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243

TNM Supplement: A Commentary on Uniform Use, Fourth Edition.

Edited by Ch. Wittekind, Carolyn C. Compton, J. Brierley and L. H. Sobin.

© 2012 UICC. Published 2012 by John Wiley & Sons, Ltd.

INDEX

‘a’ (autopsy) classification, 20Abdomen, 123, 204, 209Abdominal lavage fluid, 16Abdominal lymph nodes, 48, 85,

117, 120–1biopsy, 167

Abdominal para-aortic lymph nodes, 127Abdominal tissues, 97Abdominal wall, 57, 107–8, 143, 161Abdominoperineal resection, 63Abortion, 101Acinar adenocarcinoma, 223Acromion, 124Additional tumour nodules, 78Adenoca, 225Adenocarcinoma, 12, 23, 24, 46, 48, 50,

71, 97, 214–15, 224, 226, 228, 236Adenopathy, 8Adenosarcoma, 97–8Adipose tissue, 67Adjuvant chemotherapy, 194Adjuvant therapy, 193, 203Adnexa, 95–6, 236Adrenal cortex carcinoma (ACC), 171, 188Adrenal cortex tumours, 109–10, 127

primary tumour, 164regional lymph nodes, 164

Adrenal gland, 53, 106, 143, 240Adrenalectomy, 164Adventitia, 46, 47, 213AIDS, 82American Joint Committee on Cancer

(AJCC) Cancer Staging Manual, 6, 20, 41, 47, 48, 57, 58, 59, 66, 68, 81–4, 86, 95–7, 106–7, 110, 118, 179, 182, 188, 202, 208, 213, 220, 224, 230, 238

American Mycosis Fungoides Study Group, 177–9

Ampulla of Vater, 5, 60, 67–8, 122, 135, 146, 148, 221

Ampullary adenocarcinoma, 221Anal canal, 5, 11, 19, 61, 63, 64–5, 85,

135, 142, 144, 148, 172, 217, 219Anal carcinoma, 219Anal margin, 5, 6, 124, 178Anal squamous epithelium, 218Anaplasia, 103Anaplastic thyroid carcinoma, 136, 140Anastomosis, 52, 62Anatomical sites

cranial and facial bones, 174cutaneous T-cell lymphoma, 178gastroinstestinal sarcomas, 172

Angiosarcoma, 82Anorectal fistula, 64Anorectal lymph nodes, 121Anterior aorta, 68Anterior caecal lymph nodes, 120Anterior compartment group, 35Anterior cranial fossa, 43Anterior eyelid lamella, 165Anterior mediastinal (anterior to ascending

aorta ascendens or innominate artery), 48

Anterior orbit, 43, 138Anterior pancreatoduodenal lymph

nodes, 122Anterior resection, 3Anterior superior pancreatoduodenal

vein, 51Anterior vagina, 109Anus, 92, 121, 216Aorta, 46, 47, 72, 143, 224

Wittekind_bindex.indd 243Wittekind_bindex.indd 243 2/13/2012 6:18:28 PM2/13/2012 6:18:28 PM

COPYRIG

HTED M

ATERIAL

244 Index

Aortic arch, 74–5Aortic lymph nodes, 119, 127Aorto-caval nodes, 221–2Aaortopulmonary (AP) lymph nodes, 48Apex of ventricle, 41Apical lymph nodes, 14, 64, 125Aponeurosis epicranialis, 85Appendiceal neuroendocrine tumours, 58Appendix

carcinoid, 57, 135, 142–3, 147carcinoma, 56, 135, 142–3, 147, 214

Arm, 178lymph nodes of, 117

Arteria coeliaca lymph nodes, 48Arteria gastric sinistra lymph nodes, 48Arteria hepatica communis lymph

nodes, 48Arteria lienalis lymph nodes, 48Arteria mesenterica superior, 69Aryepiglottic fold, 40Arytenoid cartilage, 38, 40Ascending colon, 121Ascites, 11, 98–100, 157Atelectasis, 69Australia, 16Autopsy, 207Axial skeleton, 85, 151Axillary lymph nodes, 90–2, 117, 125–6,

154, 178, 181, 232metastasis, 155

Azygos vein, 74–5

Back, 122Barrett carcinoma (distal oesophagus

adenocarcinoma, AEG I), 46, 50Basal cell carcinoma, 85Basophil count, 183ßhCG level, 1, 101Bilateral cancers, 206Bilateral inguinal lymph nodes, 148, 162Bilateral internal iliac lymph nodes, 148Bilateral ovarian serous surface borderline

tumour, 238Bilateral prostatic adenocarcinoma, 238Bile ducts, 65, 67–8, 220Biliary cystadenocarcinoma, 65Biopsy, 1, 70, 91, 142, 144, 178,

210, 229

Bladder, 93, 96, 144, 161, 208, 240–1mucosa, 97, 156–7neck invasion, 102–3, 109, 160–1wall, 94–6, 108

Blastic infiltration, 185Blood count, 185Blood vessels

invasion of, 105Bone marrow, 11

biopsies, 16, 167, 178, 183hypercellularity, 184

Bone(s)erosion/destruction, 43metastasis, 16, 102primary tumours, 150–1regional lymph nodes, 151resection, 86sarcoma, 12, 24tumours, 5, 19, 81–3, 198, 230

Bowel, 8, 64, 96, 236, 241perforation, 63

Brachial plexus, 72, 81, 149Brain, 43, 82, 101, 110, 139, 151,

165, 167classification of tumours, 207–8

Breast, 6, 19, 125, 135, 207, 230–4cancer, 16, 154carcinoma, 13, 15, 23, 227, 230–2carcinosarcomas, 230–1parenchyma, 90primary tumours, 154regional lymph nodes, 154–6tumours, 89–92

Bronchial adenocarcinoma, 225Bronchial resection margin, 80Broncholoalveolar carcinomas,

71, 223–5Bronchoscopy, 70Bronchopulmonary carcinoid tumours,

69, 78, 222Bronchus (bronchi), 47, 69, 72, 75,

224, 226Bronchus intermedius, 222Buccal (facial) nodes, 33, 35Buccinators nodes, 35, 118Bulb, 113Bulbar conjunctiva, 111Buttocks, 124


Index 245

C (certainty) factor, 22Caecal lymph nodes, 120Caecum, 4, 57, 58, 117

carcinoma, 4, 61, 63Calyces, 240

Canada, 16Canaliculi, 165Capsule rupture, 99, 209Carcinoembryonic antigen (CEA), 194Carcinoids (neuroendocrine tumours), 23,

55, 58, 69Carcinoma

ampulla of Vater, 67anal, 219anaplastic/undifferentiated, 45appendix, 56ascending colon, 3Barrett, 46bladder, 240breast, 13, 15, 230–2bulbar conjunctiva, 111caecum, 4, 61, 63cardia, 46cervical, 95colon, 12, 61, 194, 209, 214, 216, 218colorectal, 3, 24, 136, 207,

210–11, 215conjunctiva, 110–11, 165cystic duct, 66endometrial, 96, 202extrathyroidal anaplastic, 45eyelid, 111, 151fallopian tube, 99, 206follicular, 45gallbladder, 24, 66–7, 220gastric, 16, 52hepatocellular, 65–6, 186ileal, 55inflammatory, 90–1, 231intrathyroidal anaplastic, 45invasive, 1kidney, 23lacrimal gland, 115large cell, 24liver, 171, 186, 206lung, 69, 222medullary, 45Merkel cell, 135

metastatic lung, 78mucinous, 56multifocal, 46nasopharyngeal, 39oesophagus, 12, 13, 24, 46–50, 202ovary, 8, 206, 238palpebral, 111pancreas, 13, 24, 68papillary, 45, 212penis, 23, 101prostate, 9, 11, 23, 102–3rectal, 3, 63, 194, 210, 216–17renal pelvis, 4, 23, 107Siewert’s, 46sigmoid colon, 7, 8skin, 4, 135, 151–2, 230small cell, 24small intestine, 55squamous cell (cloacogenic), 64stomach, 24, 46, 53thyroid, 11trachea, 208transverse colon, 4undifferentiated, 24urachus, 208ureter, 4, 23urethra, 23urinary bladder, 23, 107–8uterine cervix, 7vaginal, 93–4vocal cords, 42vulva, 93

Carcinosarcomas, 230–1Cardia, ‘real’ carcinoma of (AEG II), 46Cardioesophageal lymph nodes, 120Carina, 69–70, 74, 119, 149, 203Carotid artery, 38, 74, 137, 139Carotid bifurcation, 34Cartilage, 88, 139, 152, 230Caruncular conjunctiva, 111Caruncle, 165Caudal jugular (deep cervical) nodes,

31, 32Caudal margin, 74Caudal paratracheal (infrathyroidal, lateral

tracheal), 35Caval lymph nodes, 121Caval vein, 188


246 Index

Cavernosum, 101Cellular pleomorphism, 24Central nervous system (CNS), 166, 207

metastasis, 115Cerebral spinal fluid (CSF), 115Cerebriform nuclei, 181–2Cervical carcinoma, 95Cervical glands, 95Cervical lymph nodes, 32–3, 117–19,

