Ampulla of Vater Cancer Protocol



Ampulla of Vater Cancer Protocol


Laura Webb Lamps, MD










Ampulla of Vater: Ampullectomy, Pancreaticoduodenectomy (Whipple Resection)

































































































































































































Surgical Pathology Cancer Case Summary (Checklist)


Specimen (select all that apply)



____ Ampulla of Vater


____ Stomach


____ Head of pancreas


____ Duodenum


____ Common bile duct


____ Gallbladder


____ Other (specify): ______________________________


____ Not specified


Procedure



____ Ampullectomy


____ Pancreaticoduodenectomy (Whipple resection)


____ Other (specify): ______________________________


____ Not specified


Tumor Site



____ Intraampullary


____ Periampullary


____ Papilla of Vater (junction of ampullary and duodenal mucosa)


____ Other (specify): ______________________________


____ Cannot be determined


____ Not specified


*Tumor Size



Greatest dimension: ____________ x ____________ cm


*Additional dimensions: ____ x ____ cm


____ Cannot be determined


Histologic Type



____ Adenocarcinoma (not otherwise characterized)


____ Papillary adenocarcinoma


____ Adenocarcinoma, intestinal type


____ Mucinous adenocarcinoma


____ Clear cell adenocarcinoma


____ Signet ring cell carcinoma


____ Adenosquamous carcinoma


____ Squamous cell carcinoma


____ Small cell carcinoma


____ Other (specify): ______________________________


____ Carcinoma, not otherwise specified


Histologic Grade



____ Not applicable (histologic type not usually graded)


____ GX: Cannot be assessed


____ G1: Well differentiated


____ G2: Moderately differentiated


____ G3: Poorly differentiated


____ G4: Undifferentiated


____ Other (specify): ______________________________


Microscopic Tumor Extension (select all that apply)



____ Cannot be assessed


____ No evidence of primary tumor


____ Carcinoma in situ


____ Tumor limited to ampulla of Vater or sphincter of Oddi


____ Tumor invades duodenal wall


____ Tumor invades pancreas


____ Tumor invades peripancreatic soft tissues


____ Tumor invades extrapancreatic common bile duct


____ Tumor invades other adjacent organs or structures other than pancreas (specify): ______________________________


Margins (select all that apply)



Ampullectomy specimen




____ Cannot be assessed


____ Margins uninvolved by invasive carcinoma





Distance of invasive carcinoma from closest margin: ____________ mm


Specify margin (if possible): ______________________________




____ Margins involved by invasive carcinoma





Specify margin (if possible): ______________________________




____ Not applicable



Pancreaticoduodenal resection specimen




Proximal mucosal margin (gastric or duodenal)





____ Cannot be assessed


____ Uninvolved by invasive carcinoma


____ Involved by invasive carcinoma


____ Intramucosal carcinoma/adenoma not identified at proximal margin


____ Intramucosal carcinoma/adenoma present at proximal margin




Distal margin (distal duodenal or jejunal)





____ Cannot be assessed


____ Uninvolved by invasive carcinoma


____ Involved by invasive carcinoma


____ Intramucosal carcinoma/adenoma not identified at distal margin


____ Intramucosal carcinoma/adenoma present at distal margin




Pancreatic retroperitoneal (uncinate) margin





____ Not applicable


____ Cannot be assessed


____ Uninvolved by invasive carcinoma


____ Involved by invasive carcinoma (tumor present 0-1 mm from margin)




Bile duct margin





____ Not applicable


____ Cannot be assessed


____ Margin uninvolved by invasive carcinoma


____ Margin involved by invasive carcinoma




Distal pancreatic resection margin





____ Not applicable


____ Cannot be assessed


____ Margin uninvolved by invasive carcinoma


____ Margin involved by invasive carcinoma




If all margins uninvolved by invasive carcinoma






Distance of invasive carcinoma from closest margin: ____ mm OR ____ cm


Specify margin: ______________________________


Lymph-Vascular Invasion



____ Not identified


____ Present


____ Indeterminate


*Perineural Invasion



* ____ Not identified


* ____ Present


* ____ Indeterminate


Pathologic Staging (pTNM)



TNM descriptors (required only if applicable) (select all that apply)




____ m (multiple primary tumors)


____ r (recurrent)


____ y (post-treatment)



Primary tumor (pT)




____ pTX: Cannot be assessed


____ pT0: No evidence of primary tumor


____ pTis: Carcinoma in situ


____ pT1: Tumor limited to ampulla of Vater or sphincter of Oddi


____ pT2: Tumor invades duodenal wall


____ pT3: Tumor invades pancreas


____ pT4: Tumor invades peripancreatic soft tissues or other adjacent organs or structures



Regional lymph nodes (pN)




____ pNX: Cannot be assessed


____ pN0: No regional lymph node metastasis


____ Regional lymph node metastasis





Specify: Number examined: ____________


Number involved: ___________



Distant metastasis (pM)




____ Not applicable


____ pM1: Distant metastasis






*Specify sites (if known):______________________________


* Additional Pathologic Findings (select all that apply)



* ____ None identified


* ____ Dysplasia/adenoma


* ____ Other (specify):


* Ancillary Studies



*Specify: ______________________________


* ____ Not performed


*Clinical History (select all that apply)



* ____ Familial adenomatous polyposis coli


* ____ Other (specify): ______________________________


* ____ Not known


* Data elements with asterisks are not required. However, these elements may be clinically important but are not yet validated or regularly used in patient management. Adapted with permission from College of American Pathologists, “Protocol for the Examination of Specimens from Patients with Carcinoma of the Ampulla of Vater.” Web posting date October 2009, www.cap.org. Protocol applies to all intra-ampullary, periampullary, and mixed intra- and periampullary carcinomas. Well-differentiated neuroendocrine neoplasms (carcinoid tumors) are not included.

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Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Ampulla of Vater Cancer Protocol
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