Extent Of Local Tumour Spread

Border: pushing/infiltrative. Lymphocytic reaction: prominent/sparse. Characteristic perineural spread (25% of cases). The TNM classification applies only to carcinomas.

pTis carcinoma in situ pT1 tumour limited to gall bladder wall a. lamina propria b. muscularis pT2 tumour invades perimuscular connective tissue, no extension beyond serosa or into liver pT3 tumour perforates serosa and/or directly invades the liver and/or directly invades one adjacent organ, e.g. stomach, duodenum, colon, pancreas, omentum, extrahepatic bile ducts pT4 tumour invades main portal vein or hepatic artery, or invades two or more extrahepatic organs or structures.

Note that carcinoma in situ and adenocarcinoma may extend into Rokitansky-Aschoff sinuses and this must be distinguished from deeply invasive tumour which shows a lack of low-power lobular organization, deficient basement membrane and stromal desmoplasia.

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