This white paper originated in the fall of 2008 from work carried out by the Pathology Electronic Reporting Taskforce (PERT) of the College of American Pathologists (CAP). Under contract support from the Centers for Disease Control (CDC), the PERT was tasked to propose electronic implementations of the CAP Cancer Committee's reporting templates. During Discussions, it became obvious to participants that current frameworks for implementing structured reporting had distinct limitations, and that in particular problems of cross-terminology mapping and context representation posed serious hurdles for any possible implementation that aimed to support downstream use cases as complex as clinical decision support. These limitations seemed to be more than transient barriers that might be overcome by incremental technological enhancements to existing frameworks. Rather, they were in many cases inherent limitations of any computer-processable representation of complex medical reports. The Pathology use case, situated in the midrange of the complexity of medical reports. The Pathology use case, situated in the midrange of complexity of medical report types, provided a superb paradigmatic case for the investigation of these inherent limitations.