PNET Ewing 4.1.1.1.REL CAPCP R

Protocol for the Examination of Resection Specimens From
Pediatric Patients With Ewing Sarcoma

Version: 4.1.1.1
Protocol Posting Date: September 2022
The use of this protocol is recommended for clinical care purposes but is not required for accreditation
purposes.
This protocol should be used for the following procedures AND tumor types:
Procedure Description
Resection Includes specimens designated resection, amputation, limb salvage procedure,
or other
Tumor Type Description
Ewing sarcoma Includes pediatric patients with osseous and extraosseous Ewing sarcoma
family of tumors
The following should NOT be reported using this protocol:

Procedure
Needle, incisional or skin biopsies (consider Pediatric Ewing Sarcoma Biopsy protocol)
Tumor Type
Adult Ewing sarcoma# (consider using Bone or Soft Tissue protocols)
Round cell sarcoma with EWSR1-non-ETS fusions, CIC-rearranged sarcoma, or sarcoma with BCOR-genetic
alterations (consider using Bone or Soft Tissue protocols)
#
Ewing sarcoma in adults may be treated differently than pediatric Ewing sarcoma and use of the AJCC TNM staging system
remains appropriate for adult patients.
Authors
Jessica L. Davis, MD*; Archana Shenoy, MD; Lea Surrey, MD; Alyaa Al-Ibraheemi, MD; Katherine A.
Janeway, MD; Elyssa Rubin, MD; Erin R. Rudzinski, MD.
With guidance from the CAP Cancer and CAP Pathology Electronic Reporting Committees.
* Denotes primary author.
Accreditation Requirements
The use of this case summary is recommended for clinical care purposes but is not required for
accreditation purposes. The core and conditional data elements are routinely reported. Non-core data
elements are indicated with a plus sign (+) to allow for reporting information that may be of clinical value.
© 2022 College of American Pathologists (CAP). All rights reserved. For Terms of Use please visit www.cap.org/cancerprotocols . 1
Replaced by version 5.0.0.0 on September 20, 2023, Obsolete as of June 2024 (8 months after newest release date)
CAP Approved PNET_Ewing_4.1.1.1.REL_CAPCP
_R
Summary of Changes
v 4.1.1.1
• Corrected spelling error and format in cover page
• The 'Expert Consultation' question was made optional
• Added Explanatory ‘Note A’ and associated with the ‘Expert Consultation’ question
2
Reporting Template
Protocol Posting Date: September 2022
Select a single response unless otherwise indicated.
CASE SUMMARY: (EWING SARCOMA: Resection)
EXPERT CONSULTATION
+Expert Consultation (Note A)

___ Pending - Completion of this CAP Cancer Protocol is awaiting expert consultation
___ Completed - This CAP Cancer Protocol or some elements have been performed following expert
consultation
___ Not applicable
CLINICAL
Preresection Treatment (select all that apply)

___ No known preresection therapy
___ Chemotherapy performed
___ Radiation therapy performed
___ Therapy performed, type not specified
___ Not specified
SPECIMEN (Note B)
Procedure (Note C)
___ Resection
___ Amputation (specify type): _________________
___ Limb salvage procedure (specify type): _________________
___ Other (specify): _________________
___ Not specified
TUMOR
Multiple Primary Sites

___ Not applicable
___ Present: _________________
Please complete a separate checklist for each primary site
Tumor Site
___ Osseous
___ Long bones of upper limb, scapula and associated joints (specify): _________________
___ Short bones of upper limb and associated joints (specify): _________________
___ Long bones of lower limb and associated joints (specify): _________________
___ Short bones of lower limb and associated joints (specify): _________________
___ Overlapping lesion of bones, joints and articular cartilage of limbs (specify): _________________
___ Bone of limb, NOS (specify): _________________
3
___ Bones of skull and face and associated joints (excluding mandible C41.1) (specify):
_________________
___ Mandible (specify): _________________
___ Vertebral column (excluding sacrum and coccyx C41.4) (specify): _________________
___ Rib, sternum, clavicle and associated joints (specify): _________________
___ Pelvic bones, sacrum, coccyx and associated joints (specify): _________________
___ Overlapping lesion of bones, joints and articular cartilage (specify): _________________
___ Bone, NOS: _________________
___ Extraosseous
___ Heart / mediastinum
___ Heart (specify): _________________
___ Anterior mediastinum (specify): _________________
___ Posterior mediastinum (specify): _________________
___ Mediastinum, NOS: _________________
___ Overlapping lesion of heart, mediastinum and pleura (specify): _________________
___ Peritoneum and / or retroperitoneum
___ Retroperitoneum: _________________
___ Peritoneum, including omentum and mesentery (specify parts): _________________
___ Peritoneum, NOS: _________________
___ Other soft tissue
___ Head, face, and neck (specify): _________________
___ Upper limb and shoulder (specify): _________________
___ Lower limb and hip (specify): _________________
___ Thorax (specify): _________________
___ Abdomen (specify): _________________
___ Pelvis (specify): _________________
___ Trunk (specify): _________________
___ Overlapping lesion (specify): _________________
___ Other, NOS: _________________
___ Not specified
Tumor Size (Note C)

