CCR Clinical Informatics

Surgical Pathology#

Entere the pathology Number

20 character

Surgery Date

Enter the date of the surgical procedure.

DD-MMM-YYYY

Pathology Resoults Date

Entere the pathology results date

DD-MMM-YYYY

Specify Other Procedure

100 characters

Body Site of Collection

Use Pick List

Pathology Sample Type

Slect the Pathology Sample Type

Use Picl List

Differentiation

Use Picl List

Condition of Margin

Use Picl List

Number of Lymph Nodes Sampled

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Number of Positive Lumph Nodes

Enter number of positive nodes

Nubmer (3)

Findings

Enter findings

24 characters

Greatest Dimension of Specimen (cm)

Number (6,2)

Second Greatest Dimension of Specimen (cm)

Number (6,2)

Stage of Disease

Enter Statge of Disease

Use Pick List

Disease T Stage

Select the stage of disease

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Disease N Stage

Select the stage of disease

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Disease M Stage

Select the stage of disease

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Histologic Grade

Enter the grade of histology

10 characters

Peritoneal Lavage Result

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Lymphatic Invasion Present

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Vascular Invasion Present

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Microcalcification Present

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Notable Benign Changes

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If Yes, Description (Specify )

200 characters

Is this patient evalauable for immunostaining (IHC)

Yes
No

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Tumor Marker

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Analyzed

Yes
No

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Assay Date

DD-MMM-YYYY

Marker Test Method

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Intensity Score

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Cell Staining %

Number(3)

Mutation Detected

INDETERMINATE
NO
YES

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Result

NEGATIVE
POSSITIVE
UNKNOWN

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Biomarker Comments

Enter the comments

200 characters

Path Report Description

Enter desctioption of pathology report

200 characters