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Procedure (select all that apply)

Total hysterectomy and bilateral salpingo-oophorectomy Radical hysterectomy Simple hysterectomy Supracervical hysterectomy Bilateral salpingo-oophorectomy Right salpingo-oophorectomy Left salpingo-oophorectomy Salpingo-oophorectomy, side not specified Right oophorectomy Left oophorectomy Oophorectomy, side not specified Bilateral salpingectomy Right salpingectomy Left salpingectomy Salpingectomy, side not specified Omentectomy Peritoneal biopsies Peritoneal tumor debulking Peritoneal washing Pleurocentesis (pleural fluid) Other

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Specimen Integrity

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Tumor Site A word about assigning primary site

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A word about assigning primary site

From the CAP cancer protocol, note C

Right ovary Left ovary Bilateral ovaries Ovary, laterality cannot be determined Right fallopian tube Left fallopian tube Bilateral fallopian tubes Fallopian tube, laterality cannot be determined Right tubo-ovarian Left tubo-ovarian Bilateral tubo-ovarian Tubo-ovarian, laterality cannot be determined Primary peritoneum Other

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Ovarian Surface Involvement (required only if applicable)

Not identified Present, right ovary Present, left ovary Present, bilateral ovaries Cannot be determined Not applicable

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Fallopian Tube Surface Involvement (required only if applicable)

Not identified Present, right fallopian tube Present, left fallopian tube Present, left and right fallopian tubes Cannot be determined Not applicable

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Tumor Size (cm)

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Histologic Type (select all that apply)

Serous borderline tumor Serous borderline tumor, micropapillary / cribriform variant Serous borderline tumor with microinvasion Microinvasive low grade serous carcinoma Low grade serous carcinoma High grade serous carcinoma Mucinous borderline tumor Mucinous borderline tumor with intraepithelial carcinoma Mucinous borderline tumor with microinvasion Mucinous adenocarcinoma Endometrioid borderline tumor Endometrioid carcinoma Endometrioid carcinoma, seromucinous type Seromucinous borderline tumor Clear cell borderline tumor Clear cell carcinoma Borderline Brenner tumor Malignant Brenner tumor Mesonephric-like adenocarcinoma Small cell carcinoma, hypercalcemic type Dedifferentiated carcinoma Undifferentiated carcinoma NOS Carcinoma, subtype cannot be determined Mixed epithelial borderline tumor Mixed carcinoma Carcinosarcoma (malignant mixed Mullerian tumor) Endometrioid stromal sarcoma, low grade Endometrioid stromal sarcoma, high grade Adenosarcoma Leiomyosarcoma Fibrosarcoma Granulosa cell tumor, adult type Granulosa cell tumor, juvenile type Steroid cell tumor Sertoli-Leydig cell tumor Other sex cord-stromal tumor Immature teratoma Teratoma with malignant transformation Malignant struma ovarii Dysgerminoma Yolk sac tumor Embryonal carcinoma Gonadoblastoma Choriocarcinoma, non-gestational type Mixed malignant germ cell tumor Gastrointestinal stromal tumor Solitary fibrous tumor, malignant Desmoplastic small round cell tumor Other histologic type (specify type)

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Histologic Grade

Required for serous, endometrioid, mucinous, and seromucinous carcinomas, immature teratomas, and Sertoli-Leydig cell tumors only Note: Serous carcinomas are graded via a 2-tier system. Immature teratomas can be graded using a 2-tier or 3-tier system. Endometrioid and mucinous carcinomas are graded via a 3-tier system. Sertoli-Leydig cell tumors are graded via a modified 3-tier grading system with grade 2 tumors being termed “intermediate differentiated.” Clear cell carcinomas, borderline epithelial neoplasms, all other malignant sex-cord stromal and germ cell tumors are not graded.

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Implants

Not sampled Not identified Present Indeterminate Not applicable

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Other Tissue/ Organ Involvement

Not applicable Not identified Right ovary Left ovary Ovary (side not specified) Right fallopian tube Left fallopian tube Fallopian tube (side not specified) Uterus Cervix Pelvic peritoneum Abdominal peritoneum Omentum Other organs/tissue Cannot be determined

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Largest Extrapelvic Peritoneal Focus (required only if applicable)

Microscopic Macroscopic (2 cm or less) Macroscopic (greater than 2 cm) Not applicable

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Peritoneal / Ascitic Fluid Involvement

Not submitted / unknown Malignant cells not identified Atypical, borderline tumor cells Atypical, degenerated cells cannot be further classifed Suspicious Malignant cells present Cannot be determined Results pending

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Chemotherapy Response Score (CRS) A note about the CRS

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A note about the CRS

From the CAP cancer protocol, note J

No known presurgical therapy CRS1: No definite or minimal response identified CRS2: Moderate response identified CRS3: Marked response with no or minimal residual cancer Cannot be determined Not applicable Required only for high-grade serous carcinomas. Treatment effect is based on assessment of the section of omentum that shows the least response to chemotherapy.