___ Greatest dimension in Centimeters (cm): _________________ cm
+Additional Dimension in Centimeters (cm): ____ x ____ cm
___ Cannot be determined (explain): _________________
Site(s) Involved by Direct Tumor Extension (select all that apply)

___ Epiphysis or apophysis
___ Metaphysis
___ Diaphysis
___ Cortex
___ Medullary cavity
___ Surface
___ Joint
___ Adjacent soft tissue: _________________
___ Other (specify): _________________
___ Cannot be determined: _________________
4
Lymphovascular Invasion (Note D)

___ Not identified
___ Present
Treatment Effect (Note E)

Treatment effect includes necrosis, fibrosis and other treatment related changes.
___ Not applicable (no preresection therapy)
___ Not identified
___ Present
Percentage of Treatment Effect
___ Specify percentage: _________________ %
___ Other (specify): _________________
___ Cannot be determined
+Tumor Comment: _________________
MARGINS (Note F)
Margin Status
___ All margins negative for tumor
Closest Margin(s) to Tumor (select all that apply)
___ Bone (specify): _________________
___ Soft tissue (specify): _________________
___ Parenchymal (specify): _________________
___ Other (specify): _________________
Distance from Tumor to Closest Margin
Specify in Centimeters (cm)
___ Exact distance: _________________ cm
___ Greater than: _________________ cm
___ Other (specify): _________________
___ Tumor present at margin
Margin(s) Involved by Tumor
___ Specify involved margin(s): _________________
+Margin Comment: _________________
5
REGIONAL LYMPH NODES
Regional Lymph Node Status

___ Not applicable (no regional lymph nodes submitted or found)
___ Regional lymph nodes present
___ All regional lymph nodes negative for tumor
___ Tumor present in regional lymph node(s)
Number of Lymph Nodes with Tumor
___ Exact number (specify): _________________
___ At least (specify): _________________
___ Other (specify): _________________
___ Other (specify): _________________
Number of Lymph Nodes Examined
___ Exact number: _________________
___ At least (specify): _________________
___ Other (specify): _________________
___ Number cannot be determined (explain): _________________
+Regional Lymph Node Comment: _________________
DISTANT METASTASIS
Distant Site(s) Involved, if applicable# (select all that apply)

___ Not applicable
___ Lung: _________________
___ Bone: _________________
___ Other (specify): _________________
PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition) (Note G)

The AJCC staging systems for bone and soft tissue based tumors may be used for pathologic staging if desired.
SPECIAL STUDIES (Note H)

Results of these studies may not be available at the time of the final report
+Immunohistochemistry (specify): _________________
Cytogenetic Findings
___ Not performed
___ Pending
___ EWSR1 rearrangement, fusion partner not known
___ EWSR1-FLI1 gene rearrangement
___ EWSR1-ERG gene rearrangement
___ Other EWSR1 gene rearrangement (specify): _________________
___ Non-EWSR1 variant translocation (specify): _________________
6
___ Other (specify): _________________

