Ampulla of Vater 


Cancer Case Summary

Ampulla of Vater AJCC 6th Edition; CAP 2005  
Resection    Cancer Case Summary
NB Excludes carcinoid / neuro endocrine tumours, GISTS, Lymphoma  
Diagnosis Example: Ampulla of Vater (Pancreatico-duodenectomy) -  Adenocarcinoma, see Cancer Case Summary
Microscopic:    
# Report Header Dictation Options Notes
Surgical Pathology Cancer Case Summary  
1 Specimen Type Pancreatico-duodenectomy (Whipple Resection)  
    Other (specify)  
2 Tissues Received Head of Pancreas, Duodenum, Distal Stomach, Common Bile Duct, Gallbladder, Omentum, LN if separately identified  
3 Tumour Site Intra-ampullary  
    Peri-ampullary  
    Junction of ampullary and duodenal mucosa  
    Not specified  
4 Tumour Size L x W x D cm or greatest dimension  
    Cannot be determined (add a comment)  
5 Tumour Configuration Polypoid, Ulcerating, Infiltrative  
6 Histologic Type Adenocarcinoma WHO classification
    Papillary adenocarcinoma  
    Adenocarcinoma, intestinal type  
    Adenocarcinoma, gastric foveolar type  
    Mucinous adenocarcinoma  
    Clear cell adenocarcinoma  
    Signet-ring cell carcinoma  
    Adenosquamous carcinoma  
    Other (specify)  
7 Histologic Grade Grade X Cannot be assessed
    Grade 1 > 95% composed of glands
    Grade 2 50%-95%  composed of glands
    Grade 3 0%-49% composed of glands
    Grade 4 Undifferentiated & Small cell
8 Extent of Invasion 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  
9 Distal Pancreatic Margin Positive for invasive tumour  
    Negative for invasive tumour  
    CIS at pancreatic duct margin Present / Absent  
10 Posterior Pancreatic Margin (Circumferential Margin) Positive for invasive tumour See note re Post Pancr Margin
    Negative for invasive tumour  
11 Common Bile Duct Margin Positive for invasive tumour  
    Negative for invasive tumour  
    CIS at common bile duct margin Present / Absent  
12 Proximal (Gastric) Margin Positive / Negative for invasive tumour  
13 Distal (Duodenal) Margin Positive / Negative for invasive tumour  
14 Distance of Invasive Ca from Closest Margin __ mm from __ (specify margin)  
    NA if a margin is positive  
15 Perineural Invasion Absent / Present   
16 Venous (Large Vessel) Invasion Absent / Indeterminate V0
    Present: Intramural or Extramural V1
    Gross Venous inv. V2
17 Lymphatic (Small Vessel) Invasion Absent / Indeterminate L0
    Present: Intramural or Extramural L1
18 Regional Lymph Nodes Note Regional LN incl.: hepatic artery, subpyloric, celiac, sup mesenteric, retroperitoneal, lateral aortic. Other LN involvement is pM1 See protocol for Isolated Tumour Cells (<0.2 mm)
    # LN pos / Total #LN Specify location of LN - optimal at least 10 LN
19 Distant Metastases Unknown / Absent / Present  (specify) M1 if Peritoneum / Omentum positive bx / cytology
20 Additional Findings None  
    Dysplasia/adenoma  
    Common Bile Duct obstruction  
    Pancreatic Duct obstruction  
    Acute / Chronic pancreatitis  
21 Other Tissues / Organs Gallbladder, Stomach  
22 Correlation with Operative Consult (FS) Not applicable or specify Explain any discrepancy
23 Correlation with Prior Biopsy Not applicable or specify Explain any discrepancy
24 Internal Consultation Pathologist name / Not applicable  
25 Comments Not applicable or specify  
26 pTNM AJCC 6th ed.   Note re r, y prefix, (m) suffix
  Tumour Extent Tx pTX:  Cannot be assessed
    T0 pT0:  No evidence of primary tumor
    Tis pTis:  Carcinoma in situ
    T1 pT1:  Tumor limited to ampulla of Vater or sphincter of Oddi
    T2 pT2:  Tumor invades duodenal wall
    T3 pT3:  Tumor invades pancreas
    T4 pT4:  Tumor invades peripancreatic soft tissues or other adjacent organs or structures
  Regional Nodes NX Regional lymph nodes cannot be assessed
    N0 No regional lymph node metastasis
    N1 Regional lymph node metastasis
  Metastases Mx Mets cannot be assessed
    M0 No distant metastasis
    M1 Distant metastasis
  Histologic grade GX Grade cannot be assessed
    G1 Well differentiated
    G2 Moderately differentiated
    G3 Poorly differentiated
    G4 Undifferentiated
  Residual tumor RX Residual tumor cannot be assessed
    R0 All margins are free of tumor
    R1 Incomplete resection, microscopic tumour present at margin
    R2 Incomplete resection, gross tumour present at margin
  Venous /  Lymphatic Invasion   V, L - see note