ASSIGNING TOPOGRAPHY TO MORPHOLOGY:
RECOMMENDATIONS FOR THE PERPLEXED
Categorizing tumors can be impossible. Imagine you have a dermatofibroma
biopsied from a patient's thigh. Should you consider this a soft tissue
lesion (it's included in almost all soft tissue tumor classifications,
sometimes called a fibrous histiocytoma), or should you categorize it
by its topographic location as a tumor of thigh? Since it came from the
skin, maybe it's best to just categorize it among the skin tumors.
Maybe the best thing to do would be to just call it a dermatofibroma
and forget about trying to categorize the lesion. Unfortunately, you
can't do that. Tissue databanks, registries, pathology departments
and nomenclatures and research protocols often require pathologists
to group tumors so that the members of the groups can be counted,
compared, retrieved, averaged, whatever.
Are there standards or recommendations? No. The problem is
that most so-called tumor classifications (e.g. tumors
of lung, soft tissue tumors, endocrine tumors, etc.) don't help
resolve problems of tumor categorization. That's because most of
these site-specific classifications are simply lists of tumors that
can occur in a given location. So a classification of brain tumors
will include lymphomas of brain, endocrine tumors of brain (pituitary
tumors), germ cell tumors, etc. Classifications of lymphomas,
endocrine tumors, and germ cell tumors will include the same tumors
redundantly. So the pathologist is left with no guidelines to help
categorize tumors uniquely.
UNTIL NOW.
I have made a short and simple categorization for tumors that is
comprehensive and attempts to assign a unique and unambiguous slot for
every tumor of man.
Where possible, I tried to separate the different categories according
to clinical discipline, so that the categorization would be acceptable
to a wide range of clinicians.
This categorization is public domain, but please use the following
citation in any publications that use the categorization.
Berman JJ. Recommendations for categorizing tumors.
http://www.pathinfo.com/jjb/ca_topo.htm
December, 2002.
Inquiries may be sent to:
Jules J. Berman, Ph.D., M.D.
Program Director, Pathology Informatics
Cancer Diagnosis Program, DCTD, NCI, NIH
EPN - Room 6028
6130 Executive Blvd.
Rockville, MD 20892
email: bermanj@mail.nih.gov
Oral Cavity, nasal cavity and accessory sinuses, nasopharynx, pharynx
and hypopharynx (includes salivary gland tumors, odontogenic tumors,
soft tissue tumors except from those arising from skin and excludes
excludes primary)
Larynx (includes soft tissue tumors)
Lung (includes trachea and bronchus and excludes primary tumors of
visceral pleura)
Heart
Digestive system (includes soft tissue tumors arising in submucosa)
but excludes mucosal and submucosal lymphomas)
Esophagus
Stomach
Small Intestine (includes duodenum and jejunum and ampulla of Vater)
Large intestine
Appendix
Colon
Rectum
Anus
Liver, gall bladder and bile duct
Pancreas
exocrine pancreas
endocrine pancreas
Pleural/Peritoneal surfaces
(includes pelvic surfaces and all visceral peritoneal
surfaces except for the ovarian surfaces)
Spleen (excludes lymphomas and leukemias of spleen)
Eyes and Orbit (excludes optic nerve)
Central Nervous System (includes sella turcica, and brain
coverings -- meninges and dura -- and soft tissue arising intracranially,
excludes pituitary)
Endocrine
Includes all endocrine organs including pituitary gland and thymus
but excludes endocrine pancreas, ovaries and testes
Skin (includes lips, ears and other skin of face, melanomas occurring
on skin, epithelial tumors of epidermis and appendages, excludes primary
lymphomas of skin (including Mycosis Fungoides) and includes
soft tissue tumors of dermis and subcutis (including Kaposi's sarcoma),
includes non-areolar skin overlying breast, but otherise excludes
all lesions of breast (including areola)
Bones and Joints (includes vertebrae, and cartilage but excludes
larynx and respiratory cartilage and excludes bone marrow)
Bone marrow (includes hematopoietic tissue within bone, and excludes
extramedullary hematopoietic tissue, such as spleen)
Soft Tissue (excludes soft tissue of named organs/anatomic sites, and
includes soft tissue in extremities and trunk exclusive of skin)
Breast (requires designations of male or female, left, right or bilateral)
Gynecologic sites exclusive of breast (excludes germ cell tumors but
includes soft tissue tumors of these sites)
Ovaries and appendages
Uterus
Corpus
Cervix
Vagina
Vulva (includes accessory structures and perineum)
Male Genitalia and accessory structures
Penis (includes penile urethra)
Scrotum
Testes
Vas deferens
Seminal vesicles
Prostate (includes prostatic urethra)
Kidney and Ureters (includes transitional cell lesions)
Urinary Bladder
Lymphoid tissue: includes lymph nodes and lymphoid collections in
any organ, icluding spleen, gi tract, skin, orbit
