Recommendations for the reporting of fallopian tube neoplasms

AppendixAssociation of Directors of Anatomic and Surgical Pathology Final Anatomic Diagnosis Checklist

Fallopian tube neoplasms

Version 1.0 (3-06)

Accession no.:	Part no(s).:	Date:
Patient name:
Organ:	Procedure:
Fallopian tube (specify laterality)	Salpingectomy
Fallopian tube and ovary (specify laterality)	Salpingo-oophorectomy
Uterus, cervix, bilateral ovaries, and fallopian tubes	Hysterectomy and bilateral salpingo-oophorectomy
Uterus, cervix, bilateral ovaries, bilateral fallopian tubes, and lymph nodes (specify site)	Hysterectomy, bilateral salpingo-oophorectomy, and lymphadenectomy
Uterus, cervix, bilateral ovaries, bilateral fallopian tubes, omentum, and lymph nodes (specify site)	Hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and lymphadenectomy
Uterus, cervix, bilateral ovaries, bilateral tubes, omentum, peritoneal biopsies, and lymph nodes (specify sites)	Hysterectomy, bilateral salpingo-oophorectomy, omentectomy, peritoneal biopsies, and lymphadenectomy
Others
Primary tumor diagnosis [10]:Required
Serous tumor of low malignant potential
Endometrioid tumor of low malignant potential
Serous adenocarcinoma
Endometrioid adenocarcinoma
Mucinous adenocarcinoma
Clear cell adenocarcinoma
Transitional cell carcinoma
Squamous cell carcinoma
Mixed (each component should comprise 10% or more of the tumor)
Undifferentiated carcinoma
Metastatic carcinoma
Others (specify)
Tumor site:Required
Isthmus
Ampulla
Infundibulum (fimbria)
Note: Fimbrial carcinomas may have a poorer prognosis due to tumor cell shedding directly to the peritoneum even in the absence of invasion [2].
Tumor grade:Required
Note: Because a universal or standard grading scheme for fallopian tube carcinoma has not been established, the grading scheme must be specified. The GOG arbitrarily uses a single grading system for endometrium, ovary, and fallopian tube, which serves to maintain consistency in diagnosis and classification. Other grading schemes have also been proposed and we do not endorse one system over another. However, regardless of the grading system used, the ADASP strongly endorses a single uniform grading scheme for ovarian, fallopian tube, and extraovarian carcinoma whenever possible. The GOG system is provided below [3]. Other systems may also be used so long as this is clearly stated in the report.
Grade cannot be assessed: specify reason
Low malignant potential (borderline)
G1 (well-differentiated): 5% or less of a nonsquamous or nonmorular solid growth pattern
G2 (moderately differentiated): 6–50% of a nonsquamous or nonmorular solid growth pattern
G3 (poorly differentiated): >50% of a nonsquamous or nonmorular solid growth pattern
G4 (undifferentiated)
Notable nuclear atypia, inappropriate for the architectural grade, raises the grade of a grade 1 or grade 2 tumor by one level. Clear cell carcinomas are generally not graded.
Extent of tumor [1]:Required
Tumor is
Limited to tubal mucosa or
Confined to one fallopian tube with invasion of the lamina propria only, no positive pelvic washings or
Confined to one fallopian tube with invasion of the muscularis propria only, no positive pelvic washings or
Confined to both fallopian tubes with invasion of the lamina propria only, no positive pelvic washings or
Confined to both fallopian tubes with invasion of the muscularis propria only, no positive pelvic washings or
Confined to one or both tubes with peritoneal surface involvement and/or positive pelvic washings
Present in one or both tubes with pelvic extension (specify whether extension involves uterusa and/or ovariesa or other pelvic structures) or
Present in one or both tubes with peritoneal implants outside the pelvis and/or regional lymph node metastasis (specify microscopic, macroscopic but less than 2.0 cm, greater than 2.0 cm, and/or regional lymph node metastasis) or
Present in distant metastasis including malignant cells in pleural fluid or parenchymal liver metastasis
aInvolvement of ovaries and/or endometrium
Note: Current AJCC and FIGO staging do not distinguish between invasion into lamina propria only and invasion into muscularis propria. However, because substaging is based on depth of invasion in other hollow organs with muscle walls, such as gastrointestinal tract and urinary bladder, the ADASP recommends a similar staging standard for fallopian tube carcinoma. Different survival rates depending upon the depth of invasion have been reported [2].
Lymphovascular space invasion:Optional
Absent
Present
Associated features:Optional
Endosalpingiosis
Endometriosis
Others
Other findings:Optional
Ancillary studies:Required (if performed)
pTNM/FIGO stage [1]:Required
Primary tumor:b
TNM	FIGO
pTX		Primary tumor cannot be assessed
pT0		No evidence of primary tumor
pTis	0	Carcinoma in situ (tumor limited to tubal mucosa)
pT1	I	Tumor limited to the fallopian tube(s)
pT1a	IA	Tumor limited to one fallopian tube, without penetration of serosal surface, no malignant ascites or peritoneal washings
pT1b	IB	Tumor limited to both fallopian tubes, without penetration of serosal surface, no malignant ascites or peritoneal washings
pT1c	IC	Tumor limited to one or both fallopian tubes with extension onto or through the serosal surface, or with malignant cells in ascites or peritoneal washings
pT2	II	Tumor involves one or both fallopian tubes with pelvic extension
pT2a	IIA	Extension and/or metastasis to the uterus and/or ovaries
pT2b	IIB	Extension to other pelvic structures
pT2c	IIC	Pelvic extension with malignant cells in ascites or peritoneal washings
pT3	III	Tumor involves one or both fallopian tubes with peritoneal implants outside the pelvisc
pT3a	IIIA	Microscopic peritoneal metastasis outside the pelvis
pT3b	IIIB	Macroscopic peritoneal metastasis outside the pelvis 2.0 cm or less in greatest dimension
pT3c	IIIC	Peritoneal metastasis greater than 2.0 cm in greatest dimension
Regional lymph nodes:
pNX		Regional lymph nodes cannot be assessed
pN0		No regional lymph node metastases
pN1	IIIC	Regional lymph node metastases
Distant metastases:
pMX		Presence of distant metastases cannot be assessed
pM0		No distant metastases
pM1	IV	Distant metastases
bIn the absence of other specific staging instructions, it is recommended that all other primary malignancies of the fallopian tube be staged accordingly (e.g., carcinosarcoma)
cLiver capsule metastasis is T3; liver parenchymal metastasis is M1.