Lymph Node Pathology Report Form
Please complete the following fields to document the findings of a lymph node pathology examination.
Specimen Accession Number
*
Date of Report
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Referring Physician / Clinician
Specimen Site / Location
*
Clinical History / Indication
Gross Description
*
Microscopic Description
*
Diagnosis
*
Ancillary Studies Performed
Immunohistochemistry
Flow Cytometry
Molecular Testing
Cytogenetics
Other
Comments / Additional Notes
Submit Report
Should be Empty: