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Procedure

Ampullectomy Pancreaticoduodenectomy (Whipple) Other Not specified

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Tumor Site

Intra-ampullary, arising from intra-ampullary papillary-tubular neoplasm (IAPN) Intra-ampullary, ampullary ductal (pancreaticobiliary-type) Peri-ampullary/ampullary duodenal Intra-ampullary and peri-ampullary (mixed type) Other Cannot be determined Not specified

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Tumor Size (cm)

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Histologic Type

Adenocarcinoma Adenocarcinoma, pancreaticobiliary type Adenocarcinoma, intestinal type Mucinous adenocarcinoma Signet-ring cell carcinoma Medullary carcinoma Invasive papillary adenocarcinoma Adenosquamous carcinoma Large cell neuroendocrine carcinoma Small cell neuroendocrine carcinoma Undifferentiated carcinoma Mixed adenoneuroendocrine carcinoma Other histologic type Carcinoma, not otherwise specified

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Histologic Grade

G1: Well differentiated G2: Moderately differentiated G3: Poorly differentiated Other GX: Cannot be assessed Not applicable

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Tumor Extension

No evidence of primary tumor Carcinoma in situ/high-grade dysplasia Tumor limited to ampulla of Vater or sphincter of Oddi Tumor invades beyond sphincter of Oddi (perisphincteric invasion) Tumor invades into duodenal submucosa Tumor invades into muscularis propria of the duodenum Tumor directly invades pancreas up to 0.5 cm Tumor extends more than 0.5 cm into pancreas Tumor extends into peripancreatic soft tissues Tumor extends into periduodenal tissue Tumor extends into duodenal serosa Tumor invades other adjacent organs Tumor involves posterior surface of pancreas Tumor involves anterior surface of pancreas Tumor involves vascular bed/groove (corresponding to superior mesenteric vein/portal vein) Cannot be assessed

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Margins

All margins are uninvolved by invasive carcinoma or high-grade intraepithelial neoplasia One or more margins involved by neoplasia

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Lymphovascular Invasion

Not identified Present Cannot be determined

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+ Perineural Invasion

Not identified Present Cannot be determined

Check here if any lymph nodes submitted?

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Pathologic Staging (pTNM)

TNM Descriptors (select all that apply)

Not applicable m r y

pT

pTX: Primary tumor cannot be assessed pT0: No evidence of primary tumor pTis: Carcinoma in situ pT1a: Tumor limited to ampulla of Vater or sphincter of Oddi pT1b: Tumor invades beyond the sphincter of Oddi and/or into the duodenal submucosa pT2: Tumor invades into the muscularis propria of the duodenum pT3a: Tumor directly invades the pancreas (up to 0.5 cm) pT3b: Tumor extends more than 0.5 cm into the pancreas pT3b: Tumor extens into peripancreatic / periduodenal tissue / duodenal serosa without involvement of the celiac axis or superior mesenteric artery pT4: Tumor involves the celiac axis, superior mesenteric artery, and/or common hepatic artery, irrespective of size

pN

pNX: Regional lymph nodes cannot be assessed pN0: No regional lymph node metastasis pN1: Metastasis to one to three regional lymph nodes pN2: Metastasis to four or more regional lymph nodes

pM

pMx: Not applicable pM1: Distant metastasis

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+ Additional Pathologic Findings

None identified Dysplasia/Adenoma Other