Perihilar Bile Duct Cancer Protocol



Perihilar Bile Duct Cancer Protocol


Laura Webb Lamps, MD










Perihilar Bile Ducts: Local or Segmental Resection, Hilar Resection With or Without Hepatic Resection


























































































































































































































































































































































































































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




Other organs received





___Liver





___Gallbladder





___Other (specify):____________________


Procedure



___Hilar and hepatic resection



___Segmental resection of bile ducts(s)



___Choledochal cyst resection



___Total hepatectomy



___Other (specify):____________________



___Not specified


Tumor Site



___Right hepatic duct



___Left hepatic duct



___Junction of right and left hepatic ducts



___Cystic duct



___Common hepatic duct



___Common bile duct



___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



___Biliary cystadenocarcinoma



___Other (specify):____________________



___Carcinoma, not otherwise specified


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 into surrounding connective tissue



___Tumor invades adjacent liver parenchyma



___Tumor invades gallbladder



___Tumor invades unilateral branches of portal vein (right or left)



___Tumor invades unilateral branches of hepatic artery (right or left)



___Tumor invades main portal vein or its branches bilaterally



___Tumor invades common hepatic artery



___Tumor invades second-order biliary radicals





___Unilateral





___Bilateral


Margins (select all that apply)



Segmental resection specimen




___Cannot be assessed




___Margins uninvolved by invasive carcinoma





Distance of invasive carcinoma from closest margin: _____ mm or _____ cm





Specify margin:____________________




___Margins involved by invasive carcinoma





___Proximal bile duct margin





___Distal bile duct margin





___Hepatic parenchymal margin





___Other (specify):____________________




___Dysplasia/carcinoma in situ not identified at bile duct margin




___Dysplasia/carcinoma in situ present at bile duct 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, with extension up to muscle layer or fibrous tissue




___pT2a: Tumor invades beyond wall of bile duct to surrounding adipose tissue




___pT2b: Tumor invades adjacent hepatic parenchyma




___pT3: Tumor invades unilateral branches of portal vein or hepatic artery




___PT4: Tumor invades main portal vein or its branches bilaterally; or common hepatic artery; or second-order biliary radicals bilaterally; or unilateral second-order biliary radicals with contralateral portal vein or hepatic artery involvement



Regional lymph nodes (pN)




___pNX: Cannot be assessed




___pN0: No regional lymph node metastasis




___pN1: Regional lymph node metastasis (including nodes along cystic duct, common bile duct, hepatic artery, and portal vein)




___pN2: Metastasis to periaortic, pericaval, superior mesentery artery, &/or celiac artery lymph nodes





Specify: Number examined:_____






Number involved:_____



Distant metastasis (pM)




___Cannot be assessed





*Specify site(s), if known:____________________


*Additional Pathologic Findings (select all that apply)



* ___None identified



* ___Choledochal cyst



* ___Dysplasia



* ___Primary sclerosing cholangitis (PSC)



* ___Biliary stones



* ___Other (specify):


*Ancillary Studies



*Specify:____________________


*Clinical History (select all that apply)



* ___PSC



* ___Inflammatory bowel disease



* ___Biliary stones



* ___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 Perihilar Bile Ducts.” Web posting date October 2009, www.cap.org. Protocol applies to all invasive carcinomas of the perihilar bile ducts. Carcinomas of the distal extrahepatic bile ducts, intrahepatic bile ducts, and 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 Perihilar Bile Duct Cancer Protocol
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