124, 126–7, 141, 175, 178, 181, 205, 212

Cervicomediastinal lymph node system, 36Cervix uteri, 6, 93–6, 126, 135, 157,

159, 198, 234–5Cheek skin, 43, 138Chemotherapy, 18, 50, 64, 194, 214,

228, 233Chest, 74Chest wall, 69, 73, 76, 89–90, 149,

210, 233invasion, 79, 197lesion, 227

Chin, 136Cholangiocellular carcinoma, 65Choledochal cyst, 67Chondroblastoma, malignant, 175Chondrosarcoma, 175Choriocarcinoma, 1, 100Choroid, 112–13

malignant melanoma, 112, 166Choroidal invasion, 113–14Chronic myeloid leukaemia (CML), 171,

182–5Ciliary body, 112–13

malignant melanoma, 112, 166Circumferential resection margin

(CRM), 16Clavicle, 35, 39, 74, 125Clinical classification, 71Clinical vs pathological TNM, 203Clitoris, 83–4Clivus, 43, 139Cloacogenic carcinoma, 64Coeliac artery, 51, 66, 118, 120, 122–3Coeliac axis nodes, 47, 68, 119, 122,

145–6, 213, 221–2Coeliac lymph nodes, 187–8, 213Coeliac trunk, 122

College of American Pathologists (CAP), 83, 103, 239

Colon, 3, 5, 6, 14, 19, 54, 57, 61–3, 108, 117, 121, 135, 142, 144–5, 172, 214–19

adenocarcinoma, 23, 217anatomical sites, 61carcinoma, 12, 194, 206, 209, 214,

216, 218local recurrence, 62regional lymph nodes, 62, 147–8telescopic ramification, 194–6

Colonic polyp, 202Colorectal adenomas, 62Colorectal carcinoma, 3, 136, 171, 207,

210–11, 215liver mestasis of, 188–9

Colorectum, 11, 24, 144Committee for Head and Neck Surgery

and Oncology of the American Academy for Otolaryngology – Head and Neck Surgery, 33

Common bile duct, 67, 121–2, 221–2Common epithelial tumours, 98Common hepatic artery, 51, 66, 67, 118,

120, 122, 145Common iliac lymph nodes, 95, 108, 126,

127, 164, 198, 241Computerized tomography (CT), 3,

70, 203Conglomerate tumour, 8Conisation, 234–5Conjunctiva, 6, 113

carcinoma, 110–11, 165malignant melanoma, 111, 165–6

Conjunctival fornix, 111Contralateral hilar lymph nodes, 70, 150Contralateral internal mammary lymph

nodes, 126Contralateral lobe, 70Contralateral mediastinal lymph nodes,

70, 81, 150Contralateral pleura, 81, 149Contralateral portal vein, 145Contralateral scalene lymph nodes,

70, 150Contralateral supraclavicular, 70Cord fixation, 41


Index 247

Cord mobility, impaired, 41Corium, 231Cornea, 165Corniculate cartilage, 41Coronoid of mandible, 31, 212Corpus carcinoma, 96Corpus cavernosum, 109Corpus spongiosum, 101, 109Corpus uteri, 6, 95–7, 135, 157, 159,

204, 235–6Cortex, 175–7, 198Cortical bone, 37, 136–7Costal arch, 124Couinaud’s system of segmentation of

liver, 186Cranial nerves, 38, 43, 139Cribriform plate, 43Cricoid cartilage, 38, 138cTNM (clinical TNM) 1–2, 18, 70, 203Cortical bone, 37Cranial and facial bones, 171, 174–7Cranial jugular (deep cervical) nodes,

31, 32Cranial nerves, 137, 139Cranial paratracheal (suprathyroidal), 35Craniofacial structures, 151Cremaster fascia, 105Cremaster muscle, 105Cribriform plate, 138Cricoid cartilage, 74, 137Cricothyroid notch (clinical landmark), 34Cuneiform cartilage, 41Cutaneous T-cell lymphoma, 171, 177–80Cystectomy, 108, 160–1Cystic duct carcinoma, 66–7Cystic lymph nodes, 120–2Cytokeratin, 16Cytology, 70, 144, 156, 183, 205, 207

Deep cervical fascia, 211Deep extradermal structures, 88, 152, 230Deep parotid nodes, 35Delphian lymph nodes, 142Dermal lymphatics, 231Dermal papilla, 93Dermatopathic lymphadenopathy (DL), 181Dermis, 231Descending colon, 121

Desmoid tumour, 82Diaphragm, 46, 69, 73, 75, 81, 105–6,

110, 116–17, 142–3, 149, 164Diaphragmatic lymph nodes, 48, 120Diffuse idiopathic neuroendocrine cell

hyperplasia (DIPNECH), 78Digestive system tumours, 46–69

primary tumours, 142–6regional lymph nodes, 146–8telescopic ramification, 193–6

Dimpling of skin, 91Diopters, 113Direct spread, 209Discontinuous tumour, 81Distal bile ducts, 67, 122, 220Distal excision margin, 218Distal extrahepatic bile ducts, 67–8, 220Distal oesophagus adenocarcinoma

(AEG I, Barrett carcinoma), 46Distal splenic artery lymph nodes, 51Distal trachea, 208Distal ureter, 108Distant metastasis (pM1), 1–2, 9–11,

53, 56, 70, 76, 81, 86–7, 93–6, 98, 100, 115, 126, 173, 176, 179, 199, 209, 213, 218–19, 221, 235–6, 240

pathological assessment, 134, 207Distant micrometastasis, 206Distant peritoneal metastasis (M1 PER), 53DNA

analysis, 9technology, 184

Dorsal cervical (superficial cervical) nodes, 31, 32, 34

DSK-TNM, 174Ductal carcinoma, 89, 221Ductal adenocarcinoma, 19Duodenal lymph nodes, 120Duodenal papilla, 68Duodenal wall, 68, 221Duodenum, 54, 60, 68, 120, 143, 145, 221Dura, 43, 139Dura mater, 82

Ear, 84, 230canal, 44, 139

Eczematous patches, 178


248 Index

Elastic layer, 196, 229Elastic stain, 71, 197, 228–9Endocervix, 98Endomucosal resection (EMR), 213Endothelium, 105Endometrial adenocarcinoma, 235Endometrial carcinoma, 96, 202, 236Endometrial stromal sarcoma, 97–8Endometrial tumour, 237Endometrium, 95–8, 126, 135, 157, 236–7Endoscopic polypectomy, 3, 11Endoscopy, 1, 41, 70Endothoracic fascia, 81, 125, 197Enucleation, 86Epidermis, 87Epididymis, 104–5, 238Epiglottic cartilage, 38Epiglottis, 137Epipoloic metastasis, 237Epithelial–stromal junction, 93Epithelioid hemangioendothelioma,

malignant, 174Epithelium, 87Epithelium /submucosa (mucosal

disease), 44Epitrochlear lymph nodes, 178, 181Erlangen Cancer Center (ECC), 16, 193,

195, 198Erlangen Registry Colorectal Cancer

(ERCRC), 195–6Erythematous patches, 178Erythroderma, 179–80Erythroplasia of Queyrat, 101ESMO Clinical Practice Guidelines, 54Ethmoid bone, 174Ethmoid sinus, 5, 43, 208Europe, 61European Network for the Study

of Adrenal Tumour, 110European Neuroendocrine Tumour Society

(ENETS), 57, 58, 59, 69European Organization of Research

and Treatment of Cancer (EORTC), 177, 180, 182

Ewing sarcoma of bone and soft tissue, 24, 230

Excisional biopsyof lymph node, 134of sentinel node, 10, 91

Exenteration, 86Exocrine pancreas, 68Extensive chest wall, 81External ear, 178External iliac lymph nodes, 95, 127,

164, 219External sphincter, 63, 102,160Extra-adrenal invasion, 109Extracapsular extension, 80Extracapsular lymph node spread, 53, 93,

159, 193Extrahepatic bile ducts, 5, 66–8, 135, 148

distal, 145perihilar, 145

Extralymphatic organs, 117Extramedullary tumour, 182Extranodal extension, 101, 162–3Extranodal lymphomas, 117Extraocular extension, 112–13, 166Extraocular tumour, 114Extrapancreatic extension, 221Extrapelvic extenson, 157Extraprostatic extension, 109Extraprostatic invasion, 102Extrascleral extension, 166Extrathyroid extension, 193Extrathyroidal anaplastic carcinoma, 45Extravesical mass, 107Exudates, 205Eye, 110–15, 166Eyelid, 5, 6, 166–7

carcinoma, 85–6, 88, 111, 151, 153margin, 165

Face, lymph nodes of, 117Facial nerve, 44, 139Fallopian tube, 4, 6, 99–100, 126,

135, 157–9, 204–6, 236Fascia, 88, 152Femoral lymph nodes, 126Fibromatosis (desmoid tumour)Fibromuscular layer (tunica muscularis), 67Fibromyxosarcoma, 174Fibrosarcoma, 174Fibrotic nodules, 17Fibrous histiocytoma, malignant, 174Fifth cranial nerve, 30Fine needle aspiration (FNA) biopsy, 91,

156, 205, 207


Index 249

Flat extension, 113Fluor-desoxy-glucose, 76Flow cytometry, 9FNCLCC grading system, 83Focal chest wall, 81Focal choroidal invasion, 114Focal necrosis, 58Follicular carcinomas, 45Forniceal conjunctiva, 111, 165Fovea, 113Frontal bone, 174Frontal sinus, 43

tumours, 208Frozen pelvis, 94–6, 103

G classification (histopathological grading), 23, 25, 56–7, 82–3

gastroinstestinal sarcomas, 173gynaecological tumours, 97prostate, 103

Galea aponeurotica, 85Gallbladder, 5, 7, 24, 65–6, 68, 122,

135, 145, 148carcinoma 66–7, 220and cystic duct, 66and perihilar extrahepatic bile ducts, 66

