GROSSING, STAGING,

AND REPORTING
An Integrated Manual of Modern Surgical Pathology

Qihui “Jim” Zhai

Copyright © 2021 College of American Pathologists (CAP).
All rights reserved. None of the contents of this publication may be reproduced, stored in a retrieval system, or
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ISBN: 978-1-941096-57-4

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Contents
Contributors..........................................................................................................................................................................................................v
Acknowledgments................................................................................................................................................................................................vi
Foreword..............................................................................................................................................................................................................vii
Preface................................................................................................................................................................................................................ viii
The Perfect Cut: Focusing on Safety to Achieve Quality in Grossing Technique.........................................................................................1
Breast
1. Ductal Carcinoma in Situ....................................................................................................................................................................................5
2. Invasive Breast Carcinoma.................................................................................................................................................................................11
3. Central Nervous System.....................................................................................................................................................................................19
Endocrine
4. Adrenal Gland.....................................................................................................................................................................................................23
5. Thyroid.................................................................................................................................................................................................................28
6. Parathyroid...........................................................................................................................................................................................................37
Gastrointestinal
7. Ampulla of Vater.................................................................................................................................................................................................41
8. Anus and Perianal Skin......................................................................................................................................................................................46
9. Appendix..............................................................................................................................................................................................................51
10. Colon and Rectum..............................................................................................................................................................................................58
11. Distal Extrahepatic Bile Ducts..........................................................................................................................................................................68
12. Esophagus............................................................................................................................................................................................................71
13. Gallbladder...........................................................................................................................................................................................................76
14. Gastrointestinal Stromal Tumor.......................................................................................................................................................................80
15. Liver......................................................................................................................................................................................................................85
16. Intrahepatic Bile Ducts.......................................................................................................................................................................................90
17. Pancreas................................................................................................................................................................................................................95
18. Perihilar Bile Ducts...........................................................................................................................................................................................103
19. Small Bowel........................................................................................................................................................................................................108
20. Stomach..............................................................................................................................................................................................................114
Genitourinary
21. Kidney................................................................................................................................................................................................................125
22. Penis....................................................................................................................................................................................................................129
23. Prostate Gland...................................................................................................................................................................................................133
24. Testis...................................................................................................................................................................................................................138
25. Ureter and Renal Pelvis....................................................................................................................................................................................142
26. Urethra...............................................................................................................................................................................................................145
27. Urinary Bladder.................................................................................................................................................................................................148
Gynecologic
28. Endometrium....................................................................................................................................................................................................153
29. Ovary, Fallopian Tube, and Peritoneum........................................................................................................................................................158
30. Trophoblastic Tumors......................................................................................................................................................................................165
31. Uterine Cervix...................................................................................................................................................................................................167
32. Uterine Sarcoma................................................................................................................................................................................................171
33. Vagina.................................................................................................................................................................................................................174
34. Vulva...................................................................................................................................................................................................................180

Contents iii
Head and Neck
35. Larynx and Pharynx.........................................................................................................................................................................................191
36. Lip, Oral Cavity, and Base of Tongue/Tonsil.................................................................................................................................................194
37. Major Salivary Glands......................................................................................................................................................................................197
38. Paranasal Sinuses..............................................................................................................................................................................................199
39. Ear.......................................................................................................................................................................................................................201
40. Neck Lymph Nodes...........................................................................................................................................................................................202
Hematologic
41. Bone Marrow.....................................................................................................................................................................................................203
42. Lymph Node, Extranodal Tissue, and Spleen................................................................................................................................................208
Opthalmic
43. Opthalmic Enuceation.....................................................................................................................................................................................211
Pediatric
44. Extragonadal Germ Cell Tumors....................................................................................................................................................................219
45. Hepatoblastoma.................................................................................................................................................................................................222
46. Neuroblastoma..................................................................................................................................................................................................227
47. Wilms Tumor.....................................................................................................................................................................................................233
Dermatologic
48. Skin.....................................................................................................................................................................................................................237
Bone and Soft Tissue
49. Soft Tissue..........................................................................................................................................................................................................249
50. Bone....................................................................................................................................................................................................................254
Thorax
51. Heart and Great Arteries..................................................................................................................................................................................261
52. Lung....................................................................................................................................................................................................................265
53. Pleural Mesothelioma.......................................................................................................................................................................................272
54. Thymus...............................................................................................................................................................................................................276
Index...................................................................................................................................................................................................................280

