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1.2.40.0.34.6.0.11.2.170/static-2026-07-17T103533

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<table xmlns="http://www.w3.org/1999/xhtml" width="100%" border="0" cellspacing="3" cellpadding="2" class="artdecor " style="background: transparent;"><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Id</th><td style="text-align: left;">1.2.40.0.34.6.0.11.2.170</td><th style="width: 20em; text-align: left;">Gültigkeit ab</th><td style="text-align: left;">2026‑07‑17 10:35:33</td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Status</th><td style="text-align: left;">[[File:Kyellow.png|14px]] Entwurf</td><th style="width: 20em; text-align: left;">Versions-Label</th><td style="text-align: left;">2.0</td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Name</th><td style="text-align: left;">MicroscopySection</td><th style="width: 20em; text-align: left;">Bezeichnung</th><td style="text-align: left;">Microscopic Observation Section</td></tr><tr style="vertical-align: top;"><td style="text-align: left;" colspan="4"><table id="templateDescTable" width="100%" border="0" cellspacing="3" cellpadding="2" class="artdecor treetable" style="background: transparent;"><tr class="desclabel"><td style="height: 1.5em;">Beschreibung</td></tr><tr><td><div>The Microscopic Observation section contains optionally the histopathologic findings of the case and of all of its derived specimens. This section shpould be used to record the results of histochemical and immunohistochemical stains as well as of image-based molecular procedures. </div></td></tr></table></td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Kontext</th><td style="text-align: left;" colspan="3">Elternknoten des Template-Element mit Id 1.2.40.0.34.6.0.11.2.170</td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Label</th><td style="text-align: left;" colspan="3">atpatho_section_MicroscopicObservationSection </td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Klassifikation</th><td style="text-align: left;" colspan="3">CDA Section level template</td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Offen/Geschlossen</th><td style="text-align: left;" colspan="3">Geschlossen (nur definierte Elemente sind erlaubt)</td></tr><tr style="vertical-align: top;"><th style="width: 20em; text-align: left;">Beziehung</th><td style="text-align: left;" colspan="3">Spezialisierung: Template 1.3.6.1.4.1.19376.1.8.1.2.4 Microscopic Observation Section (2014‑05‑13 14:25:17) <div class="repo ref sspacing">ref</div><div class="non-selectable repo refvalue sspacing">psr-</div> Spezialisierung: Template 2.16.840.1.113883.10.12.201 CDA Section (2005‑09‑07) <div class="repo ref sspacing">ref</div><div class="non-selectable repo refvalue sspacing">ad1bbr-</div></td></tr><tr class="explabel " style="vertical-align: top;"><th class="" style="width: 20em; text-align: left;">Beispiel</th><td colspan="3" class="explabelgreen"><table width="100%" border="0" cellspacing="3" cellpadding="2" class="artdecor treetable" style="background: transparent;"><tr class="desclabel"><td style="height: 1.5em;" class="togglertreetable">example from use case #1</td></tr><tr><td><section classCode="DOCSECT"> <templateId root="1.3.6.1.4.1.19376.1.8.1.2.4"/> <code code="22635-7" displayName="Pathology report microscopic observation" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"/> <title>MICROSCOPIC OBSERVATION SECTION</title>  <text> INVASIVE ADENOCARCINOMA OF THE BREAST. <br/> HISTOLOGIC TYPE: DUCTAL. <br/> NOTTINGHAM COMBINED HISTOLOGIC GRADE: 1 OF 3. <list> <item>TUBULE FORMATION SCORE: 2.</item> <item>NUCLEAR PLEOMORPHISM SCORE: 2.</item> <item>MITOTIC RATE SCORE: 1.</item> </list> IN-SITU CARCINOMA: EQUIVOCAL. <br/> <br/> BREAST CANCER BIOMARKER STUDIES: <list> <item>PARAFFIN BLOCK NUMBER: A1.</item> <item>ER INTERPRETATION: POSITIVE ESTROGEN RECEPTOR ACTIVITY (ALLRED SCORE = 8, Allred Percentage Score = 5, Allred Staining Score = 3).</item> <item>PR INTERPRETATION: POSITIVE PROGESTERONE RECEPTOR ACTIVITY (ALLRED SCORE = 8).</item> <item>DAKO EGFR PHARMDX IMMUNOHISTOCHEMISTRY: NEGATIVE (0) FOR EXPRESSION OF EPIDERMAL GROWTH FACTOR RECEPTOR.</item> <item>HER2/NEU IMMUNOHISTOCHEMISTRY: EQUIVOCAL (2+) FOR OVEREXPRESSION OF HER2/NEU ONCOPROTEIN.</item> <item>HER2/NEU FISH RESULTS: NOT AMPLIFIED.</item> </list> </text></section></td></tr></table></td></tr><tr style="vertical-align: top;"><td colspan="4" class="tabtab"><table id="transactionTable" width="100%" border="0" cellspacing="3" cellpadding="2" class="artdecor treetable" style="background: transparent;"><tr><th style="width: 30%; text-align: left;">Item</th><th style="width: 2em; text-align: left;">DT</th><th style="width: 2em; text-align: left;">Kard</th><th style="width: 2em; text-align: left;">Konf</th><th style="text-align: left;">Beschreibung</th><th style="width: 2em; text-align: left;">Label</th></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td class="columnName"><table cellpadding="1" class="artdecor ad-diffblock-horizontal " style="background: transparent;border: none;"><tr><td>hl7:section </td></tr></table></td><td></td><td>0 … 1</td><td>R</td><td></td><td style="background-color: #FFEEEE;">atpa...tion</td></tr><tr style="vertical-align: top; background-color: #FAFAD2;"><td style="background-color: white;" colspan="1"> </td><td class="conf">Constraint</td><td style="background-color: #FAFAD2;" colspan="4">[[File:EN-US.png]]

