........................................................................

NHS Trust

Registry No:

Soft Tissue Sarcoma Histopathology Report

Version 20 February 2002

This form should be completed by a Consultant Histopathologist - Please do not complete for recurrent disease
Patient
Name:

D.O.B

Sex:

NHS
No:

Date of
Opn:

Surgeon:

Hospital No:
Specimen
No:

1. Specimen Details
Type of Specimen

Biopsy
wide local

local

Excision

radical excision

Site of Tumour

compartectomy
amputation

Skin/Subcutis

(Location)

Deep soft tissue (incl, retroperitoneum)

(Location)

Visceral

(Please Specify)

Other

(Please Specify)

2. Macroscopic Details
mm

Maximum Dimension

mm

Distance to nearest margin

Is this a fascial plane?

Yes

Necrosis

Nil

No
>50%

<50%

3. Microscopic Details
Type of Tumour
Distance to nearest margin

mm

Tumour Extent

Intracompartmental

Mitotic Count (per 10hpf)

0-9

Necrocis
Differentiation
Grade

Name of
Pathologist:

10-19
<50%

Nil

like adult tissue

1

>=20
>50%

certain histo type

2

SNOMED
Code:

Extracompartmental

T:

M:

undifferentiated
(see reverse)

Date:

When completed, please send this form, with a copy of the typed report, to:NYCRIS, Arthington House, Hospital Lane, Leeds, LS16 6QB

SOFT TISSUE SARCOMAS - TROJANI GRADING SYSTEM

MITOSES:

Score 1: 0-9/10 hpf

2: 10-19/10 hpf
3: 20+/10 hpf

NECROSIS:

Score 0: no necrosis
1: 1-50% necrosis
2: 50% + necrosis

DIFFERENTIATION:

Score 1: Like adult tissue

2: Certain histological type
3: Embryonal or undifferentiated

SCORE TOTAL
GRADE 1
GRADE 2
GRADE 3

:
:
:

2 OR 3
4 OR 5
6,7,8