___ No rearrangement identified
___ Not known
Method for Cytogenetic Studies

___ Not applicable (Cytogenetic Studies not performed)
___ Conventional karyotyping
___ Fluorescent in situ hybridization (FISH)
___ Reverse transcriptase polymerase chain reaction (RT-PCR)
___ Other (specify): _________________
___ Not known
ADDITIONAL FINDINGS
+Additional Findings (specify): _________________
COMMENTS
Comment(s): _________________
7
Explanatory Notes
A. Expert Consultation
Expert consultation is not required. This question has been added to annotate, if so desired, that the case
has been sent out for consultation and thus items of the CAP protocol could not be completed pending
expert consultation. Completion of the CAP protocol will then be performed following consultation.
B. Tissue Handling
Tissue specimens optimally are received fresh/unfixed because of the importance of ancillary studies,
such as cytogenetics and molecular testing, which may prefer fresh tissue. First priority should always be
given to formalin-fixed tissues (FFPE) for morphologic evaluation. Ideally, some tissue can be submitted
for FPPE without decalcification or following decalcification in EDTA or ETDA+acid decalcification
solutions to preserve nucleic acids for molecular testing, to including FISH, RT-PCR, and/or next
generation sequencing (NGS). Decalcification in pure acid decalcification solutions degrade nucleic acids
and limit molecular testing. Following submission of FFPE, submission of fresh tissue for cytogenetics
and/or snap freezing a minimum of 100 mg of viable tumor may be needed potential molecular studies
and/or COG study purposes.1 Molecular testing on formalin-fixed paraffin-embedded tissue may be
performed for FISH evaluation of EWSR1 rearrangement, for RT-PCR evaluation of EWSR1-FLI1,
EWSR1-ERG, and other ES translocations, or NGS. When the amount of tissue is limited, the pathologist
can keep the frozen tissue aliquot used for frozen section (usually done to determine sample adequacy
and viability) in a frozen state (-70°C is preferable). Translocations may be detected using RT-PCR on
frozen or fixed paraffin-embedded tissue, or FISH on touch preparations made from fresh tissue or
formalin-fixed paraffin-embedded tissue.
Note that classification of many subtypes of sarcoma is not always dependent upon special studies, such
as cytogenetics or molecular genetics, but frozen tissue may be required to enter patients into treatment
protocols. Discretion should be used in triaging tissue from sarcomas. Adequate tissue should be
submitted for conventional light microscopy before tissue has been taken for cytogenetics, electron
microscopy, or molecular analysis.
References
1. Qualman SJ, Morotti RA. Risk assignment in pediatric soft-tissue sarcoma: an evolving molecular
classification. Curr Oncol Rep. 2002;4:123-130.
C. Procedures
Tumor Resection
Resection specimens may be intralesional, marginal, wide, or radical in extent.1 Intralesional resections
extend through tumor planes, with gross or microscopic residual tumor identifiable at surgical margins. A
marginal resection involves a margin formed by reactive tissue surrounding the tumor. A wide radical
resection has surgical margins that extend through normal tissue, usually external to the anatomic
compartment containing the tumor. For all types of resections, marking (tattoo with ink followed by use of
a mordant) and orientation of the specimen (prior to cutting) by the surgeon are highly recommended for
accurate pathologic evaluation.2 Full representative mapping of the specimen is also recommended,2 as
discussed below.
A full sagittal section of a bone tumor resection specimen,3 as illustrated in Figure 1, allows for mapping
of the entire central face of the tumor and adjacent marginal tissue. Sectioning the specimen in a
8
longitudinal plane that allows for evaluation of the tumor in its greatest cross-sectional dimension is
important. Soft tissue and bone marrow margins should be inked and taken prior to sectioning the
specimen with both amputation and limb salvage specimens. Freezing of the specimen prior to cutting
with a bone saw (with intraosseous specimens) is the preferred method at some institutions. This face of
the specimen should be documented using digital imaging photography or alternatively by a photocopy of
the specimen when sealed in a plastic bag. As shown in Figure 1 of an amputation specimen with soft
tissue in place, the central full face of the specimen and lesional region can be mapped and blocked
following fixation and with adequate decalcification for complete microscopic examination, including
estimate of percentage of tumor necrosis. If possible, at least one section of tumor without decalcification
or decalcification with less harsh decalcification methods to include EDTA or ETDA+formic acid is
recommended to preserve integrity of nuclei acids.
Figure 1. Grid diagram of histologic sections taken, superimposed on photograph of a sagittally-sectioned amputation
specimen including the distal femur and proximal tibia.
References
1. Conrad EU, Bradford L, Chonsky HA. Pediatric soft tissue sarcomas. Orthop Clin North Am.
1996;27:655-664.
2. Coffin CM, Dehner LP. Pathologic evaluation of pediatric soft tissue tumors. Am J Clin Pathol.
1998;109(suppl 1):S38-S52.
3. Patterson K. The pathologic handling of skeletal tumors. Am J Clin Pathol. 1998;109(suppl
1):S53-S66.
D. Lymphovascular Invasion (LVI)

