Intrahepatic Bile Duct Cancer Protocol



Intrahepatic Bile Duct Cancer Protocol


Laura Webb Lamps, MD










Intrahepatic Bile Ducts

















































































































































































































































































































































































Surgical Pathology Cancer Case Summary (Checklist)


Specimen



___ Liver



___ Gallbladder



___ Other (specify): ______________________________


Procedure (select all that apply)



___ Wedge resection



___ Partial hepatectomy




*___ Major hepatectomy (3 segments or more)




*___ Minor hepatectomy (< 3 segments)



___ Total hepatectomy



___ Other (specify): ______________________________



___ Not specified


Tumor Size



Greatest dimension: ___ cm



*Additional dimensions: ___ x ___ cm



___ Cannot be determined


Tumor Focality



___ Solitary (specify location): ______________________________



___ Multiple (specify location): ______________________________


Histologic Type



___ Cholangiocarcinoma



___ Combined hepatocellular and cholangiocarcinoma



___ Bile duct cystadenocarcinoma



___ Other (specify): ______________________________


Histologic Grade



___ Not applicable



___ GX: Cannot be assessed



___ GI: Well differentiated



___ GII: Moderately differentiated



___ GIII: Poorly differentiated



___ GIV: Undifferentiated



___ Other (specify): ______________________________


Tumor Growth Pattern



___ Mass forming



___ Periductal infiltrating



___ Mixed mass-forming and periductal infiltrating



___ Cannot be determined


Microscopic Tumor Extension (select all that apply)



___ Cannot be assessed



___ No evidence of primary tumor



___ Tumor confined to intrahepatic bile ducts histologically (carcinoma in situ)



___ Tumor confined to hepatic parenchyma



___ Tumor involves visceral peritoneal surface



___ Tumor directly invades adjacent organs other than gallbladder (specify): ______________________________


Margins (select all that apply)



Hepatic parenchymal margin




___ Cannot be assessed




___ Uninvolved by invasive carcinoma





Distance of invasive carcinoma from closest margin: __________ mm





Specify margin: ____________________




___ Involved by invasive carcinoma



Bile duct margin




___ Cannot be assessed




___ Uninvolved by invasive carcinoma




*___ Dysplasia/carcinoma in situ not identified




*___ Dysplasia/carcinoma in situ present




___ Involved by invasive carcinoma



Other margin




Specify margin: ______________________________




___ Cannot be assessed




___ Uninvolved by invasive carcinoma




___ Involved by invasive carcinoma


Lymph-Vascular Invasion



Venous (major vessel) invasion (V)



(invasion of right or left portal vein, 1 or more hepatic veins)




___ 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 (intraductal tumor)



___ pT1: Solitary tumor without vascular invasion



___ pT2a: Solitary tumor with vascular invasion



___ pT2b: Multiple tumors, ± vascular invasion



___ pT3: Tumor perforating visceral peritoneum or involving local extrahepatic structures by direct invasion



___ pT4: Tumor with periductal invasion



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)



*___ Cirrhosis/severe fibrosis (Ishak fibrosis score 5-6)



*___ Primary sclerosing cholangitis



*___ Biliary stones



*___ Chronic hepatitis (specify type): ______________________________



*___ Other (specify): ______________________________



*___ None identified


*Ancillary Studies



*Specify: ______________________________


*Clinical History (select all that apply)



*___ Cirrhosis



*___ Primary sclerosing cholangitis



*___ Inflammatory bowel disease



*___ Hepatitis C infection



*___ 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 Intrahepatic Bile Ducts.” Web posting date October 2009, www.cap.org.

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

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