iv Contents
Contributors Wai Chin Foo, MD
The University of Texas
MD Anderson Cancer Center
Editor
Houston, TX
Qihui “Jim” Zhai, MD
Ruifeng Guo, MD, PhD
Mayo Clinic Florida
Mayo Clinic Rochester
Jacksonville, FL
Rochester, MN
Contributing authors Jian He, MD, PhD
Volkan Adsay, MD Medical College of Wisconsin
Koc Universitesi Hastanesi and KUTTAM Research Center Milwaukee, WI
Istanbul, Turkey Pei Hui, MD, PhD
Sylvia L. Asa, MD, PhD Yale University
University Hospitals Cleveland Medical Center New Haven, CT
And University Health Network, Toronto Evita Henderson-Jackson, MD
Case Western Reserve University Moffitt Cancer Center
Diana Bell, MD Tampa, FL
The University of Texas Mark E. Jentoft, MD
MD Anderson Cancer Center Mayo Clinic Florida
Houston, TX Jacksonville, FL
Marilyn M. Bui, MD, PhD Murli Krishna, MD
Moffitt Cancer Center Mayo Clinic Florida
Tampa, FL Jacksonville, FL
Natalia Buza, MD Brandon T. Larsen, MD, PhD
Yale University Mayo Clinic Arizona
New Haven, CT Scottsdale, AZ
Shelley Caltharp, MD Li Liang, MD, PhD
Children’s Healthcare of Atlanta Goshen Health
Emory University School of Medicine Goshen, IN
Atlanta, GA Xiuli Liu, MD, PhD
Patricia Chévez-Barrios, MD University of Florida
Houston Methodist Hospital Gainesville, FL
Houston, TX Dylan V. Miller, MD
Mark A. Cappel, MD Intermountain Medical Center
Gulf Coast Dermatopathology Laboratory Salt Lake City, UT
Tampa, FL Matthew T. Olson, MD
Mathieu C. Castonguay, MD Mayo Clinic Florida
Dalhousie University Jacksonville, FL
Halifax, NS Khela R. Pursell, PA(ASCP)
Deyali Chatterjee, MD Mayo Clinic Florida
Washington University School of Medicine Jacksonville, FL
St. Louis, MO Xiaohua Qian, MD, PhD
Qingqing Ding, MD, PhD Stanford University
The University of Texas Stanford, CA
MD Anderson Cancer Center Beverly Rogers, MD
Houston, TX Children’s Healthcare of Atlanta
Ahmet Dogan, MD, PhD Emory University School of Medicine
Memorial Sloan Kettering Cancer Center Atlanta, GA
New York, NY Heather Rytting, MD
Ashwini K Esnakula, MD Children’s Healthcare of Atlanta
University of Florida Emory University School of Medicine
Gainesville, FL Atlanta, GA
Fang Fan, MD, PhD Rashmi Samdani, MD
City of Hope Medical Center The University of Texas
Duarte, CA MD Anderson Cancer Center
Houston, TX

Contributors v
Inga-Marie Schaefer, MD Paul Wawryko, MD
Brigham and Women’s Hospital University of Manitoba
Harvard Medical School Winnipeg, MB
Boston, MA Shi Wei, MD, PhD
Sasan Setoodeh, MD University of Alabama at Birmingham
University of Texas Southwestern Medical Center Birmingham, AL
Dallas, TX Wenbin Xiao, MD, PhD
Melissa W. Taggart, MD Memorial Sloan Kettering Cancer Center
The University of Texas New York, NY
MD Anderson Cancer Center Hong Yin, MD
Houston, TX Children’s Healthcare of Atlanta
Laura H. Tang, MD, PhD Emory University School of Medicine
Memorial Sloan Kettering Cancer Center Atlanta, GA
New York, NY Yaxia Zhang, MD, PhD
Huamin Wang, MD, PhD Hospital for Special Surgery
The University of Texas New York, NY
MD Anderson Cancer Center Ming Zhou, MD, PhD
Houston, TX University of Texas Southwestern Medical Center
Dallas, TX

Acknowledgments Caryn Tursky, CAP Publications editorial and production

manager, spent a tremendous amount of time to make this book
possible. Thank you.
The creation of this manual was a highly complex project which
CAP President, Dr. Patrick Godbey, graciously wrote the
required the expertise of many amazing individuals who contrib-
Foreword of this book. Thank you for your kind words and long-
uted to the concept, planning, writing, and editing. The contrib-
term support!
utors of this manual are some of the most talented and dedicated
Mom and dad, thank you for being the amazing role models.
pathologists who generously dedicated so much of their time, ef-
Your lifelong love, support, and guidance has paved the way for
fort, and wisdom despite their busy surgical pathology practices.
me!
The Publication Committee of the College of American Pa-
I wanted to thank my wife Jenny and our daughter Jasmine
thologists (CAP) has provided incredible support and guidance
for putting up with me during this and the many other projects
in the creation of this manual. Committee chairs Drs. Katherine
I spend time on. Your love and support has been an anchor and
Galagan and Marilyn Bui, thank you. Your support has been in-
what allows me to continue to succeed in my career.
valuable. To the chief editor of the AJCC cancer staging system
version 9, Dr. Mary Kay Washington, thank you for the review of
Qihui “Jim” Zhai
various chapters and constructive advice.

vi Contributors