Gastrectomy, 53, 214Gastric antrum, signet ring cell carcinoma

of 53Gastric carcinoid tumours, 59–60,

142–3, 147Gastric carcinoma, 16, 46, 209Gastric cardia, 50Gastric lymphoma, 117, 189Gastric primary, 209Gastric stump carcinoma, 52Gastrocolic ligament, 53Gastroenteropancreatic (GEP) carcinomas,

57Gastroepiploic lymph nodes, 120, 122Gastrointestinal adenocarcinomas, 24Gastrointestinal malignant lymphoma,

171, 189Gastrointestinal sarcomas, 171–3Gastrointestinal stromal tumour (GIST),

23, 46, 53–5, 120, 142–3, 147, 172

Gastrointestinal tract, 10, 19, 60, 101, 117

Gene fusion, 184Germ cell tumours, 98German Colorectal Liver Metastasis

Workflow in Burghausen, 2008, 196German Federal Ministry for Research and

Technology Cutaneous Lymphoma Group, 177

German hepatoblastoma study group, 186German TNM Committee, 100Germany, 33Gerota fascia, 105–6, 160, 218Gestational trophoblastic tumours, 6, 24,

100–1, 158Giant condyloma of Buschke-Löwenstein,

84Glandular differentiation, 24Glans penis, 83–4, 241Glaucoma, 112–13Gleason scoring of prostate needle

biopsies, 103–4, 238–9Globe, 111, 115, 167Glottis, 41, 138Gluteal sulcus, 124Goblet cell carcinoids, 56, 57Granulation tissue, 17Great vessels, 70, 110, 149, 164, 224Greater curvature, 120Greater omental gastroduodenal lymph

nodes, 120Greater omentum, 53, 68Groin, 124, 126Grossly encapsulated tumour, 193Grossly non-encapsulated tumour, 193Gynaecological tumours, 92–101,

198–9, 234–8primary tumours, 156–8regional lymph nodes, 158–9

Haemangioma, 3, 12Haematopoetic tumours, 185Haemoglobin value, 183Haemorrhage, 185Haemorrhoidal lymph nodes, 121Hair follicles, 87Hard palate, 38, 43, 137Head and neck, 19, 30–45, 122, 124

anatomy, 30extension to adjacent sites, 31masticator space (MS), 30–1


250 Index

Head and neck (cont’d )malignant melanoma, 24, 43–4primary tumour (pT), 136–40, 222regional lymph nodes (pN), 31–6, 117,

140–2, 178telescopic ramification, 193

Heart, 47, 70, 149Hemangioendothelioma, malignant, 174Hemangiopericytoma, malignant, 174Hemangiosarcoma, 174Hemicolectomy, 3Hemilarynx, 40Hepatectomy, 220Hepatic artery, 67, 121, 221Hepatic carcinoma, 65Hepatic flexure, 121Hepatic lymph nodes, 120–2, 222Hepatic parenchyma, 67Hepatic vein, 65, 144Hepatoblastoma, 171, 186–8Hepatocellular carcinoma, 65, 186Hepatocellular/cholangiocellular

carcinoma, 65Hepatoduodenal ligament lymph nodes,

51, 120–1, 187–8High-grade (intraepithelial) dysplasia, 62Hilar fat, 229Hilar lymph nodes, 48, 70, 75, 81,

119–23, 127, 135, 187–8Hilum, 72, 123, 226, 239Hindgut NETs, 57Hip, 178Histological types of tumours, 174–5Histology, 205, 239Hodgkin lymphoma, 116–18, 167Hollow viscera, 82Hydatiforme mole, 100Hyoid bone, 137Hyperconvoluted cerebriform nuclei, 181Hyperplastic lesions, 58Hypogastric lymph nodes, 95, 121,

126–7, 164Hypopharynx, 4, 5, 31, 38, 118, 137

tumour, 40Hysterectomy, 236

Ileal carcinoma, 55Ileocaecal valve, 117

Ileocolic lymph nodes, 120–1Ileum, 54, 56, 57, 58, 60, 63,

117, 120Iliac lymph nodes, 85, 127Imaging, 1, 15, 70, 178, 181, 183,

189, 218Immunohistochemistry, 9, 71, 89, 92, 211,

214, 227Imprint cytology, 16Infection, 185Inferior alveolar nerve, 37, 136Inferior mesenteric lymph nodes, 7,

51, 121Inferior nasal concha, 174Inferior phrenic lymph nodes, 121Inferior rectal lymph nodes, 121Inferior vena cava, 72Infiltrating lobular carcinoma, 231Inflammatory carcinoma, 90–1, 231Infraauricular (infra- or subparotid)

nodes, 35Infraclavicular lymph nodes, 89–91, 125Infradiaphragmatic lymph nodes, 52Infrahepatic lymph nodes, 187–8Infrapyloric lymph nodes, 47, 120Infratemporal fossa, 38, 43, 137–8Inguinal lymph nodes, 96, 117, 121,

126–7, 178, 181metastasis, 94, 162

Inguinal lymphadenectomy, 135Inguinal surgery, 127Inguinofemoral (groin) lymph nodes, 126Innominate vein, 74In situ carcinoma, 202–3In situ ‘flat’ tumour, 107Interaortocaval lymph nodes, 127Interlobar lymph nodes, 75–6, 119, 123Internal carotid artery, 37, 137Internal iliac lymph nodes, 95, 121,

127, 218Internal jugular vein, 34, 125, 141Internal mammary lymph nodes, 80–1,

90–2, 123, 125, 155Internal maxillary artery, 31, 212International Association for the Study of

Lung Cancer (IASLC) Lung Cancer Staging Project, 69, 73, 82, 149, 174, 197


Index 251

International Federation of Gynaecology and Obstetrics (FIGO), 92–8, 208, 235, 238

International League of Dermatological Societies (ILDS), 179

International Prognostic Index for Non-Hodgkin Lymphomas, 185

International Society for Cutaneous Lymphomas (ISCL), 177, 180, 182

International Society for Paediatric Oncology (SIOPEL), 186

International Society of Urological Pathology (ISUP), 103, 107, 239

International Thymic Malignancy Interest Group (ITMIG), 174

International Union Against Cancer (UICC), 57, 59, 66, 68, 69, 78, 86, 95, 98, 103, 110, 118, 182, 188, 202, 220, 230, 235, 238

Interpectoral (Rotter) lymph nodes, 125Interpterygoid fascia, 30, 211Intestinal lymphoma, 189Intra-abdominal lymph nodes, 96, 117Intra-abdominal tumour, 64Intracranial extension, 38, 137Intraepithelial carcinoma, 62Intraepithelial neoplasia, 47intrahepatic bile ducts, 65–6, 145Intrahepatic cholangiocarcinoma, 65Intrahepatic metastasis, 65Intramammary lymph nodes, 92, 125, 126Intramucosal carcinoma, 62Intramural direct extension, 62–3Intramural metastasis, 47Intraocular compartments, 165Intraocular disease, 114Intraparotid lymph nodes, 119Intrapelvic lymph nodes, 127Intrapericardial portions

of right and left pulmonary artery, 72, 224of superior and inferior right and left

pulmonary veins, 72, 224Intrapericardial resection, 223, 225Intraperitoneal disease, 94Intraperitoneal metastasis, 56Intrapulmonary lymph nodes, 150, 228Intrathoracic lymph nodes, 73, 80, 85,

117, 123, 227

Intrathyroidal anaplastic carcinoma, 45Intratubular germ cell neoplasia, 160Invasive carcinoma, 15Invasive component, 6Invasive hydatiforme mole, 100Investing fascia, 30Ipsilateral adrenal gland, 105, 160Ispilateral axillary lymph nodes, 124, 155Ipsilateral bronchopulmonary lymph

nodes, 81, 150Ipsilateral epitrochlear lymph nodes, 124Ipsilateral hilar lymph nodes, 70, 150Ipsilateral infraclavicular lymph nodes, 155Ipsilateral inguinal lymph nodes, 124Ipsilateral internal mammary lymph nodes,

150, 154–5Ipsilateral lung lymph nodes, 81Ipsilateral lymph nodes, 70–1, 76, 140,

142, 149, 154Ipsilateral mediastinal nodes, 70, 81,

150, 229Ipsilateral multiple, 37, 38, 41, 43, 44Ipsilateral parietal pleura, 76, 81Ipsilateral peribronchial lymph nodes,

70, 150Ipsilateral popliteal, 124Ipsilateral preauricular lymph nodes, 124Ipsilateral scalene lymph nodes, 150Ipsilateral single, 37, 38, 41, 43, 44Ipsilateral supraclavicular lymph

nodes, 155Iris malignant melanoma, 111–13, 166isolated tumour cells (ITC), 9, 10, 53,

92, 211

Japan Lung Cancer Society, 79, 197Japanese Gastric Cancer Association, 52Japanese TNM Committee, 186Jejunum, 54, 60, 120Jugular lymph nodes, 117–19Jugulodigastric node, 34Juguloomohyoid lymph node, 34Juxtacortical chondrosarcoma, 81Juxtacortical osteosarcoma, 81

