot be assessed
    G1: Well differentiated
    G2: Moderately differentiated
    G3: Poorly differentiated
    G4: Undifferentiated
    Other (specify):

Margins:
Cannot be assessed
Margins uninvolved by carcinoma, distance of invasive carcinoma to closest margin: mm
Margin(s) involved by carcinoma at

Tumor Capsule:
Cannot be assessed
Totally encapsulated
Partially encapsulated
None

Tumor Capsular Invasion:
   Cannot be assessed
   Not identified
   Present:
    Extent: Minimal
    Extent: Widely invasive
   Indeterminate

Lymph-Vascular Invasion:
Cannot be assessed
Not identified
Present:
    Extent: Focal (less than 4 vessels)
    Extent: Extensive (4 or more vessels)
Indeterminate

Perineural Invasion:
    Not identified
    Present
    Indeterminate

Extrathyroidal Extension:
Cannot be assessed
Not identified
Present:
    Extent: Minimal
    Extent: Extensive

Second Tumor (for multifocal tumors only)

Tumor Laterality:
       Right lobe
       Left lobe
       Isthmus
       Not specified

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

Histologic Type:
       Papillary carcinoma:
           Variant, specify:
               Classical (usual)
               Clear cell variant
               Columnar cell variant
               Cribriform-morular variant
               Diffuse sclerosing variant
               Follicular variant
               Macrofollicular variant
               Microcarcinoma (occult, latent, small, papillary microtumor)
               Oncocytic or oxyphilic variant
               Solid variant
               Tall cell variant
               Warthin-like variant
                Other, specify:
           Architecture:
               Classical (papillary)
               Cribriform-morular
               Diffuse sclerosing
               Follicular
               Macrofollicular
               Solid
               Other, specify:
           Cytomorphology:
               Classical
               Clear cell
               Columnar cell
               Oncocytic or oxyphilic
               Tall cell
       Follicular carcinoma:
           Variant, specify:
               Clear cell
               Oncocytic (Hürthle cell)
               Other, specify:
       Poorly differentiated thyroid carcinomas, including insular carcinoma
       Medullary carcinoma
       Undifferentiated (anaplastic) carcinoma
       Other (specify):
       Carcinoma, type cannot be determined

Histologic Grade:
    Not applicable
    GX: Cannot be assessed
    G1: Well differentiated
    G2: Moderately differentiated
    G3: Poorly differentiated
    G4: Undifferentiated
    Other (specify):

Margins:
    Cannot be assessed
    Margins uninvolved by carcinoma, distance of invasive carcinoma to closest margin: mm
    Margin(s) involved by carcinoma at

Tumor Capsule:
    Cannot be assessed
    Totally encapsulated
    Partially encapsulated
    None

Tumor Capsular Invasion:
       Cannot be assessed
       Not identified
       Present:
        Extent: Minimal
        Extent: Widely invasive
       Indeterminate

Lymph-Vascular Invasion:
    Cannot be assessed
    Not identified
    Present:
        Extent: Focal (less than 4 vessels)
        Extent: Extensive (4 or more vessels)
    Indeterminate

Perineural Invasion:
    Not identified
    Present
    Indeterminate

Extrathyroidal Extension:
    Cannot be assessed
    Not identified
    Present:
        Extent: Minimal
        Extent: Extensive

End second tumor

Pathologic Staging (pTNM)

TNM Descriptors

m (multiple primary tumors)
r (recurrent)
y (post-treatment)

Note: There is no category of carcinoma in situ (pTis) relative to carcinomas of thyroid gland.

Primary Tumor (pT):
pTX: Cannot be assessed
pT0: No evidence of primary tumor
pT1: Tumor size 2 cm or less, limited to thyroid
pT1a: Tumor 1 cm or less in greatest dimension limited to the thyroid.
pT1b: Tumor more than 1 cm but not more than 2 cm in greatest dimension, limited to the thyroid
pT2: Tumor more than 2 cm, but not more than 4 cm, limited to thyroid
pT3: Tumor more than 4 cm limited to thyroid or any tumor with minimal extrathyroid extension (eg, extension to sternothyroid muscle or perithyroid soft tissues)
pT4a: Moderately advanced disease. Tumor of any size extending beyond the thyroid capsule to invade subcutaneous soft tissues, larynx, trachea, esophagus or recurrent laryngeal nerve
pT4b: Very advanced disease. Tumor invades prevertebral fascia or encases carotid artery or mediastinal vessels
Anaplastic Carcinoma: pT4a: Intrathyroidal anaplastic carcinoma—surgically resectable
Anaplastic Carcinoma: pT4b: Extrathyroidal anaplastic carcinoma—surgically unresectable

Regional Lymph Nodes (pN):
pNX: Cannot be assessed
pN0: No regional lymph node metastasis
pN1a: Nodal metastases to Level VI (pretracheal, paratracheal and prelaryngeal/Delphian) lymph nodes ( / )
pN1b: Metastases to unilateral, bilateral or contralateral cervical (Levels I, II, III, IV, V) or retropharyngeal or superior mediastinal lymph nodes (Level VII). ( / )

Superior mediastinal lymph nodes are considered regional lymph nodes (level VII). Midline nodes are considered ipsilateral nodes.

Lymph Node, Extranodal Extension:
    Not identified
    Present
    Indeterminate

Distant Metastasis (pM):
Not applicable
pM1: Distant metastasis at Specify site(s), if known, and source of pathologic metastatic specimen

Additional Pathologic Findings:
       Adenoma
       Adenomatoid nodule(s) or Nodular follicular disease (eg, nodular hyperplasia, goitrous thyroid)
       Diffuse hyperplasia (Graves’ disease)
       Thyroiditis:
           Advanced
           Focal (nonspecific)
           Palpation
           Other (specify):
       Parathyroid gland(s):
           Within normal limits
           Hypercellular
           Other (specify):
       C-cell hyperplasia
       None identified
       Other (specify):

Ancillary Studies: eg, histochemistry, immunohistochemistry, DNA analysis

Patient History:
       Radiation exposure:
        Yes (specify type):
        No
        Indeterminate
       Family history:
       Other (specify):

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