Major Salivary Gland Tumor Synoptic Report — CAP elements with AJCC 9th Edition (auto stage)
Case / Specimen
Tumor / Pathologic features
AJCC 9 (major salivary glands) pT summary: - pT1: Tumor ≤2 cm in greatest dimension without EPE. - pT2: Tumor >2–4 cm without EPE. - pT3: Tumor >4 cm and/or any size tumor with minor EPE (soft tissue extension beyond gland, but not skin, mandible, skull base). - pT4: More advanced local disease: - pT4a: Tumor invades skin, mandible, ear canal, facial nerve (in parotid), or soft tissues beyond minor EPE. - pT4b: Tumor invades skull base and/or pterygoid plates and/or encases carotid artery or other very advanced structures.
Note: Extraparenchymal extension (EPE) is a key modifier; report presence/extent (microscopic vs macroscopic), facial nerve status, perineural invasion (PNI) and bone/skin/soft tissue invasion.
Regional lymph nodes
AJCC 9 (salivary glands) pN summary: - pN0: No regional lymph node metastasis. - pN1: Metastasis in single ipsilateral lymph node ≤3 cm. - pN2: Metastasis in single ipsilateral node >3–6 cm, multiple ipsilateral nodes, or bilateral/contralateral nodes (site-specific subdivisions). - pN3: Metastasis >6 cm or extranodal extension with extensive disease (site-specific). Record number of positive nodes, size of largest deposit, extranodal extension, and levels involved.
Distant metastasis
AJCC 9 pM summary for salivary glands: - pM0: No distant metastasis. - pM1: Distant metastasis present (biopsy-proven when possible).
Any M1 = Stage IV. Common sites include lung, bone, liver; document site(s), number of lesions, method of confirmation.
AJCC 9 Stage Group Guidance (expanded)
Simplified AJCC 9 stage grouping for major salivary gland tumors (verify site-specific details): - Stage I: pT1, N0, M0. - Stage II: pT2, N0, M0. - Stage III: pT3 or pN1, M0. - Stage IV: pT4 or pN2–N3 or any M1.
Use AJCC 9 tables for exact substage combining T, N, and M and consider histologic grade and PNI for prognosis.