Lymphovascular invasion (LVI) indicates whether microscopic lymphovascular invasion is identified in the
pathology report. LVI includes lymphatic invasion, vascular invasion, or lymphovascular invasion.
9
Evaluation of LVI may require immunohistochemical staining for endothelial markers (CD31, CD34, D240,
etc). By American Joint Committee on Cancer (AJCC) and International Union Against Cancer (UICC)
convention, LVI does not affect the T category indicating local extent of tumor unless specifically included
in the definition of the T category.
E. Prognostic Factors
Typically, ES has a lobular growth pattern consisting of tumor cells that are distinctly monotonous in their
nuclear uniformity. Nuclei measure 10 µm to 15 µm in diameter with distinct nuclear membranes, finely
granular chromatin, and 1 to 2 inconspicuous nucleoli. Cytoplasm is poorly defined, scant, pale-staining,
and may be vacuolated due to irregular glycogen deposition. Some cases of ES may show increased
nuclear size, more pronounced atypia, and increased mitotic activity. Multinucleated giant cells are not
seen. Large areas of tumor necrosis with “ghost-like tumor cells” may be striking and in some biopsy
specimens may represent the majority of the tumor. Areas of neuroectodermal differentiation (Homer-
Wright rosettes; rarely Flexner-Wintersteiner rosettes, ganglionic differentiation or primitive
neuroepithelium) may be evident in some tumors. Some cases may show extensive epithelial
differentiation, in particular the adamantinoma-like variant most commonly seen in the head-neck region.
Currently, extraosseous Ewing sarcoma receives identical therapy as intraosseous Ewing sarcoma. There
are no histopathologic ES subtypes that possess an established prognostic importance.
A summary of the prognostic factors is detailed below.1 Of all prognostic factors, age at onset, tumor size,
site, and stage have proven to be the most important in predicting outcome.
Factor Favorable Prognosis Unfavorable Prognosis
Age Less than 10 years (EFS 69%); Greater than or equal to 18 years (EFS 44%)
10-17 years (EFS 74%)
Site Distal extremity (EFS 74%); Pelvis (EFS 50%)

Proximal extremity (EFS 62%)
Size Less than 8 cm greatest diameter (EFS 75%) Greater than or equal to 8 cm in greatest dimension
(EFS 55%)
Stage Nonmetastatic tumor Metastatic tumor (EFS approximately 20%)
(EFS approximately 70%)
Definition: EFS, event-free survival.
Histologic response to chemotherapy is an excellent predictor of outcome in osteosarcomas and may

also be of value in ES. However, the evaluation of percentage necrosis in ES can be difficult, because
unlike osteosarcoma, there is no residual acellular osteoid framework left to demarcate the original tumor
bed. Furthermore, data regarding correlation of necrosis with outcome in extraosseous ES is not
available. Currently, histologic assessment of percentage necrosis is not used formally to guide therapy in
ES; however, it is recommended that the report includes the estimated percentage of necrosis.
References
1. Grier HE, Krailo MD, Tarbell NJ, et al. Addition of ifosfamide and etoposide to standard
chemotherapy for Ewing's sarcoma and primitive neuroectodermal tumor of bone. N Engl J Med.
2003;348:694-701.
F. Margins
The extent of resection (ie, gross residual disease versus complete resection with negative margins) has
the strongest influence on local control of malignancy.1 The definition of what constitutes a sufficiently
10
“wide” margin of normal tissue in the management of ES and the significance of reactive and/or necrotic
tissue at the margin are current study questions for the Children’s Oncology Group, and may evolve in the
future. Currently, any tumor at the margin, whether viable, nonviable, or treated, is considered positive.
The significance of treated tumor at the margin when there has been an excellent chemotherapeutic
response (ie, greater than 90% tumor necrosis) remains unclear. There is currently no consensus as to
whether margins involved by treated tumor require further treatment, and this is considered a negative
margin on some studies. The presence of treated tumor at the margin should be reported, however, and
can be included in the comment section of the checklist. The following margins are considered adequate:
Cortical bone margin: 2 to 5 cm

Fascia, periosteum, and intermuscular septa: 2 mm
Fat, muscle, and medullary bone: 5 mm
With Ewing sarcoma involving an encapsulated organ, surgical margins are considered to be negative if
the organ’s capsule is not surgically violated or breached by the tumor.
References
1. Fletcher C, Kempson RL, Weiss S. Recommendations for reporting soft tissue sarcomas. Am J
Clin Pathol. 1999;111:594-598.
G. TNM and Stage Groupings