Kaposi sarcoma, 5, 81Karyotype, 183

analysis, 184


252 Index

Kidney, 6, 23, 53, 101, 105–6, 110, 127, 136, 143, 160, 162–4, 239–40

cancer, 239–40non-functioning, 94

Klatskin tumour, 67, 220

L (lymphatic) classification, 7, 21, 25, 48, 63, 77, 92, 209, 232,

Labium majus, 83–4Labium minus, 83–4Lacrimal apparatus, 113Lacrimal bone, 174Lacrimal gland, 6

carcinoma, 115, 167Lacrimal punctum, 165Lamina cribrosa, 114Lamina propria, 46, 53, 55, 60, 62, 66,

108, 226Laparoscopy, 11, 204Laparotomy, 11, 116, 204, 237Large bowel carcinoid tumours, 59–60Large cell carcinoma of lung, 24Large intestine, 108

carcinoid tumours, 142, 147Laryngeal nerves, 35Laryngeal saccule, 42Laryngectomy, 212Laryngopharynx, 40Larynx, 5, 38, 118, 135, 137–9, 205, 212

tumour, 40–1, 212Larynx supraglottis, 138Lateral compartment lymph nodes, 119Lateral nasopharynx, 38, 137Lateral pterygoid muscle, 38Lateral sacral lymph nodes, 95, 121,

126–7, 218Left brachiocephalic vein, 36Left colic lymph nodes, 7, 121Left gastric artery, 51, 118, 120, 213Left gastroepiploic artery (perigastric area),

51Left liver, 122, 220Left subphrenic artery, 51Leg, 178

lymph nodes of, 117Leiomyosarcoma, 97–8Leptomeningeal, 115Lesser curvature, 120–1

Lesser omentum, 68, 120Leukaemia, 5, 17

chronic myeloid leukaemia (CML), 171, 182–5

Levator muscles, 102, 160Ligamentum arteriosum, 74–5Lip and oral cavity, 5, 37–45, 118, 135–7

anatomical definitions, 41–2non-hair bearing, 84

Liver, 4–7, 19, 68, 95, 101, 110, 121, 135, 143, 145, 164, 181, 209

biopsy, 116, 167, 178carcinoma, 171, 206, 222diaphragm, 53hepatocellular carcinoma (HCC), 65,

144–5, 148intrahepatic bile ducts, 65–6intrahepatic cholangiocarcinoma (ICC),

145, 148, 219–20lesions, 3metastasis, 14, 15, 171, 196, 207

of colorectal carcinoma, 188–9primary liver carcinoma in infants and

children, 171, 186–8resection, 21, 196segmentation, 186sonography, 3, 203

Liver hilus lymph nodes, 188Liver parenchyma, 220Liver Tumour Study Group of International

Society for Paediatric Oncology (SIOPEL), 186

Lobar bronchi, 76Lobar lymph nodes, 119, 123Lobectomy, 73, 149, 224, 228–9Lobular carcinoma, 89Localized single extralymphatic

organ/site, 116Locoregional recurrence rates, 196Loins, 124Low axilla, 125Lower alveolus, 212Lower cervical lymph nodes, 74, 123, 126Lower jugular group, 34Lower limb, 124Lower oesophagus, 50Lower paratracheal lymph nodes, 48,

74, 123


Index 253

Lumpers, 192Lung(s), 5, 7, 19, 47, 58–60, 69–81, 87–8,

95, 101, 104, 117, 123, 135cancer, 71, 76, 197, 222lymphangitic spread, 9metastasis, 100primary tumours, 148–9, 203

Q&A, 222–9recommendations for tumours, 79–80regional lymph nodes, 149–50

Lymph node(s), 1–2biopsy, 116, 162digestive system tumours, 53fixation, 193histopathological staging, 181–2lung and pleural tumours, 73–6head and neck tumours, 36, 39metastasis, 7, 36, 53, 73, 96, 125, 142,

154–5, 162, 202, 209, 212, 214, 216, 219, 221, 228, 232, 234, 238

number, 207staging, 116–18see also regional lymph nodes

Lymphadenectomy, 14, 17, 80, 135, 167regional, 53, 162

Lymphangiosis carcinomatosa (aka lymphangitic spread), 9, 11

Lymphangitis carcinomatosis, 76Lymphatic invasion, 7–8, 76, 104–5,

194, 232Lymphatic sinus walls, penetration of, 9Lymphatic vessels, 7, 95, 232, 236Lymphatics

of parametrium, 7tumour cells in, 209

Lymphocites, 181–2Lymphoid tumours, 185Lymphoscintigraphy, 91–2, 154–5Lymphovascular invasion, 84, 101,

231, 239

M classification, 2–4, 10–13, 22, 25, 48–50, 71, 82, 86, 102–3, 134, 174, 176, 178, 182, 188, 192, 199, 203, 206, 207, 209, 214, 226, 235

cranial and facial bones, 174cutaneous T-cell lymphoma, 179

digestive system tumours, 64gastroinstestinal sarcomas, 172–3lung and pleural tumours, 76–7primary liver carcinoma in infants and

children/hepatoblastoma, 187M0 classification, 3, 11, 13–14, 21, 42,

44, 49, 54–7, 64, 76, 82–3, 87–9, 87, 103–4, 106, 110, 173, 176, 179–80, 187–8, 203–4, 207, 215–16, 218, 221, 226, 237

M1 classification, 3, 11–14, 42, 44, 49, 53, 55, 63, 66, 82–3, 85, 87–9, 93–100, 103–4, 106, 110, 114–15, 125, 173, 176, 179–80, 187–8, 192, 199, 203–5, 207, 209, 213, 219–22, 224, 235–7, 240–1

Macrometastasis, 91, 156, 232Macroscopic incomplete resection, 80Macroscopic metastases, 86, 90Macroscopic peritoneal metastasis, 98,

100, 237Macroscopic residual tumour, 17Macule, 179Main bronchus, 69Major salivary glands, 119, 135, 139Major vascular invasion, 69Malignant blood vessel tumours, 174Malignant carcinoid, 214Malignant chondromatous tumours, 175Malignant fibrous tumours, 174Malignant lymphoma, 5, 17, 81Malignant melanoma

of bulbar conjunctiva, 111of conjunctival fornix, 111of palpebral conjunctiva, 111of skin, 13, 24, 86–7, 152–3of uvea, 24, 111–13, 166of upper aerodigestive tract, 139–40

Malignant odontogenic tumours, 175Malignant ovarian neoplasms, 238Malignant pericardial effusion, 81Malignant peripheral nerve sheath

tumours (MPNST), 175Malignant pleural effusion, 70Malignant pleural mesothelioma, 80–1Malignant thymic epithelial tumours

(thymoma), 171, 174Mammography, 91, 230


254 Index

Mandible, 38, 44, 85, 137, 139, 174–7, 211

Mandibular nodes, 35Manubrium, 74Marrow biopsy, 116Mastectomy, 20, 91, 210Mastication muscles, 30–1, 211–12Masticator space (MS), 30–1, 37,

137, 139, 211Maxilla, 85Maxillary hone, 174Maxillary sinus, 5, 37, 43, 137–9, 208Meckel diverticulum, 55Medial jugular (deep cervical) nodes, 31, 32Medial pterygoid, 38, 137Mediastinal fat, 72, 81, 223, 225Mediastinal invasion, 81, 149, 223,

227, 229Mediastinal lymph nodes, 17, 40, 95, 123,

135, 149Mediastinal lymphadenectomy, 135, 227Mediastinal pleura, 69, 223, 229Mediastinal structures, 139Mediastinal vessels, 45, 70, 139Mediastinoscopy, 70Mediastinotomy, 70Mediastinum, 5, 70, 79, 149, 208, 213,

223, 225–6Medullary carcinoma, 45Melanoma, 87, 135

upper aerodigestive tract, 141Merkel cell carcinoma, 24, 59, 84, 85,

88–9, 152, 153Mesenchymal chondrosarcoma, 175Mesenteric fat, 68Mesenteric lymph nodes, 7, 8, 120,

122, 217Mesenteric mass, 214Mesentery, 54, 55, 63, 68, 143Mesoappendix, 56, 58, 214Mesocolic fat, 63Mesocolon, 63, 68Mesorectal excision, 16Mesorectal fascia, 217Mesorectal lymph nodes, 218Mesorectum, 62, 218Mesothelioma, 5, 149, 208Mesothelium, 226

Metachronous second primary tumour, 205–6

Metastatic adenocarcinoma, 236Metastatic carcinoma, 221Metastatic lung carcinoma, 78Metastatic melanoma, 210Metastasis, 1, 3, 7–11, 53, 150, 210,

215–16, 226Microinvasion, 90, 231–2Microinvasive breast cancer, 233Micrometastasis, 9, 11, 90, 206, 211, 232Microscopic bladder neck invasion, 102Microscopic incomplete resection, 80Microscopic invasion of skin (dermis), 91Microscopic metastases, 86, 90–2, 237Microscopic non-invasive epithelial

implants in omentum, 238Microscopic peritoneal metastasis, 98, 100Microscopic residual tumour, 17Microscopy, 94Middle colic lymph nodes, 121Middle cranial fossa, 30, 43, 139, 211Middle jugular group, 34Middle nasal meatus, 43Middle paraoesophageal lymph nodes, 48Middle rectal lymph nodes, 121Midgut NETs, 57Mid-transverse axis, 124Mitotic count, 23, 82, 86Mixed adenoneuroendocrine carcinoma

