Ampulla of Vater
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Ampulla of Vater (ICD‐O C24.1) Rules for Classification The classification applies only to carcinomas. There should be histological confirmation of the disease. The following are the procedures for assessing T, N, and M categories. T categories Physical examination, imaging, and/or surgical exploration N categories Physical examination, imaging, and/or surgical exploration M categories Physical examination, imaging, and/or surgical exploration
The regional lymph nodes are the same as for the head of the pancreas and are the lymph nodes along the common bile duct, common hepatic artery, portal vein, pyloric, infrapyloric, subpyloric, proximal mesenteric, coeliac, posterior and anterior pancreaticoduodenal vessels, and along the superior mesenteric vein and right lateral wall of the superior mesenteric artery. Note The splenic lymph nodes and those of the tail of the pancreas are not regional; metastases to these lymph nodes are coded M1.
TNM Clinical Classification T – Primary Tumour TX T0 Tis
Primary tumour cannot be assessed No evidence of primary tumour Carcinoma in situ
T1a Tumour limited to ampulla of Vater or sphincter of Oddi T1b Tumour invades beyond the sphincter of Oddi (perisphincteric inva sion) and/or into the duodenal submucosa T2 Tumour invades the muscularis propria of the duodenum T3 Tumour invades pancreas T3a Tumour invades 0.5 cm or less into the pancreas T3b Tumour invades more than 0.5 cm into the pancreas or extends into peripancreatic tissue or duodenal serosa but without involvement of the celiac axis or the superior mesenteric artery
Digestive System
Regional Lymph Nodes
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Digestive System Tumours
T4 Tumour with vascular involvement of the superior mesenteric artery or celiac axis, or common hepatic artery
N – Regional Lymph Nodes NX N0 N1 N2
Regional lymph nodes cannot be assessed No regional lymph node metastasis Metastasis in 1 or 2 regional lymph nodes Metastasis in 3 or more regional lymph nodes
M – Distant Metastasis M0 No distant metastasis M1 Distant metastasis
pTNM Pathological Classification The pT and pN categories correspond to the T and N categories. For pM see page 8. pN0 Histological examination of a regional lymphadenectomy specimen will ordinarily include 12 or more lymph nodes. If the lymph nodes are negative, but the number ordinarily examined is not met, clas sify as pN0.
Stage – Ampulla of Vater Stage 0 Stage IA Stage IB Stage IIA Stage IIB Stage IIIA Stage IIIB Stage IIIB Stage IV
Tis T1a T1b,T2 T3a T3b T1a, T1b, T2, T3 Any T T4 Any T
N0 N0 N0 N0 N0 N1 N2 Any N Any N
M0 M0 M0 M0 M0 M0 M0 M0 M1