The AJCC TNM staging system for bone or soft tissue tumors1 may be used for pathologic staging of
Ewing sarcoma and can be reported in the Comment section. However, the presence or absence of
metastatic disease (a feature that may not be known to the pathologist) is the primary factor in the staging
and treatment of pediatric patients with Ewing sarcoma.
References
1. Amin MB, Edge SB, Greene FL, et al, eds. AJCC Cancer Staging Manual. 8th ed. New York, NY:
Springer; 2017.
H. Ancillary Studies
Immunohistochemistry
Immunohistochemistry with monoclonal antibodies against the cell surface glycoprotein CD99 is positive
in virtually all cases of ES.1 This glycoprotein is diffusely expressed in the vast majority of cases in a
membranous pattern (Figure 2). The results of staining using monoclonal antibodies O13, HBA71, and
12E7 are similar, but individual tumors may exhibit better staining with one of these antibodies versus
other antibodies.
11
Figure 2. CD99 staining in Ewing sarcoma shows strong, diffuse, membranous staining. (CD99 antibody O13 with
hematoxylin counterstain.)
Lymphoblastic lymphomas/leukemias, rhabdomyosarcomas, synovial sarcomas, solitary fibrous tumors,

rhabdoid tumors, neuroendocrine tumors, desmoplastic small round cell tumors, and mesenchymal
chondrosarcomas may also demonstrate immunoreactivity to CD99. In some of these tumors, CD99
immunostaining is often weakly granular and intracytoplasmic; in others (lymphoblastic
lymphoma/leukemia, occasional cases of poorly differentiated synovial sarcoma, alveolar
rhabdomyosarcoma), distinct membrane staining is present, as seen in ES. Because these other tumors
with small round cell morphology can exhibit CD99 expression, it is very important to consider including
other immunohistochemical stains such as muscle markers (desmin, muscle-specific actin, myoD1,
myogenin), S-100, epithelial markers (epithelial membrane antigen, cytokeratin), INI-1, and lymphoid
markers (CD45, CD30, Tdt, T-cell and/or B-cell markers) when CD99 is performed to properly exclude
CD99-expressing tumors. Cytokeratin positivity may be seen in ES and may be diffusely positive in the
adamantinoma-like variant of Ewing sarcoma.2,3 Newer immunohistochemical antibodies, such as
NKX2.2, may also be useful for the diagnosis of ES, although NKX2.2 staining may rarely be seen in
other small round cell tumors.4 The value of other immunohistochemical markers for diagnosis, such as
Ki-67, p53, and C-kit (CD117), has not been established.
Chromosomal Translocations
The 2020 World Health Organization (WHO) classification of bone and soft tissue tumors defines Ewing
sarcoma as a round cell sarcoma harboring a FET-ETS gene fusion. FET represents a family of genes to
include FUS, EWSR1, and TAF15; whereas the ETS gene family is a large family of transcription factors
involved in cell cycle regulation, cellular differentiation, among other functions. In relation to Ewing
sarcoma, the characteristic translocations involve the EWSR1 gene at 22q12, most often either the FLI1
gene at 11q24 (90-95%) or the ERG gene at 21q22 (5-10%). These two fusions account for the vast
majority of genetic alterations in ES. It should be emphasized that there are numerous other EWSR1 or
FUS gene partners that occur in a minority (5%-10%) of ES. The failure to identify an EWSR1-FLI or
EWSR1-ERG translocation by RT-PCR or cytogenetics does not exclude ES from the diagnosis. If RT-
PCR is negative, in the context of a tumor suspicious for ES, other molecular studies (cytogenetics, NGS)
may be important for identification of the less common ES translocations and for discovering novel
EWSR1 translocations in ES. Some of the less common ES translocations involve FUS (ch16) rather than
EWSR1, or involve other ETS partners including ETV1, ETV4, or FEV. FISH analysis for EWSR1 (or
FUS) is helpful as a first step and may confirm the diagnosis in those tumors with histomorphologic
12
features and immunohistochemical phenotypes of ES. Because other small round cell tumors of
childhood can have EWSR1 rearrangements with specific tumor-defining partners, EWSR1 FISH
positivity alone is not diagnostic of ES. Some of these tumors with EWSR1 rearrangement include
angiomatoid fibrous histiocytoma, clear cell sarcoma of soft parts, desmoplastic round cell tumor, and
extraskeletal myxoid chondrosarcoma, as well as a subset of myxoid liposarcomas and myoepithelial
carcinoma. This underscores the necessity for histologic and immunohistochemical correlation with FISH
and/or cytogenetic data.5
Therefore, considerations when choosing testing methodologies may include, classic versus non-classic
histomorphology, immunophentype, need to confirm translocation partner, turnaround time, cost, and
ultimately may be depend on the availability of testing modalities at each institution. While obtaining
evidence of a diagnostic fusion is recommended, it should be noted that absence of a fusion can either
result from 1) true lack of fusion, 2) test failure (eg. FISH for EWSR-ERG fusions can miss
rearrangements) or 3) mismatch between the testing approach and the fusion present (eg. EWSR1-ERG
present and test is for RT-PCR for EWSR1-FLI1).
Of note, the specific EWSR1 translocation and subtype based upon exon fusion type do not influence
treatment, prognosis, or outcome.6
References
1. Collini P, Sampietro G, Bertulli R, et al. Cytokeratin immunoreactivity in 41 cases of Ewing
sarcoma/primitive neuroectodermal tumor confirmed by molecular diagnostic studies. Am J Surg
Pathol. 2001;25:273-274.
2. Ambros IM, Ambros PF, Strehl S, Kovar H, Gadner H, Salzer-Kuntschik M. MIC2 is a specific
marker for Ewing’s sarcoma and peripheral primitive neuroectodermal tumor: evidence for a
common histogenesis of Ewing’s sarcoma and peripheral neuroectodermal tumors from MIC2
expression and specific chromosome aberration. Cancer. 1992;67:1886-1893.
3. Folpe AL, Goldblum JR, Rubin BP, Shehata BM, Liu W, Dei Tos AP, Weiss SW. Morphologic and
immunophenotypic diversity in Ewing family tumors: a study of 66 genetically confirmed cases.
Am J Surg Pathol. 2005;29:1025-1033.
4. Machado I, Yoshida A, Lopez-Guerrero JA, Nieto MG, Navarro S, Picci P, Llombart-Bosch A.
Immunohistochemical analysis of NKX2.2, ETV4 and BCOR in a large series of genetically
confirmed Ewing sarcoma family tumors. Pathol Res Pract 2017;213(9):1048-1053.
5. Tsokos M, Allagio RD, Dehner LP, et al. Ewing sarcoma/peripheral neuroectodermal tumor and
related tumors. Pediatr Dev Pathol. 2012;15(1 suppl):108-126.
6. Van Doorninck JA, Ji L, Schaub B, et al. Current treatment protocols have eliminated the
prognostic advantage of Type 1 fusions in Ewing sarcoma: a report from the Children’s Oncology
Group. J Clin Oncol. 2010;28:1989-1994.
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Protocol for the Examination of Resection Specimens From