(MANEC), 58Mixed exocrine–endocrine carcinoma

(MEEC), 58Mixed forms carcinoid neuroendocrine

carcinoma, 58Mixed germ cell tumours, 105Molar nodes, 35Monoclonal antibodies, 16Morphological techniques, 11Morphology, 71Mouth, 37, 136, 205MRI (magnetic resonance imaging), 22Mucin lakes, 17Mucinous adenocarcinomas, 55, 218Mucinous peritoneal tumour, 56Mucocarcinoid, 58Mucosa, 10, 20, 43, 59, 68, 85, 93–6,

108, 156–7


Index 255

Mucosal surface (of lip), 37Multicentric carcinomas, 89Multifocal carcinomas, 46, 47, 89, 235Multimodal therapy, 18, 213, 234Multiple metastasis, 115Multiple myeloma, 81, 171, 185–6Multiple primary tumours, 10, 18, 106Multiple simultaneous tumours, 3–6Muscularis, 106–7Muscularis mucosae, 46, 53, 55, 62Muscularis propria, 20, 46, 53, 55, 56,

58–60, 62–4, 66, 194, 206, 209–10, 215–16, 218

Musculi longitudinalis inferior, 37Musculi longitudinalis superior, 37Musculus genioglossus, 137–8Musculus hyoglossus, 137–8Musculus palatoglossus, 137–8Musculus sphincter ani, 63Musculus sphincter internus, 102Musculus sphincter urethrae externus,

102–3Musculus sphincter vesicae, 102–3Musculus styloglossus, 137–8Mycosis fungoides, 171, 177, 180–2Myocardium, 81, 149Myometrium, 7, 96, 98Myxoid chondrosarcoma, 175

N classification, 2–3, 8, 10–13, 22, 25, 36, 42, 44, 48–50, 55, 57, 63–4, 70, 73, 82–3, 103–4, 110, 126, 134, 149, 161, 175–8, 182, 188, 192–3, 198, 202–3, 206–7, 209, 213–16, 226–7, 232, 234–6

breast tumours, 90–2cranial and facial bones, 174cutaneous T-cell lymphoma, 179gastroinstestinal sarcomas, 172–3gynaecological tumours, 97kidney, 106lung and pleural tumours, 73–6Merkel cell carcinoma, 88–9primary liver carcinoma in infants and

children/hepatoblastoma, 187synchronous primary malignant

melanomas, 87–8

N0 classification, 8, 11, 42, 44, 49, 54–7, 82–3, 87–9, 97, 103–4, 106, 110, 156, 161, 173, 175, 178–80, 187–8, 202, 206, 226–7

N1 classification, 8, 37–8, 40–4, 46, 49, 53–7, 60, 65–8, 70, 73, 76, 79, 81–3, 85–8, 90, 94, 96–111, 113–15, 122–3, 135, 149, 173, 175–81, 187–8, 193,197–8, 202, 213, 219, 221, 227–8, 237

N2 classification, 37–8, 40–2, 44, 46, 49, 53, 55–7, 64–6, 70, 72–3, 76, 81, 85, 87–9, 96–7, 101, 104, 106–9, 122, 178, 180–1, 187–8, 193, 197, 202, 219–20, 228–9

N3 classification, 25, 37–8, 40–4, 46, 49, 65, 70, 73, 81, 85, 87–9, 93, 101, 103–4, 107–8, 178, 180–2, 193, 213, 219, 241

Nasal bone, 174Nasal cavity, 5, 43, 118, 135, 139, 167Nasal sinuses, 208Nasolabial nodes, 35Nasolacrimal system, 111, 166Nasopharyngeal MS, 30, 211

carcinoma, 39Nasopharynx, 5, 12, 38–9, 43, 118, 137,

139–41National Cancer Institute Surveillance,

Epidemiology, and End Results (SEER), 5, 61, 172, 206

Navel, 124Neck, 19, 38, 39, 124, 178

dissection, 135, 141–2primary tumour (pT), 136–40regional lymph nodes (pN), 31–6, 117,

119, 140–2Necrosis, 83Necrotic cell debris, 18Needle biopsy, 102–3, 203, 226Negative lymph nodes, 8, 222Neoadjuvant therapy, 13–14, 17, 18, 50,

64, 196, 205, 218, 224Neoplastic, 182Nephrectomy, 106, 160Neurilemmoma, malignant, 175Neuroendocrine neoplasms (NENs),

58–60


256 Index

Neuroendocrine tumours (carcinoids), 23, 46, 55, 214

WHO classifications, 58Nipple, 234

retraction, 91Nodal metastases, 11, 45, 71, 92, 95Nodal zones, 76Non-bulbar conjunctiva, 111Non-caruncular conjunctiva, 111Non-CML myelodysplastic syndrome, 184Non-Hodgkin lymphoma, 116–18, 167Non-invasive papillary, 106–7, 109Non-invasive verrucous carcinoma, 101Non-morular solid growth pattern, 97Non-mucinous adenocarcinomas, 55Non-neoplastic endometrial stroma, 96Non-peritoneal metastasis, 56Non-peritonealized pericolic/perirectal

tissue, 147, 194–5Non-peritonealized perimuscular

tissues, 55Non-regional lymph nodes, 102, 104Non-small cell lung carcinomas

(NSCLC), 222Non-squamous solid growth pattern, 97Non-transmural pericardium, 81Nose, 136

skin, 43N/pN classification, 8–10

and tumour deposits (satellites), 63–4Nuclear atypia, 97Nuclear pleomorphism, 24

Obturator lymph nodes, 95, 126–7, 164, 218

Occipital bone, 174Occipital nodes, 33, 35,141Ocular structures, 151Oedema

breast, 231skin, 90–1

Oesophageal drainage area, 119Oesophageal intraepithelial neoplasia,

202Oesophageal tumour resection, 47Oesophagectomy, 213Oesophagogastric junction, 46, 49, 119,

135, 142–3, 146

Oesophagojejunostomy, 20Oesophagoscopy, 70Oesophagus, 5, 19, 54, 70, 72, 119,

135, 137–9, 142–3, 146, 149, 172, 193–4, 203, 212–13

carcinoma, 12, 13, 24, 46–50, 202Omental metastases, 237Omentum, 54, 68, 99, 145, 209, 236–8Omohyoid muscle (surgical landmark),

34, 125‘One organ’, definition of, 5Ophthalmic tumours, 110–15, 127, 136

primary tumour, 165–7regional lymph nodes, 167

Ophthalmology, 113Optic nerve, 113–15

invasion, 114, 166Oral cavity, 5, 37, 135, 137, 211–12Oral squamous cell carcinoma, 24Orbit, 6, 38, 85, 110, 111, 113–14,

137, 151apex, 43, 139floor/medial wall, 43invasion of, 165–6sarcoma, 115, 166–7

Orbital bone, 115, 167Orbital soft tissues, 110, 115Orchiectomy, 160, 205Oropharynx, 4, 5, 38, 118, 137Osteosarcomas, 19, 174–5, 177, 230Ostium, 107Outer eye muscles, 113Ovarian endometriosis, 98Ovarian neoplasms, 98Ovarian primary tumours, 11,

208–9, 237Ovary, 4, 6, 7, 98–9, 126, 135, 157–9,

204, 206, 209, 237carcinoma, 8, 238

Overlapping lesions, 83–4

Paget disease of nipple, 89–90, 233Palate, 43Palatine bone, 174Palpable mobile multiple or bilateral

inguinal, 101Palpebral conjunctiva, 111, 165Pancoast tumour, 72


Index 257

Pancreas, 5, 19, 60, 67–9, 110, 117, 122–3, 135, 143, 145–6, 148, 164, 220–2

abdominal wall, 53carcinoma, 13, 24

Pancreatic cancer resections, 221Pancreatic endocrine tumours, 59Pancreatic neuroendocrine tumours, 68–9Pancreatic parenchyma, 221Pancreatic tail, 51Pancreatoduodenal lymph nodes, 120,

122, 187–8, 221Pancreaticolienal lymph nodes, 120Papilla of Vater, 68Papillary adenocarcinoma, 224Papillary carcinomas, 45, 208, 212Papillary serous adenocarcinoma, 237Papillary urothelial (transitional cell)

neoplasm of low malignant potential (PUNLMP), 107

Papules, 178–80Paraaortic lymph nodes, 52, 75, 95–6,

117, 123, 126–7, 220metastases, 199, 219, 241

Paracardial lymph nodes, 48, 120Paracaval lymph nodes, 127Paracervical lymph nodes, 95, 126Paraglottic pace, 40Paraglottis, 41Paralaryngeal lymph nodes, 119Parametrial invasion, 7Parametrial lymph nodes, 95–6, 126Parametrial soft tissue, 236Parametrium, 94–5, 235Paranasal sinuses, 38, 43, 110, 118, 135,

139, 165, 167, 208Paraoesophageal lymph nodes, 118–19,

123below carina, 75in diaphragmatic oesophageal hiatus,

52in lower thorax, 52in neck, 47

Parapharyngeal extension, 38Paraproctium, 62Parathyroid soft tissues, 193Paratracheal (anterior cervical) lymph nodes,

32, 33, 35, 118–19, 142, 212

Paravertebral fascia/muscles, 38Paravesical lymph nodes, 109Paravaginal tissue, 93Parenchymatous organs, 82Parietal bone, 174Parietal pericardium, 72, 223, 225Parietal peritoneum, 106Parietal pleura, 69, 73, 76, 79, 197Parotid fascia, 35Parotid gland, 4, 5Parotid nodes, 33, 35, 117Partial atelectasis, 69Patch, 178–80Pathological staging, 70

