Neuroblastoma

Specimen:
Adrenal/periadrenal
Retroperitoneal, nonadrenal
Thoracic paraspinal
Cervical
Other (specify):
Not specified

Procedure:
Resection
Incisional biopsy
Other (specify):
Not specified

Specimen Size:
       Greatest dimension (cm):
       Additional dimensions (cm):
       Specimen Weight (gm):

Specimen Laterality:
   Right
   Left
   Midline
   Other (specify):
   Not specified

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

Tumor Weight (gm)(if separate from total specimen):

Patient Age:
Not specified
<18 months
≥18 months and <5 years
≥5 years

Histologic Type:
   Neuroblastoma
   Ganglioneuroblastoma:
       Nodular subtype ( nodules)
       Intermixed subtype
   Ganglioneuroma
   Indeterminate
   Cannot be assessed

Note: For nodular (composite) ganglioneuroblastomas with more than 1 nodule, degree of differentiation and mitotic-karyorrhectic index (MKI) must be given for each nodule. Please indicate the differentiation and MKI for the least favorable nodule in the checklist below. Classification of additional nodules can be described in the Comment.

Degree of Differentiation (neuroblastic component):
Undifferentiated
Poorly differentiated
Differentiating
Cannot be assessed
Not applicable

Mitotic-Karyorrhectic Index (MKI) (neuroblastic component):
Low (<100 per 5000 cells; <2%)
Intermediate (100-200 per 5000 cells; 2%-4%)
High (>200 per 5000 cells; >4%)
Indeterminate
Cannot be assessed
Not applicable

Tumor Calcification:
    Present
    Not identified
    Cannot be assessed

Treatment History:
No known presurgical chemotherapy
Presurgical chemotherapy given
Not specified

International Neuroblastoma Pathology Classification (INPC):
   Favorable Histopathology:
       Any age; ganglioneuroma (Schwannian stroma-dominant); maturing or mature
       Any age; ganglioneuroblastoma, intermixed (Schwannian stroma-rich)
       Less than 18 months old; neuroblastoma (Schwannian stroma-poor) or nodular ganglioneuroblastoma; poorly differentiated or differentiating subtypes with low or intermediate mitosis-karyorrhexis index (MKI)
       18 months up to less than 5 years old; neuroblastoma (Schwannian stroma-poor) or nodular ganglioneuroblastoma; differentiating subtype and low MKI
   Unfavorable Histopathology:
       Any age; neuroblastoma (Schwannian stroma-poor) or nodular ganglioneuroblastoma with undifferentiated histology and any MKI
       Less than 18 months old; neuroblastoma (Schwannian stroma-poor) or nodular ganglioneuroblastoma with poorly differentiated or differentiating subtypes with high MKI
       18 months up to less than 5 years old; neuroblastoma (Schwannian stroma-poor) or nodular ganglioneuroblastoma; poorly differentiated and any MKI, or differentiating and intermediate or high MKI
       Equal to or greater than 5 years old; neuroblastoma (Schwannian stroma-poor) or nodular ganglioneuroblastoma; any subtype and any MKI
   Not applicable secondary to previous chemotherapy
   Cannot be determined secondary to insufficient material
   Indeterminate

Note: INPC applies to untreated primary tumors and tumors in metastatic sites provided that there is sufficient material to classify histologically. Bone marrow biopsy is useful only for evaluation of degree of neuroblastic differentiation, but not eligible for MKI determination.

Margins:
Cannot be assessed
Margins uninvolved by tumor
Margin(s) involved by tumor:

Lymph-Vascular Invasion:
    Not identified
    Present
    Indeterminate

Extent of Tumor:

Primary Tumor:
Cannot be assessed
Encapsulated
Extracapsular extension without adjacent organ involvement
Extension into adjacent organs
Extension into spinal canal

Regional Lymph Nodes:
   Cannot be assessed
   Regional lymph node metastasis not identified
   Regional lymph node metastasis present at
   Number of lymph nodes examined:
   Number of lymph nodes involved by tumor:

Distant Metastasis:
Cannot be assessed
Distant metastasis at

International Neuroblastoma Staging System (INSS):
Stage 1: localized tumor with complete gross excision, with or without microscopic residual disease; representative ipsilateral nonadherent lymph nodes negative for tumor microscopically (nodes attached to and removed with the primary tumor may be positive)
Stage 2A: localized tumor with incomplete gross excision; representative ipsilateral nonadherent lymph nodes negative for tumor microscopically
Stage 2B: localized tumor with or without complete gross excision with ipsilateral nonadherent lymph nodes positive for tumor; enlarged contralateral lymph nodes must be negative microscopically
Stage 3: unresectable unilateral tumor infiltrating across the midline, with or without regional lymph node involvement; localized unilateral tumor with contralateral regional lymph node involvement; midline tumor with bilateral extension by infiltration (unresectable) or by lymph node involvement
Stage 4: any primary tumor with dissemination to distant lymph nodes, bone, bone marrow, liver, skin, and/or other organs (except as defined for stage 4S)
Stage 4S: localized primary tumor (as defined for stage 1, 2A, or 2B), with dissemination limited to skin, liver, and/or bone marrow (limited to infants less than 1 year old)

Multifocal primary tumors (eg, bilateral adrenal primary tumors) should be staged according to the greatest extent of disease, as defined above, and followed by a subscript “M” (eg, 3M).
The midline is defined as the vertebral column. Tumors originating on one side and crossing the midline must infiltrate to or beyond the opposite side of the vertebral column.
Marrow involvement in stage 4S should be minimal (ie, less than 10% of total nucleated cells identified as malignant on bone marrow biopsy or marrow aspirate). More extensive marrow involvement would be considered stage 4. The meta-iodobenzylguanidine (MIBG) scan (if performed) should be negative in the marrow.

Additional Pathologic Findings:

MYCN Amplification Status:
    Not assessed
    Not amplified
    Amplified
    Gain
    Indeterminate

Note: Results of MYCN amplification information may not be available to the pathologist at the time of the report.

Comment(s):