Eye enucleation Macroscopic reporting dictation template
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Eye enucleation Macroscopic reporting dictation template Data element Fresh tissue received Procedure Volume of fluid Specimen dimensions Total specimen (if exenteration) Globe Optic nerve Cornea Pupil Other tissues (if exenteration) Specimen external description Episclera/sclera Conjunctiva Cornea Pupil Iris Optic nerve Globe (by gentle palpation) Transillumination Retroillumination Response No Yes Text __ ml Tumour description Tumour on the surface of the eye Choroidal invasion Extraocular spread If retinoblastoma indicated Vitreous seeding Tumour growth pattern Absent Absent Absent Absent Present Present Present Present Absent Endophytic Present Exophytic Eye enucleation dictation template If yes, describe any additional tests/ frozen sections/biobanking performed As stated by the clinician __x__ x __ mm __x__ x __ mm antero-posterior x horizontal x vertical maximum __ mm __x__ mm __x__ mm __x__ x __ mm (each tissue) Text (e.g. evidence of previous biopsy or surgery and each anatomical component) Normal Abnormal Describe e.g. sentinel vessels, staphylomas, fibrosis Normal Abnormal Describe e.g. congested vessels, fibrosis, tumours Normal Abnormal Describe e.g. epithelial separation, ulcer, perforation Normal Abnormal Shape Normal Abnormal Describe e.g. colour, ectropian/entropian uveae, iridectomy sites Normal Abnormal Describe e.g. atrophic, demyelination, infarction Normal Abnormal Describe e.g. globally firm/soft, focally firm/soft Normal Abnormal Describe e.g. tumour, areas of thinning Normal Abnormal Describe e.g. iris atrophy, pupil abnormalities Date: 22 October 2015 Number ____ (if >1 designate accordingly & describe each) Distance to veins __ mm < 5 mm > 5 mm Version: 1.0 Eye enucleation Macroscopic reporting dictation template Maximum tumour diameter __mm Tumour site and compartments/tissues involved Distance of tumour to head of optic nerve Distance of tumour to pars plicata Distance of tumour to closest soft tissue margin Specimen internal description Anterior chamber Aqueous humour (more than one may apply) Angle Lens Natural Artificial Ciliary body Vitreous Retina Optic disc Choroid Evidence of previous surgery Text (more than one may apply) __mm __mm __mm Text Deep (normal) Shallow Clear Blood Pus Tumour Closed Open Describe any blood, pigment deposits or abnormal blood Absent Present Describe Size (max. dim.) __mm Shape Colour Cataract No Yes Opacification No Yes Decentration No Yes Laser capsulotomy site No Yes Describe e.g. effusions, evidence of cryotherapy, ciliary body ablation Normal (gelatinous) Abnormal, describe e.g. haemorrhage, pus, tumour, oil/silicone Normal Abnormal, describe e.g. detached, holes/tears, exudates, haemorrhage etc. Normal Abnormal, describe e.g. papilloedema, atrophy, cupping, neovascular tissue growth Thickening (if present), due to ____ (e.g. haemorrhage, exudate, inflammation, tumour) Scars Filtration bleb Evidence of retinal repair Other, describe Other relevant macroscopic information Text Describe nature and site of blocks Text Eye enucleation dictation template E.g. any additional orientation; specimen integrity (if disrupted) etc. Date: 22 October 2015 Version: 1.0
