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



___Other (specify):____________________


___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



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



Perineural Invasion

___Not identified



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


*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, 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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