This section SHALL contain a code element populated with these attributes:


@code
="22635-7" 


@codeSystem
="2.16.840.1.113883.6.1" 


@displayName
="Pathology report microscopic observation" 


This section SHALL contain a narrative block, represented by a text element, which renders the information to the human reader.


The section SHOULD contain as many Problem Organizer entry elements as there are problems or groups thereof to be described. These entries provide the machine-readable data corresponding to the narrative block.


This section SHOULD contain author elements in case the authors of this section differ from those declared at a higher level in the document.


This section does not contain any subsections. 

</td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td class="columnName"><table cellpadding="1" class="artdecor ad-diffblock-horizontal " style="background: transparent;border: none;"><tr><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td>hl7:templateId </td></tr></table></td><td>II</td><td>1 … 1</td><td>M</td><td></td><td style="background-color: #FFEEEE;">atpa...tion</td></tr><tr style="vertical-align: top;"><td style="vertical-align: top;" class="columnName"><table cellpadding="1" class="artdecor " style="background: transparent;border: 0;"><tr><td style="vertical-align: top;">[[File:Treeblank.png|16px]]</td><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td>@root </td></tr></table></td><td>uid</td><td>1 … 1</td><td>F</td><td style="vertical-align: top;" colspan="2">1.2.40.0.34.6.0.11.2.170</td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td class="columnName"><table cellpadding="1" class="artdecor ad-diffblock-horizontal " style="background: transparent;border: none;"><tr><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td>hl7:code </td></tr></table></td><td>CE</td><td>1 … 1</td><td>M</td><td></td><td style="background-color: #FFEEEE;">atpa...tion</td></tr><tr style="vertical-align: top;"><td><table cellpadding="1" class="artdecor " style="background: transparent;border: 0;"><tr><td style="vertical-align: top;">[[File:Treeblank.png|16px]]</td><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td>@code </td></tr></table></td><td rowspan="4" class="conf">CONF</td><td>1 … 1</td><td>F</td><td colspan="2">22635-7</td></tr><tr style="vertical-align: top;"><td><table cellpadding="1" class="artdecor " style="background: transparent;border: 0;"><tr><td style="vertical-align: top;">[[File:Treeblank.png|16px]]</td><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td>@codeSystem </td></tr></table></td><td>1 … 1</td><td>F</td><td colspan="2">2.16.840.1.113883.6.1 (LOINC)</td></tr><tr style="vertical-align: top;"><td><table cellpadding="1" class="artdecor " style="background: transparent;border: 0;"><tr><td style="vertical-align: top;">[[File:Treeblank.png|16px]]</td><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td>@codeSystemName </td></tr></table></td><td>1 … 1</td><td>F</td><td