8. Structural report of colorectal endoscopic resection specimens*.

Name　　　　　　　　 Sex　　　　　　　Age　　　　　　Pathology number　　　　 Medical record number　　　　　　　　　 Inspection site
*, For complete polyp or mucosal/intestinal wall excision specimens only.
Specimen size	Maximum diameter: ___ cm; Other two diameters: ___ cm × ___ cm
Polyp size	Maximum diameter: ___ cm; Other two diameters: ___ cm × ___ cm
Polyp structure	□ Peduncle length ___ cm, diameter ___ cm □ Broad base
Type of polyp	□ Glandular tubular adenoma □ Villous adenoma □ Villous glandular adenoma □ Traditional serrated adenoma □ Sessile serrated polyp/adenoma □ Hamartoma-like polyps □ Other
High-level intraepithelial neoplasia	□ None □ Yes □ Inherent membrane invasion (intramucosal carcinoma)
Invasive carcinoma (carcinoma infiltrating submucosa)	□ None □ Yes
Size of invasive cancer	Maximum diameter: ___ cm Other two diameters: ___ cm × ___ cm
Histological classification	□ Adenocarcinoma, non-special type □ Adenocarcinoma, special type □ Mucinous adenocarcinoma □ Signet ring cell carcinoma □ Serrated adenocarcinoma □ Micropapillary carcinoma □ Medullary carcinoma □ Sieve-like acne carcinoma □ Adenosquamous carcinoma □ Squamous cell carcinoma □ Spindle cells/sarcoma-like carcinoma □ Undifferentiated carcinoma □ Other special types: _______________ □ Cancer, uncertain type
Histological grade	□ Uncertain □ Low level (well/moderately differentiated) □ High level (poorly differentiated, undifferentiated)
Tumor invasion (deepest point)	□ Membrane propria □ Muscularis mucosae □ Submucosal layer (<1,000 infiltration) □ Submucosal layer (>1,000 infiltration) □ Muscularis propria
Deep resection margin (pedunculated resection margin)	□ Cannot be assessed □ Non-invasive cancer, invasive cancer distance from resection margin: ___ mm □ Invasive cancer involvement
Mucosal resection margin	□ Cannot be assessed □ No intradermal tumor and dysplasia □ Adenoma (low-grade intraepithelial neoplasia/dysplasia) visible □ High-grade intraepithelial neoplasia/dysplasia or intramucosal carcinoma □ Invasive cancer involvement
Tumor budding	□ Low (0−4/20 times if visual field) □ Medium (5−9/20 times of visual field) □ High (10 or more/20 times of visual field) □ Cannot be assessed
Vascular invasion	□ Invisible □ Visible □ Uncertain
Immunohistochemistry of mismatch repair protein	MLH1 (　)　PMS2 (　) MSH2 (　)　MSH6 (　)