ࡱ> U zbjbjnn aaP&P&P&P&P&d&d&d&8&\&d&Z''('''*+D,$*,,,,,,$TPP&$,**@$,$,PP&P&''eD.D.D.$,^P&'P&'RD.$,*D.D.&t'Pj,$d>{0@-X^P&P$,$,D.$,$,$,$,$,PP-$,$,$,$,$,$,$,$,$,$,$,$,$,$,$,$,B %: Appendix D Reporting proforma for testicular cancer (retroperitoneal lymph node dissections, other lymph node excisions or resections of metastatic deposits) Surname.. Forenames Date of birth. Sex.. Hospital... Hospital no....... NHS/CHI no.... Date of surgery... Date of report authorisation. Report number.... Date of receipt. Pathologist................ Surgeon Clinical information required History of chemotherapy (if known) Nature of specimen/procedure and core macroscopic items Retroperitoneal lymph node dissection ( Other ( Please specify Size of specimen (three dimensions): .......... x ......... x .... mm Size of any lymph node masses present: ..... mm Core microscopic items Tumour typing state percentage of each viable tumour element present Tumour type(s) (one or more)Germ cell tumour%Non-germ cell tumour%SeminomaPlease specifyEmbryonal carcinomaYolk sac tumour, post-pubertal typeChoriocarcinomaTeratoma, post-pubertal typeSemi-viable tumour, non-viable tumour, necrosis or fibrosis only (no viable tumour)OtherPlease specify: Tumour parameters Maximum tumour dimension (if not assessed macroscopically): ................ mm Number of positive lymph nodes: .. Total number of lymph nodes: .. Margin status: Involved ( Not involved ( Uncertain ( Not applicable ( If not involved, distance to margin ........mm Tumour viability (post-chemotherapy specimens): Viable ( Non- or semi-viable ( Extranodal spread of tumour (retroperitoneal lymph node dissection or other lymph node excision only): Present ( Not identified ( Cannot be assessed ( pT stage: ............(TNM 8) SNOMED codes: T.. M. T.. M. Signature of pathologist Date ....     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