Vagina                                                                        
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Vagina (SVAGR)


- For resection specimens with carcinoma, including squamous cell carcinoma, adenocarcinoma and variants, carcinosarcoma, neuroendocrine carcinoma, and mixed epithelial – neuroendocrine tumors. Summary recommended but not required for biopsy specimens. Not used for lymphoma or sarcoma.

Specimen and Surgical Procedure

Specimen, procedure.....................................................................

Lymph nodes submitted and/or identified in the specimen.................. yes/no

Tumor

Tumor site................................................................................... upper third/middle third/lower third/not specified

Tumor size...................................................................................  ___ cm

Histologic type..............................................................................

Histologic grade...............well/moderately/poorly differentiated/undifferentiated

Other tissue/organ involvement.....................................................

Lymphovascular invasion................................................not identified/present

Final Margins

Peripheral margin

       Invasive carcinoma at margin…………………….uninvolved/involved (specify location(s):)

       Intraepithelial neoplasia at margin…………….uninvolved/involved by high-grade squamous intraepithelial lesion (VAIN 2-3)/involved by adenocarcinoma in situ

Deep margin

       Invasive carcinoma at margin…………………….uninvolved/involved (specify location(s):)

       Intraepithelial neoplasia at margin…………….uninvolved/involved by high-grade squamous intraepithelial lesion (VAIN 2-3)/involved by adenocarcinoma in situ

Lymph Nodes* (required only if lymph nodes are present in specimen)

Total number of nodes examined: _____

Specify site(s)#: ____________________________

# Note: Information should include location and laterality of lymph nodes examined.

Specify lymph node(s) with tumor#: ____________________________

# Note: Information should include location and laterality of lymph nodes with tumor.

Number of nodes with metastasis (excludes ITCs): _____

Number of nodes with isolated tumor cells (ITCs) (0.2 mm or less): _____


Pathologic stage (AJCC 8th ed.)...................................................pT__N__M__


Gynecologic


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