Pathology report no.:			Previous pathology report no:
Name:	Gender:	Age:	Occupation:	Phone no.:
Ward:	Bed no.:	Medical record no.:		ID no.:
Name of institution sending specimen:			Sending doctor:	Sending date:

Specimen type: Proximal/Distal/Total Stomach/Unspecified Tumor margin from: Lesser curvature:  cm; Greater curvature:  cm; Thickness:  cm; Tumor location: Cardia/Body/Fundus/Pylorus Tumor distance from upper margin:  cm Tumor distance from lower margin:  cm Macroscopic characteristics: Ulcerative/Infiltrative/Fungating/Elevated Tumor size: cm × cm × cm Color: Grey‐red/Grey‐yellow/Grey‐white/Grey‐brown    Texture: Soft/Medium/Hard/Bleeding/Necrosis Depth of Invasion:                   Gross infiltration depth

Histological type: (e.g., tubular adenocarcinoma)

Histological grade (e.g., moderately differentiated)		Lauren classification: Diffuse/Intestinal/Mixed
Depth of infiltration		Involvement of adjacent organs
Vascular invasion		Perineural invasion
Upper resection margin status:		Lower resection margin status:
Lymph node involvement: Number of metastatic/Total lymph nodes ( / ) Lesser curvature: ( / ); Left gastric artery: ( / ); Right gastric artery: ( / ); Upper pyloric: ( / ); Lower pyloric: ( / ); Cardiac: ( / ); Greater curvature: ( / ); Hepatic artery: ( / ).
Associated lesions:
Other specimens:
Immunohistochemistry: MLH1 ( ), PMS2 ( ), MSH2 ( ), MSH6 ( ), HER‐2 (), EBERs ( ), Others:
Pathological staging: pT N M
Primary physician:     Audit physician: Signature:        Signature:     Date of report:
Note: If the clinical physician has any doubts about the pathological diagnosis, please contact the pathologist as soon as possible. Pathological diagnosis of small or fragmented tissue samples may not represent the full extent and nature of the lesion. Please be aware of this as a clinical physician. This report is effective after the physician's signature.
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