colspan="2">LOINC</td></tr><tr style="vertical-align: top;"><td><table cellpadding="1" class="artdecor " style="background: transparent;border: 0;"><tr><td style="vertical-align: top;">[[File:Treeblank.png|16px]]</td><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td>@displayName </td></tr></table></td><td>1 … 1</td><td>F</td><td colspan="2">Pathology report microscopic observation</td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td class="columnName"><table cellpadding="1" class="artdecor ad-diffblock-horizontal " style="background: transparent;border: none;"><tr><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td>hl7:title </td></tr></table></td><td>ST</td><td>1 … 1</td><td>R</td><td></td><td style="background-color: #FFEEEE;">atpa...tion</td></tr><tr style="vertical-align: top; background-color: #FFEEEE;"><td style="background-color: white;" colspan="1"> </td><td class="conf">CONF</td><td colspan="4" style="background-color: white;"><table width="100%" border="0" cellspacing="2" cellpadding="2" class="artdecor " style="background: transparent;"><tr style="vertical-align: top;"><td>Elementinhalt MUSS "Mikroskopie" sein</td></tr></table></td></tr><tr class="explabel " style="vertical-align: top;"><td style="background-color: white;" colspan="1"> </td><td>Beispiel</td><td colspan="4" class="explabelgreen"><title>MICROSCOPIC OBSERVATION SECTION</title></td></tr><tr style="vertical-align: top; background-color: #FFEAEA;"><td class="columnName"><table cellpadding="1" class="artdecor ad-diffblock-horizontal " style="background: transparent;border: none;"><tr><td style="vertical-align: top;">[[File:Treetree.png|16px]]</td><td>hl7:text </td></tr></table></td><td>SD.TEXT</td><td>1 … 1</td><td>M</td><td></td><td style="background-color: #FFEEEE;">atpa...tion</td></tr><tr class="explabel " style="vertical-align: top;"><td style="background-color: white;" colspan="1"> </td><td>Beispiel</td><td colspan="4" class="explabelgreen"><div>example from use case#1</div><text> INVASIVE ADENOCARCINOMA OF THE BREAST. <br/> HISTOLOGIC TYPE: DUCTAL. <br/> NOTTINGHAM COMBINED HISTOLOGIC GRADE: 1 OF 3. <list> <item>TUBULE FORMATION SCORE: 2.</item> <item>NUCLEAR PLEOMORPHISM SCORE: 2.</item> <item>MITOTIC RATE SCORE: 1.</item> </list> IN-SITU CARCINOMA: EQUIVOCAL. <br/> <br/> BREAST CANCER BIOMARKER STUDIES: <list> <item>PARAFFIN BLOCK NUMBER: A1.</item> <item>ER INTERPRETATION: POSITIVE ESTROGEN RECEPTOR ACTIVITY (ALLRED SCORE = 8, Allred Percentage Score = 5, Allred Staining Score = 3).</item> <item>PR INTERPRETATION: POSITIVE PROGESTERONE RECEPTOR ACTIVITY (ALLRED SCORE = 8).</item> <item>DAKO EGFR PHARMDX IMMUNOHISTOCHEMISTRY: NEGATIVE (0) FOR EXPRESSION OF EPIDERMAL GROWTH FACTOR RECEPTOR.</item> <item>HER2/NEU IMMUNOHISTOCHEMISTRY: EQUIVOCAL (2+) FOR OVEREXPRESSION OF HER2/NEU ONCOPROTEIN.</item> <item>HER2/NEU FISH RESULTS: NOT AMPLIFIED.</item> </list></text></td></tr></table></td></tr></table>

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