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Regional Lymph Nodes

Check here if any lymph nodes submitted?

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Distant Site(s) Involved, if applicable

Not applicable Pleural effusion with positive cytology Liver parenchyma Splenic parenchyma Extra-abdominal organ(s) Inguinal or retroperitoneal lymph node(s) and lymph node(s) outside the abdominal cavity Transmural involvement of intestine Other Cannot be determined

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Pathologic Staging (pTNM)

TNM Descriptors (select all that apply)

Not applicable r y

pT

pTX: Primary tumor cannot be assessed pT0: No evidence of primary tumor pT1a: Tumor limited to one ovary (capsule intact) or fallopian tube, no tumor on ovarian or fallopian tube surface; no malignant cells in ascites or peritoneal washings # pT1b: Tumor limited to both ovaries (capsules intact) or fallopian tubes; no tumor on ovarian or fallopian tube surface; no malignant cells in ascites or peritoneal washings pT1c1: Surgical spill pT1c2: Capsule ruptured before surgery or tumor on ovarian or fallopian tube surface pT1c3: Malignant cells in ascites or peritoneal washings pT2a: Extension and/or implants on uterus and/or fallopian tube(s) and/or ovaries. pT2b: Extension to and/or implants on other pelvic tissues. pT3a: Microscopic extrapelvic (above the pelvic brim) peritoneal involvement with or without positive retroperitoneal lymph nodes pT3b: Macroscopic peritoneal metastasis beyond pelvis 2 cm or less in greatest dimension with or without metastasis to retroperitoneal lymph nodes pT3c: Macroscopic peritoneal metastasis beyond pelvis more than 2 cm in greatest dimension with or without metastasis to the retroperitoneal lymph nodes

pN

pNX: No lymph nodes are submitted or Regional lymph nodes cannot be assessed pN0: No regional lymph node metastasis pN0(i+): Isolated tumor cells in regional lymph node(s) no greater than 0.2 mm pN1: Positive retroperitoneal lymph nodes only (histologically confirmed) pN1a: Metastasis up to and including 10 mm in greatest dimension pN1b: Metastasis more than 10 mm in greatest dimension

N suffix modifiers (if applicable)

Not applicable (sn) metastasis is identified only by sentinel lymph node biopsy (sn i-) metastasis is identified only by sentinel lymph node biopsy, immunos negative (sn i+) metastasis is identified only by sentinel lymph node biopsy, immunos positive metastasis is identified only by FNA or core biopsy

pM

pMx: Not applicable pM1a: Pleural effusion with positive cytology pM1b: Liver or splenic parenchymal metastases; metastases to extra-abdominal organs

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+ FIGO Stage (2015)

IA: Tumor limited to 1 ovary (capsule intact) or fallopian tube; no tumor on ovarian or fallopian tube surface; no malignant cells in the ascites or peritoneal washings IB: Tumor limited to both ovaries (capsules intact) or fallopian tubes; no tumor on ovarian or fallopian tube surface; no malignant cells in the ascites or peritoneal washings IC: Tumor limited to 1 or both ovaries or fallopian tubes, with any of the following: IC1: Surgical spill intraoperatively IC2: Capsule ruptured before surgery or tumor on ovarian or fallopian tube surface IC3: Malignant cells present in the ascites or peritoneal washings IIA: Extension and/or implants on the uterus and/or fallopian tubes and/or ovaries IIB: Extension to other pelvic intraperitoneal tissues IIIA: Metastasis to the retroperitoneal lymph nodes with or without microscopic peritoneal involvement beyond the pelvis IIIA1: Positive retroperitoneal lymph nodes only (cytologically or histologically proven) IIIA1(i): Metastasis ≤10 mm in greatest dimension IIIA1(ii): Metastasis >10 mm in greatest dimension IIIA2: Microscopic extrapelvic (above the pelvic brim) peritoneal involvement with or without positive retroperitoneal lymph nodes IIIB: Macroscopic peritoneal metastases beyond the pelvic brim ≤2 cm in greatest dimension, with or without metastasis to the retroperitoneal lymph nodes IIIC: Macroscopic peritoneal metastases beyond the pelvic brim >2 cm in greatest dimension, with or without metastases to the retroperitoneal nodes IVA: Pleural effusion with positive cytology IVB: Metastases to extra-abdominal organs (including inguinal lymph nodes and lymph nodes outside of abdominal cavity)