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Penis
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- For resection specimens with primary carcinoma of the penis. Primary urethral carcinomas and melanomas are not included.
Specimen and Surgical Procedure
Specimen, procedure....................................................................................
Foreskin..................................................... present/absent/cannot be determined
Tumor
Tumor site...................................................................................
Tumor size...................................................................................
Histologic type..............................................................................
Histologic grade............................................................................
Tumor extension...........................................................................
Lymphovascular invasion.............................................................. present/absent
Perineural invasion...................................................................... present/absent
Final margins
Penectomy
Urethral margin.............................................................. positive/negative
Periurethral tissues margin*............................................. positive/negative
* subepithelial connective tissue (lamina propria), corpus spongiosum, Buck’s fascia
Corpus cavernosum margin.............................................. positive/negative
Buck’s fascia at penile shaft............................................. positive/negative
Skin.............................................................................. positive/negative
Other margin(s) (if applicable; please specify).................... positive/negative
Circumcision
Coronal sulcus margin..................................................... positive/negative
Cutaneous margin.......................................................... positive/negative
Regional Lymph Nodes
Lymph node involvement............................................................. Yes (Specify site) /No
Number of Lymph nodes involved............................................................... __
Number of Lymph nodes examined............................................................. __
Extranodal Extension ……………………………………….Not identified/Present/Cannot be determined
Additional Pathologic Findings (select all that apply)
___ None identified
___ HPV-related penile intraepithelial neoplasia (PeIN)
___ Warty
___ Basaloid
___ Warty-basaloid
___ Non-HPV-related PeIN (differentiated [simplex] penile intraepithelial neoplasia)
___ Other rare patterns of PeIN
___ Pleomorphic
___ Spindle
___ Clear cell
___ Pagetoid
___ Lichen sclerosus
___ Squamous hyperplasia
___ Condyloma acuminatum
___ Other (specify): __________________________
Ancillary Studies
Specify: ________________________________
___ Not performed
Pathologic stage (AJCC 8th Edition) .................................. pT__N__M__