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RESEARCH INFORMATION COLLECTION FORM
Code: Date ST: ST Type: Needle ST □ Surgery □ Patient Name: Age: Gender:
1. Hepatocellular carcinoma
1.1. Serum AFP index:
<20 mg/l □ 20-200mg/l □ >200-400 mg/l □ >400 mg/l □
1.2. Hepatitis B: yes □ no □
1.3. Hepatitis C: yes □ no □
1.4. Co-infection of hepatitis: yes □ no □
1.5. Number of tumors: 1 mass □ multiple masses: □
1.6. Tumor size: < 2cm □ 2-5cm □ > 5cm □
1.7. Histopathological type: Trabecular □ acinar □ solid □
1.8. Special tips:
Sclerosing UTMBMTBG, □ | |
Undifferentiated carcinoma, □ | UTBM resembles epithelial lymphoma □ |
Sarcomatous B-cell lymphoma □ | Other □ |
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1.9. Cellular Variants of HCC: Typical Cells □
Light cells □ | |
Fat transformation □ | Bile secretion □ |
Hyaline body □ | Pale body □ |
Ground glass inclusions □ |
1.10. Histological grade according to WHO 2010: High □ Moderate □ Poor □ None □
1.11. Vascular invasion status: yes □ no □
1.12. Liver cirrhosis status: Yes □ no □ Fibrosis level: F1 □, F2 □, F3 □, F4 □
1.13. HMMD disclosure:
Arginase 1: positive □ negative □ | |
CD34: positive □ negative □ | GP3: positive □ negative □ |
GS: positive □ negative □ | HSP70: positive □ negative □ |
CK7: positive □ negative □ | CK19: positive □ negative □ |