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Retinoblastoma
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Retinoblastoma
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Retinoblastoma (SORET)
- Enucleation, Partial or Complete Exenteration
Specimen and Surgical Procedure
Procedure.......................................................................................
Response Options:
___ Enucleation
Length of optic nerve: ___ mm
___ Partial exenteration
___ Complete exenteration
___ Other (specify): ____________
___ Not specified
Specimen laterality..........................................................................
Response Options:
___ Right
___ Left
___ Unspecified
Tumor
Tumor site (macroscopic examination/transillumination)........................
Response Options:
___ Cannot be determined
___ Superotemporal quadrant of globe
___ Superonasal quadrant of globe
___ Inferotemporal quadrant of globe
___ Inferonasal quadrant of globe
___ Between ___ and ___ o'clock
___ Other (specify): ___________
Tumor site after sectioning...............................................................
Response Options:
___ Cannot be determined
___ Superonasal
___ Inferonasal
___ Superotemporal
___ Inferotemporal
Tumor size after sectioning (greatest basal diameter).......................... ___ mm
Tumor involvement of other ocular structures.....................................
Response Options:
___ Cannot be determined
___ Cornea
___ Anterior chamber
___ Iris
___ Angle
___ Lens
___ Ciliary body
___ Vitreous
___ Retina
___ Sub-retinal space
___ Optic disc
___ Choroid, minimal (solid tumor nest less than 3 mm in maximum diameter
[width or thickness])
___ Choroid, massive (solid tumor nest 3 mm or more in maximum diameter
[width or thickness])
___ Sclera
___ Vortex vein
___ Orbit
___ Other (specify): ________________
Growth pattern............................................................................
Response Options:
___ Cannot be determined
___ Endophytic
___ Exophytic
___ Combined endophytic/exophytic
___ Diffuse
___ Anterior diffuse
Extent of optic nerve invasion.........................................................
Response Options:
___ Cannot be determined
___ None
___ Anterior to lamina cribrosa
___ At lamina cribrosa
___ Posterior to lamina cribrosa but not to end of nerve
___ To cut end of optic nerve
Histologic grade............................................................................
Response Options:
___ pGX: Grade cannot be assessed
___ pG1: Well differentiated
___ pG2: Moderately differentiated
___ pG3: Poorly differentiated
___ pG4: Undifferentiated
Margins (select all that apply).........................................................
Response Options:
___ Cannot be assessed
___ No tumor at margins
___ Tumor present at surgical margin of optic nerve
___ Extrascleral extension (for enucleation specimens)
___ Other margin(s) involved (specify): ______________
Pathologic stage........................................................................ pT__N__M__