Hodgkin and non-Hodgkin lymphomas, 116, 167

Pathological vs clinical TNM, 203Peau d’orange, 231Pectoralis minor, 125Pectoralis muscle, 233Pedunculated polyp of sigmoid colon, 12Pelvic bone, 93, 156Pelvic endometriosis, 98Pelvix extension, 98–9, 101Pelvic lymph nodes, 85, 95–6, 117, 126–7

metastasis, 94, 162Pelvic lymphadenectomy, 135Pelvic peritoneum, 158Pelvic serosa, 95–6Pelvic side wall nodes, 218Pelvic wall, 93–5, 102, 107–8, 160–1Pelvis, 93, 96–100, 109, 127, 156–8,

164, 237frozen, 94–6, 103

Penis, 6, 7, 23, 83–4, 86, 101, 126, 136, 159, 161

Perforation, 219Perianal skin, 5, 6, 65, 124, 144, 178Periaortic lymph nodes, 122, 127Periappendiceal adipose tissue, 56Pericardial effusion, 70, 73, 76, 80, 149Pericardial fibrous tissue, 223, 225Pericardial pericardium, 223Pericardium, 46, 69, 142, 149, 223Pericaval lymph nodes, 122Pericholedochal lymph nodes, 120, 122Pericolic fat, 215–16Pericolic lymph nodes, 8, 63, 120–1


258 Index

Pericolorectal tissues, 62Peridiaphragmatic lymph nodes, 123Periductal growth, 219–20Periductal invasion, 65, 220Periduodenal artery, 66Periduodenal lymph nodes, 121Perifibromuscular connective tissue, 67Perigastric/greater curvature, 48Perigastric/lesser curvature, 48Perigastric lymph nodes, 52, 117–18,

120, 213Perihilar bile ducts, 67, 122Perihilar cholangiocarcinoma (Klatskin

tumour), 220Perihilar extrahepatic bile ducts, 66–7Perihilar fat, 105, 239Perimuscular invasion, 194–5Perimuscular tissue, 20, 66Perineal surgical skin scar, 63Perineum, 92Perineural invasion (Pn), 22, 63, 84–5,

151, 171Perineural spaces, 7Perinodal tumour, 8Perioesophageal fatty tissue, 212–13Perioesophageal lymph nodes, 213Perioesophageal soft tissue, 47Periorbital structures, 115, 167Periosteum, 167, 198Peripancreatic artery, 66Peripancreatic lymph nodes, 120–1, 221Peripancreatic soft tissues, 146, 221Peripancreatic spread, 69Perinephric fat, 105–6, 160Perinephric veins, 105Periosteum, 115Periparotid lymph nodes, 119Peripelvic fatty tissue, 106, 239–40Peripheral adenocarcinoma, 229Peripheral blood lymphocytes, 180Peripheral lymph nodes, 180–1Peripheral zone, 119Perirectal lymph nodes, 63, 65, 219Periportal lymph nodes, 121Perirectal lymph nodes, 121Perirectal-pelvic lymphadenectomy, 135Perithyroidal lymph nodes, 35Peritoneal cavity, 11, 204, 215–16

tumour extension into, 62Peritoneal fluid, 95Peritoneal implants, 237Peritoneal mesotheliomas, 209Peritoneal metastasis, 98–100, 157–8,

204, 237Peritoneal reflection, 217Peritoneal serosa, 217Peritoneal spread, 95Peritoneal washing, 11, 98–100, 157,

204–5Peritoneum, 16, 57, 58, 62, 68, 81, 149

invasion, 106, 108primary neoplasms, 208–9

Peritumoural deposits, 63Peritumoural nodule, 56Periurethral muscle, 109Perivesical pelvic lymph nodes, 127PET (positron emission tomography),

70, 226for staging, 76

Pharynx, 38, 118, 135, 205Philadelphia chromosome, 184Phrenic nerves, 47, 72, 75Placental site trophoblastic tumour, 100Plaques, 178–80Platelet count, 183Pleura, 5, 46, 70, 142Pleural aspiration, 70Pleural connective tissue, 196Pleural effusions, 11, 73, 76, 80Pleural membane, invasion of, 222Pleural mesothelioma, 24, 80–1, 123,

149–50Pleural space, 74Pleural tumours, 69–81

primary tumours, 148–9regional lymph nodes, 149–50

Pleural washing, 11, 205Plexus pampiniformis, 105Plica, 165pM (distant metastasis), 1–2, 9–13,

70, 134, 176, 179. 187, 189, 205–7

pM0, 10, 21, 207pM1, 2–3, 9, 11, 13, 53, 70–1, 115, 134,

204, 206–7, 209, 213–14, 219–21, 224, 227, 236, 241


Index 259

pMX, 10, 207pN (lymph nodes) classification, 1–2,

8–9, 12–13, 36, 63–4, 91–2, 106, 134–7, 139–41, 143, 145–7, 149, 151–5, 157–9, 161, 163–5, 167–9, 173, 176, 179, 187, 195–6, 205–6, 227, 234

pathological assessment, 134Pn (perineural invasion), 22Pneumonectomy, 73, 149Pneumonia, 224pN0 (absence of regional lymph node

metastasis), 1, 8–10, 53, 70, 73, 80, 88–9, 134–6, 140, 149–50, 162, 167, 178–9, 195–6, 207, 211, 227–8, 232, 234

pNX, 10–11, 13, 54, 207, 211, 227Polymerase chain reaction (PCR), 89Polypoid, 109Popliteal lymph nodes, 178Portal vein, 65–7, 121–2, 144–5Positive cytology, 80, 149, 204–5, 235Positive lavage cytology, 11, 62, 204–5Positive lymph nodes, 8, 22Posterior bony wall maxillary sinus, 43Posterior caecal lymph nodes, 120Posterior mediastinal lymph nodes, 48Posterior pancreatoduodenal lymph

nodes, 122Posterior caecal lymph nodes, 120Posterior eyelid lamella, 165Posterior triangle group, 34, 118–19Posterolateral neck dissection, 141Postricoid area, 40Post-surgical histopathological

classification, 70Pouch of Douglas, 95Preaortic lymph nodes, 127Preauricular lymph nodes, 3, 127,

175, 178Precaval lymph nodes, 127Precricoid lymph nodes, 35Pre-epiglottic space, 38, 40Preinvasive carcinoma, 92Pregnancy, 101Prelaryngeal (anterior cervical) nodes, 32,

33, 35, 118–19, 142Prelaryngeal strap muscles, 137

Preneoplastic lesions, 58Pre-operative neoadjuvant therapy, 64Prepuce, 83–4Prerenal fascia, 106Presacral fascia, 63Presacral lymph nodes, 95, 121,

126–7, 164PRETEXT system (pretreatment extension)

of Liver Tumour Study Group of International Society for Paediatric Oncology (SIOPEL), 186

Pretracheal lymph nodes, 5, 74, 142Pre-vascular lymph nodes, 74, 119, 123Prevertebral fascia, 40, 41, 45, 137, 139Prevertebral space, 138–9Primary adenocarcinoma of RUL of

lung, 223Primary cutaneous lymphomas, 171, 177Primary extranodal lymphomas, 118Primary gastric lymphomas, 117Primary liver carcinoma in infants and

children, 171, 186–8Primary peritoneal adenocarcinomas, 98Primary peritoneal carcinoma, 208Primary peritoneal neoplasms, 208–9Primary retinoblastoma, 166Prognostic grouping, 12

adenocarcinoma, 50prostate, 104squamous cell carcinoma, 49

Promomtory (Gerota’s) lymph nodes, 127Prostate, 6, 23, 102–4, 109, 127, 136,

161–3, 199, 238–9adenocarcinoma, 159–60carcinoma, 9, 11, 23, 102–3

perineural spread, 238transitional cell carcinoma, 161

Prostate stroma, 107–8, 160Prostatectomy, 103, 159, 238Prostatic capsule, 102, 109Prostatic ducts, 108–9Prostatic stroma, 109, 160Prostatic urethra, 103, 108–9Proximal mesenteric lymph nodes, 122Proximal splenic artery lymph nodes, 51PSA grading, 104Pseudotumour lesions, 58Pseudomyxoma peritonei, 56


260 Index

pT (primary tumour), 1–2, 6–7, 10, 12, 36, 63, 70, 85, 87–8, 90–1, 96, 102–3, 105,–6, 134–7, 139, 173, 176, 179, 187, 194–5, 212, 224, 229, 233, 240

adrenal cortex tumours, 164bone and soft tissues tumours, 150–1breast tumours, 154gynaecological tumours, 156–8lung and pleural tumours, 148–9digestive system tumours, 142–6head and neck tumours, 136–40ophthalmic tumours, 165–7pathological assessment, 134skin tumours, 151–2urological tumours, 159–61

Pterygoid fossa, 43, 167Pterygoid plates, 37, 38, 43, 137–9Pterygoid plexus, 31, 212pTNM (pathological classification of TNM),

1–3, 12, 14, 18, 20–1, 47, 70, 173, 176, 179, 187, 203, 233, 235

Pulmonary ligament lymph nodes, 48, 119, 123

Pulmonary artery, 72, 75, 224Pyloric lymph nodes, 120, 122

R (residual tumour) classification, 7, 11, 14–17, 21, 25, 48, 79, 196, 199, 203–5, 217, 219, 233