Pediatric Patients With Ewing Sarcoma

The following should NOT be reported using this protocol:

CASE SUMMARY: (EWING SARCOMA: Resection)

+Expert Consultation (Note A)

Preresection Treatment (select all that apply)

Multiple Primary Sites

Tumor Size (Note C)

Site(s) Involved by Direct Tumor Extension (select all that apply)

Lymphovascular Invasion (Note D)

Treatment Effect (Note E)

+Tumor Comment: _________________

+Margin Comment: _________________

REGIONAL LYMPH NODES

Regional Lymph Node Status

+Regional Lymph Node Comment: _________________

Distant Site(s) Involved, if applicable# (select all that apply)

PATHOLOGIC STAGE CLASSIFICATION (pTNM, AJCC 8th Edition) (Note G)

SPECIAL STUDIES (Note H)

+Immunohistochemistry (specify): _________________

___ Other (specify): _________________

Method for Cytogenetic Studies

+Additional Findings (specify): _________________

D. Lymphovascular Invasion (LVI)

Site Distal extremity (EFS 74%); Pelvis (EFS 50%)

Histologic response to chemotherapy is an excellent predictor of outcome in osteosarcomas and may

Cortical bone margin: 2 to 5 cm

G. TNM and Stage Groupings

Lymphoblastic lymphomas/leukemias, rhabdomyosarcomas, synovial sarcomas, solitary fibrous tumors,

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_ Other (specify): _______________