Histopathology Report

• tumour type - ampulla/bile duct: adenocarcinoma

- pancreas: benign/of low malignant potential/adenocarcinoma/endocrine tumour/other.

• tumour differentiation/grade:

- ampullary/bile duct adenocarcinoma: well/moderate/poor.

- pancreatic carcinoma well/grade 1 > 95% glands moderate/grade 2 50-95% glands poor/grade 3 5-49% glands undifferentiated/grade 4 < 5% glands

• tumour edge - pushing/infiltrative/lymphoid response.

• extent of local tumour spread

Ampulla.

pTis carcinoma in situ.

pT1 tumour limited to the ampulla or sphincter of Oddi. pT2 tumour invades duodenal wall. pT3 tumour invades pancreas.

pT4 tumour invades peripancreatic soft tissues, or other adjacent organs or structures. Pancreas.

pTis carcinoma in situ.

pT1 tumour limited to the pancreas, < 2 cm maximum dimension. pT2 tumour limited to the pancreas, > 2 cm dimension.

pT3 tumour extends beyond pancreas, but without involvement of coeliac axis or superior mesenteric artery. pT4 tumour involves coeliac axis or superior mesenteric artery.

Extrahepatic bile ducts.

pT1 tumour confined to the bile duct.

pT2 tumour invades beyond the wall of the bile duct.

pT3 tumour invades the liver, gall bladder, pancreas, and/or unilateral tributaries of the portal vein (right or left) or hepatic artery (right or left). pT4 tumour invades any of the following: main portal vein or its tributaries bilaterally, common hepatic artery, or other adjacent structures, e.g., colon, stomach, duodenum, abdominal wall.

• lymphovascular invasion - present/not present. Perineural space or lymphovascular invasion is present in up to 50% of pancreaticobiliary carcinomas with spread to regional nodes at diagnosis. Involvement of large named vessels, e.g., portal vein, is a major determinant of postoperative survival.

• regional lymph nodes: peripancreatic, pancreaticoduodenal, pyloric and proximal mesen-teric. Also coeliac (for head of pancreas tumour), and tail of pancreas/splenic hilum nodes (for body/tail of pancreas tumours). Also cystic duct, pericholedochal and periportal (for extrahepatic bile duct tumours).

pN0 no regional lymph node metastasis. pN1 metastasis in regional lymph node(s).

• excision margins.

- proximal gastric and distal duodenal limits of tumour clearance (cm).

- distal pancreatic surgical margin/common bile duct margin of tumour clearance (mm) -also, is mucosal dysplasia present?

- peripancreatic edge tumour clearance (mm) - superior/inferior/anterior capsule/posterior retroperitoneal/medial (superior mesenteric vein). The peripancreatic circumferential margin is the most commonly involved.

- for extrahepatic bile duct cancer - tumour clearance (mm) of the distal and proximal bile duct, hepatic and radial resection margins.

• other pathology.

- duodenal adenoma(s), secondary pancreatitis, fat necrosis, calculi, ulcerative colitis, sclerosing cholangitis, choledochal cysts.

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