R0 classification, 3, 14–17, 21, 79–80, 150, 195–6, 203–4, 217, 219, 229

R1 classification, 3, 11, 14–17, 21, 74, 79–80, 196, 204–5, 229, 233

R2 classification, 14, 15, 80, 204Radiotherapy, 3, 18, 96, 193, 199Ramus of mandible, 31, 212Rectal adenocarcinoma, 218Rectal carcinoma, 22, 63, 194, 210, 216–17

pathogram, 21Rectal mucinous adenocarcinoma, 218Rectal mucosa, 156–7Rectal tumour, 61Rectal wall, 94–6, 144Rectosigmoid, 172

lymph nodes, 7, 121pericolic fat, 237–8tumour, 61

Rectum, 5, 6, 19, 54, 57, 61–3, 93, 102, 121, 135, 142, 144, 160, 172, 205, 214–19

anatomical sites, 61cancer, 16, 219local recurrence, 62mucosa, 97regional lymph nodes, 62, 147–8telescopic ramification, 194–6

Recurrent laryngeal nerve, 139, 149Recurrent nerves, 47Recurrent (r) tumour, 20, 210Regional lymph nodes, 7–9, 31–6, 102,

116, 118, 120, 124, 136, 178, 202, 209, 213–15, 218–19

adrenal cortex tumours, 164bone and soft tissue tumours, 150–1breast tumours, 154–6cranial and facial bones, 175cutaneous T-cell lymphoma, 178digestive system tumours, 146–8gastroinstestinal sarcomas, 172gynaecological tumours, 158–9head and neck tumours, 140–2lung and pleural tumours, 149–50metastasis, 1, 8, 9, 11–12, 44, 60,

64, 70, 96, 98–100, 105, 114, 140–1, 146–8, 152–4, 158–9, 163–4, 175, 187, 198, 210, 216, 237, 241

ophthalmic tumours, 167pathological assessment, 134primary liver carcinoma in infants and

children/hepatoblastoma, 187skin tumours, 152–4urological tumours, 161–4

Renal cell carcinoma, 239–40Renal fascia, 106Renal hilar lymph nodes, 127Renal parenchyma, 240Renal pelvis, 6, 106–7, 127, 136, 160,

162–3, 240carcinoma, 4, 23, 107

Renal vein(s), 105–6, 121, 188, 239Resection

definitions of completeness, 17specimens, 7uncertain, 17


Index 261

Residual tumour (R) classification, 14–17, 204

Rete testis, 105Retina, 6Retinal detachment, 113Retinoblastoma, 24, 113–15, 166Retroaortic lymph nodes, 127Retroauricular (mastoid, posterior

auricular) nodes, 33, 35, 141Retrocaval lymph nodes, 127Retropancreatic lymph nodes, 53Retroperitoneal lymph nodes, 127Retroperitoneal soft tissue, 68

sarcoma, 7Retroperitoneum, 5, 53, 55, 60, 143, 219Retropharyngeal lymph nodes, 33, 35, 38,

118–19, 141–2Retrorenal fascia, 106Retrotracheal lymph nodes, 74, 119, 123Retrovascular lymph nodes, 123Rhabdomyosarcoma of soft tissue, 24Ribs, 81, 149, 197, 233Right colic lymph nodes, 120–1Right gastric artery, 51Right gastroepiploic artery, 51Right liver, 121, 220Right paratracheal lymph nodes, 74Rnyometrium, 95Rules for classification

chronic myeloid leukaemia, 182–3cranial and facial bones, 174cutaneous T-cell lymphoma, 178gastroinstestinal sarcomas, 172primary liver carcinoma in infants and

children/hepatoblastoma, 186–7RX, 14, 17, 79, 204

Sacculus larynges, 42Sacral lymph nodes, 95, 127Sacral promontory, 61St. Jude Staging System for Paediatric

Lymphoid Malignancy, 185Salivary glands, 44, 119, 135Sarcomas, 5, 7, 12, 19, 24, 69, 81–3, 95,

97–9, 115, 126, 157, 166Satellite skin nodules, 90Scalene lymph nodes, 73, 80–1, 123Scalp, 178

Scars, 17Sclera, 113Scrotum, 6, 86, 104, 178

invasion, 105, 160surgery, 127

Sebaceous carcinoma, 85Sebaceous glands, 87Second-order biliary radicals, 67, 145SEER Program of National Cancer Institute,

5, 61, 172, 206Segmental bronchi, 76, 119, 123Segmentectomy, 73Seminal vesicles, 107–8, 160, 240

invasion, 108Sentinel lymph node, 10, 14, 89,

210–11, 234biopsy, 90–2, 154–5

Serosa, 53, 56, 59–60, 63, 66, 96, 99, 144, 214, 216, 236

perforation of, 243scraping of, 7, 62

Serum albumin, 185–6Serum ß2-microglobulin, 185–6Serum lactic dehydrogenase (LDH), 86Sézary cells, 181Sézary Syndrome, 171, 177, 180–2Short gastric arteries (perigastric area), 51Shoulder, 39, 124, 178Siewert’s carcinoma, 46Sigmoid colon, 121

carcinoma, 7, 8, 61, 63, 215–16, 238pedunculated polyp, 12

Sigmoid lymph nodes, 121Simultaneous tumours, 206Signet ring cell carcinoma of gastric

antrum, 53, 214, 224Single palpable mobile unilateral

inguinal, 101Single tumour cells, 206Sinuses, 111, 166Skeletal muscle, 88, 152Skin, 5

biopsies, 91, 178carcinoma, 83–5, 135, 151–3, 230

of eyelid and neck, 4, 83, 153of trunk and arm, 4

dimpling, 91lesions, 178


262 Index

Skin (cont’d )malignant melanoma, 13, 24, 64,

83, 135Merkel cell carcinoma, 135microscopic invasion, 91nodules, 89of nose/cheek, 43oedema, 90–1primary tumours, 151–2regional lymph nodes, 152–4tumours, 83–9, 124ulceration, 89–90, 231

Skip metastasis, 10, 47Skull, 44, 174

base, 38, 85, 137, 139, 151, 211Small bowel carcinoid tumours, 59–60Small cell carcinoma, 24, 69, 76–7, 222Small cell lung cancer (SCLC), 76–7, 222Small intestine (jejunum), 5, 7, 53, 54,

55, 108, 120, 135, 142–3, 147, 172

carcinoid tumours, 147Soft tissue tumours, 19, 81–3, 123, 198

peripheral, 5primary tumours, 150–1regional lymph nodes, 151sarcoma, 12, 227

Sonography, 3, 113, 203Southern blot analysis, 181Spermatic cord, 104, 239

invasion, 105Spermatic fascia, 105Spermatic vein lymph nodes, 127Sphenoid bone, 174Sphenoid /frontal sinus, 43, 138

tumours, 208Sphincter muscles, 65, 144, 218Sphincter of Oddi, 68Spinal accessory nerve, 31, 34–5,

118–19, 141Spinal canal, 72Spine, 81, 149Spleen, 53, 101, 123, 143, 167, 181Splenectomy, 116Splenic artery, 118, 120–2

distal to pancreatic tail, 51Splenic flexure, 121Splenic hilum, 47, 122

Splenomegaly, 184Splitters, 192Spontaneous rupture, 209Squamous cell carcinoma, 22, 24, 48, 50,

64, 85, 203, 205, 208, 235Stage grouping, 12–14

adrenal cortex tumours, 110bone sarcoma, 81–2chronic myeloid leukaemia, 183–4cranial and facial bones, 176cutaneous T-cell lymphoma, 179digestive system tumours, 48–9, 54–5,

56–7, 66gastroinstestinal sarcomas, 172head and neck tumours, 42, 45kidney, 106Merkel cell carcinoma, 89prostate, 103–4soft tissue sarcoma, 83synchronous primary malignant

melanomas, 87–8visceral arcomas, 173

Stagingsymbols for methods, 22of tumours without TNM classification,

22–3Standardized Uptake Value (SUVmax), 77Stellate ganglion, 72Stenosis, 12Sternal notch nodes, 74, 119, 123Sternocleidomastoid muscle, 34Sternohyoid muscle, 34Sternocleidomastoid muscle, 34–5, 141Sternothyroid muscle, 193Sternum, 74, 125Stomach, 5, 6, 19, 46, 117, 120, 135,

142–3, 145–6, 172, 205, 213–14anatomy, 50cancer, 16carcinoma, 24, 46, 53regional lymph nodes, 51–2

Strap muscles, 40,138Stromal invasion, 92Stromal reaction, 9Subaortic aortopulmonary lymph nodes,

48–50, 75, 119Subcapsular sinus, 232Subcardial carcinoma of stomach, 46


Index 263

Subcarinal lymph nodes, 48, 70, 73, 75, 79, 81, 119, 123, 135, 149–50, 227

Subclavian vessels, 72, 126Suclavicular lymph nodes, 125Subcutaneous fat, 137Subcutaneous perianal tissue, 65Subcutaneous tissues, 43, 87, 88, 139, 144Subepithelial connective tissue (tunica

mucosa), 67, 101, 106–9Subglottic space, 42Subglottis, 41, 138Sublobar resections, 73Sublingual gland, 5, 37Submandibular gland, 4, 5, 37Submandibular (submaxillary) nodes, 31,

32, 34, 118–19, 124, 127, 175, 178Submaxillary gland, 5Submental nodes, 31, 32, 34, 118–19Submucosa, 10, 20, 47, 53, 55–6, 59–60,

