Distal Extrahepatic Bile Duct Cancer Protocol



Distal Extrahepatic Bile Duct Cancer Protocol


Laura Webb Lamps, MD










Distal Extrahepatic Bile Ducts: Local or Segmental Resection, Pancreaticoduodenectomy




































































































































































































































































































































































































































































































































Surgical Pathology Cancer Case Summary (Checklist)


Specimen (select all that apply)



___Common bile duct



___Right hepatic duct



___Left hepatic duct



___Junction of right and left hepatic ducts



___Common hepatic duct



___Cystic duct



___Not specified




Other organs received





___Stomach





___Duodenum





___Pancreas





___Ampulla





___Gallbladder





___Other (specify):____________________


Procedure



___Pancreaticoduodenectomy



___Segmental resection of bile duct(s)



___Choledochal cyst resection



___Other (specify):____________________



___Not specified


Tumor Site (select all that apply)



___Common bile duct





___Extrapancreatic





___Intrapancreatic



___Other (specify):____________________



___Not specified


Tumor Size



Greatest dimension: _____cm



*Additional dimensions: _____ x _____ cm



___Cannot be determined


Histologic Type



___Adenocarcinoma (not otherwise characterized)



___Papillary adenocarcinoma



___Mucinous adenocarcinoma



___Clear cell adenocarcinoma



___Signet ring cell carcinoma



___Adenosquamous carcinoma



___Squamous cell carcinoma



___Small cell carcinoma



___Large cell neuroendocrine carcinoma



___Biliary cystadenocarcinoma



___Other (specify):____________________



___Carcinoma, type cannot be determined


Histologic Grade



___Not applicable



___GX: Cannot be assessed



___G1: Well differentiated



___G2: Moderately differentiated



___G3: Poorly differentiated



___G4: Undifferentiated


Microscopic Tumor Extension (select all that apply)



___Carcinoma in situ



___Tumor confined to bile duct histologically



___Tumor invades beyond wall of bile duct



___Tumor invades duodenum



___Tumor invades pancreas



___Tumor invades gallbladder



___Tumor invades other adjacent structures (specify):____________________


Margins (select all that apply)



Segmental resection specimen



___Cannot be assessed



___Margins uninvolved by invasive carcinoma





Distance of invasive carcinoma from closest margin: _____ mm





Specify margin:____________________



___Margins involved by invasive carcinoma





___Proximal bile duct margin





___Distal bile duct margin





___Other (specify):____________________



___Dysplasia/carcinoma in situ not identified at bile duct margin



___Dysplasia/carcinoma in situ present at bile duct margin



Pancreaticoduodenal resection specimen




Proximal margin (gastric or duodenal)





___Cannot be assessed





___Uninvolved by invasive carcinoma





___Involved by invasive carcinoma




Distal margin (distal duodenal)





___Cannot be assessed





___Uninvolved by invasive carcinoma





___Involved by invasive carcinoma




Pancreatic retroperitoneal 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 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 confined to bile duct histologically




___pT2: Tumor invades beyond wall of bile duct




___pT3: Tumor invades gallbladder, pancreas, duodenum, or other adjacent organs without involvement of celiac axis or superior mesenteric artery




___Tumor involves celiac axis or superior mesenteric artery



Regional lymph nodes (pN)




___pNX: Cannot be assessed




___pN0: No regional lymph node metastasis




___pN1: Regional lymph node metastasis





Specify: Number examined:_____






Number involved:_____



Distant metastasis (pM)




___Not applicable




___pM1: Distant metastasis





*Specify site(s), if known:____________________


*Additional Pathologic Findings (select all that apply)



*___None identified



*___Choledochal cyst



*___Dysplasia



*___Primary sclerosing cholangitis (PSC)



*___Stones



*___Other (specify):____________________


*Ancillary Studies



*Specify:____________________


*Clinical History (select all that apply)



*___Primary sclerosing cholangitis



*___Inflammatory bowel disease



*___Biliary stones



*___Other (specify):____________________


* 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 Distal Extrahepatic Bile Ducts.” Web posting date October 2009, www.cap.org. Protocol applies to all invasive carcinomas of the distal extrahepatic bile ducts. Well-differentiated neuroendocrine neoplasms (carcinoid tumors) are not included. Carcinomas of the perihilar bile ducts are not included.

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Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Distal Extrahepatic Bile Duct Cancer Protocol
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