62, 85, 206, 209–10, 215Suboccipital nodes, 141Subphrenic artery, 52Subpleural adenoca, 225Subpleural lung parenchyma, 79, 196Subretinal fluid, 113Subretinal seeding, 113–14Subserosa, 53, 55, 56, 58–60, 62, 64,

147, 194–5, 215Subsegmental bronchi, 76, 119–20, 123Substantia propria, 111Superficial parotid nodes, 35Superior mediastinal lymph nodes, 45,

119, 142Superior mesenteric artery, 145–6, 221Superior mesenteric lymph nodes, 7, 66,

68, 120, 122Superior rectal (haemorrhoidal) lymph

nodes, 7, 61, 121Superior sulcus of lung, 72Superior vena cava, 72, 74, 224Supraclavicular lymph nodes, 31, 32,

34–5, 38, 47, 73–4, 80, 89, 91, 95, 118–19, 123–7, 141, 150, 181, 213–14

Supradiaphragmatic lymph nodes, 52Supraglottis, 40, 41Suprahepatic lymph nodes, 187–8Supraomohyoid dissection, 141

Suprapyloric at splenic hilum, 47Suprazygomatic MS, 30, 211Surface/juxtacortical osteosarcoma, 81Sympathetic nerves, 47Synchronous bilateral tumours, 105Synchronous primary malignant

melanomas, 87–8Synchronous primary tumours, 10, 106,

205–6, 223

T-cell, 181T classification, 2–4, 6–8, 11–13, 20, 22,

25, 36–7, 42, 44–5, 48–50, 53, 55, 57–8, 60, 62–5, 69, 78–9, 82–3, 85–6, 89, 91–2, 95–7, 103–4, 106–8, 110, 134, 159, 171–84, 187–8, 192–3, 197–8, 200, 203–4, 206–9, 212, 215, 217, 219–20, 222–7, 229–30, 233–7, 239–41

cutaneous T-cell lymphoma, 178–9digestive system tumours, 53gastroinstestinal sarcomas, 172gynaecological tumours, 96head and neck tumours 36kidneys, 106lung and pleural tumours, 71–3primary liver carcinoma in infants and

children/hepatoblastoma, 187T0 classification, 13, 22, 172, 175, 178,

187, 205, 215, 232T1 classification, 11, 25, 37–8, 40–6, 49,

53–60, 62, 64–9, 72, 81–2, 85–6, 88–9, 91, 93–113, 115, 172–3, 175–6, 178–80, 183–4, 187–8, 193, 198, 209, 215, 222, 225–6, 230, 233

T2 classification, 3–4, 10, 37–47, 49, 53–60, 62, 64–9, 71, 81–2, 85, 88–9, 91–102, 105–13, 115, 172–3, 175–6, 178–80, 183–4, 187–8, 198, 208–9, 221–2, 225–6, 228–31, 233, 235

T3 classification, 4, 37–46, 49, 53–60, 62, 65–9, 71–3, 78–9, 81–2, 85, 88–9, 91, 93–103, 105–7, 109–15, 158, 175–6, 179–80, 183–4, 187–8, 193, 195, 197, 215–21, 223, 225–6, 230, 237, 240


264 Index

Tarsal conjunctiva, 165Tarsal plate, 86Telescopic ramification

bone and soft tissues, 198colon and rectum, 194–6digestive system tumours, 193–6gynaecological tumours, 198–9head and neck tumours, 193lung tumours, 196–8urological tumours, 199

Temporal bone, 85, 174Temporal fossa, 167Temporalis muscle, 30, 211Tendon, 125Testicular tumour, 239Testis, 6, 7, 104–5, 127, 136, 160,

162–3, 209biopsy, 160malignant tumours, 24

Thoracal lymph nodes, 48Thoracic vertebrae, 124Thoracocentesis, 70Thoracotomy, 76, 79, 198, 229Thorax, 124, 203Thrombocytosis, 184Thymus, 225Thyroid, 5, 35, 45, 119, 135,

137–40, 212carcinoma, 11, 24cartilage, 138, 212tumours, 193

Thyroidal (perithyroidal), 35Thyroidectomy, 11TNM classification

7th edn, 22–3, 47, 57, 59, 78–9, 82–3, 89, 94, 97–8, 103–4, 118, 134, 140, 171–2, 188, 197, 206–9, 212–16, 222, 230–3, 238–9

additional descriptors, 18–24clinical and pathological classifications,

6–17, 172–3general rules of system, 1–6

new classifications, 171–89telescopic ramification, 192–9

TNM Prognostic Factors Core Group, UICC, 172

Tongue, 37, 137–8Total Mesorectal Excision (TME), 195–6Trachea, 13, 40, 46, 70, 72, 74–5, 117,

138–9, 143, 149, 212carcinoma, 208

Tracheobronchial (hilar) lymph nodes, 48, 117

Tracheo-oesophageal (posterior mediastinal) nodes, 36

Transmural pericardium, 81Transitional cell carcinoma of prostate,

161, 238Transrectal ultrasonography, 239Transurethral resection (TUR), 103,

108, 161Transverse cervical artery, 35Transverse colon, 4, 53, 121, 143Transversus linguae, 37Trapezius muscle, 35Trochanter, 124Truncus coeliacus, 69Trunk, 178Tubular adenoma, 12Tumour

cells in lymphatics, 209definition, 179deposits (satellites) (TDs), 8, 63–4, 216foci, 235regression, 64thrombus, 215ulceration, 86

Tumour-like lesions (TLL), 58Tumour spillage during surgery, 7, 209Tunica albuginea, 104–5Tunica mucosa, 67Tunica muscularis, 67Tunica vaginalis, 104, 239TX, 11, 13, 172, 175, 178, 187,

205, 215

Ulceration, 86–7, 89–90, 93, 152, 231, 234

Ultrasound (u), 22, 70, 230, 239Uncertain resection, 80Undifferentiated carcinoma, 24, 227Unilateral inguinal lymph nodes, 65, 148Unilateral internal iliac, 65, 148


Index 265

Unilateral second-order biliary radicals, 67

United Kingdom, 16United States, 16University of Erlangen, Germany, 189University of Jena, Germany, 189Unknown primary, 210Unresected metastases, 204Upper aerodigestive tract, 135, 140

malignant melanoma, 24, 43–4, 139Upper anterior mediastinal nodes, 36Upper jugular group, 34, 119Upper limb, 124Upper lobectomy, 228Upper paraoesophageal lymph

nodes, 48Upper paratracheal lymph nodes, 47, 74,

119, 123Upper (superior) mediastinal lymph nodes,

36, 119Urachus, carcinoma of, 208Ureter, 4, 6, 7, 23, 106–8, 127, 136, 160,

162–3, 240Ureterosigmoidostomy, 108Urethra, 4, 6, 23, 92–3, 101, 103, 109,

127, 136, 144, 156, 159, 161–2, 164, 240

Urethral diverticular carcinoma, 109Urimary ßhCG, 101Urinary bladder, 4, 6, 107–9, 127, 136,

160, 162, 164carcinoma, 23, 107–8

Urological tumours, 199, 238–9primary tumours, 159–61regional lymph nodes, 161–4

Urothelial (transitional cell) carcinoma of prostate (prostatic urethra), 109, 240–1

Uterine cavity, 96Uterine cervix, 7Uterine corpus tumour, 235Uterine sarcomas, 24, 95, 97–8,

126, 157Uterus, 94, 97–100, 107–8, 126,

157–8, 160Uvea, 6

malignant melanoma, 24, 111–13, 166

V (venous invasion) classification, 7, 21, 25, 77, 209, 232

Vagina, 6, 63, 92–6, 107–8, 126, 135, 144, 156, 158–60

Vaginal carcinoma, 93–4Vaginal wall, 93Vagus nerve, 72Vallecula, 137Vascular invasion, 65–6, 76, 104Veins, 7Vena azygos, 47Vena cava, 47, 72, 105–6Venous invasion, 7, 8, 21, 63, 194,

215, 232Vermilion surface (of lip), 37Verrucous (squamous cell) carcinoma,

84, 109Vertebral body, 46, 70, 72, 143, 149Verticalis linguae, 37Vessel wall, invasion of, 211Video-assisted thoracoscopy, 70Viscera, 11Visceral pericardium, 72Visceral peritoneum, 53, 55, 56, 59–60,

62, 65–6, 143–5, 219perforated, 215

Visceral pleura, 71, 76, 81, 226, 228–9

invasion (VPI), 78–9, 196–8, 222Visceral serosa, penetration of, 6Vitreous seeding, 113–14Vocal cord fixation (impaired vocal cord

mobility), 40, 212carcinoma, 42pathological criteria, 42

Vocal cord paralysis, 72Vomer, 174Vulva, 6, 83–4, 86, 92–3, 126, 135,

156, 158carcinoma, 93

Well-differentiated endocrine tumours (WDET), 58

Well-differentiated neuroendocrine carcinomas, 59–60

Well-differentiated neuroendocrine tumours, 59–60


266 Index

White blood cells, 185World Health Organization and European

Organization of Research and Treatment of Cancer (WHO-EORTC), 177

World Health Organization International Histological Classification of Tumours, 23, 24, 58, 107

X classification, 3, 11

ypTNM classification, 14, 18, 64ypT0N0M0, 18ypTisN0M0, 18

Zygomatic arch, 30, 211Zygomatic bone, 174


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