From: Clinicopathological features and surgical outcomes of neuroendocrine tumors of ampulla of Vater
WHO classification (2010) | ||||||||
---|---|---|---|---|---|---|---|---|
Grade 1 | <2 mitoses/10 HPF and <3% Ki–67 | |||||||
Grade 2 | 2–20 mitoses/10 HPF or 3–20% Ki–67 | |||||||
Grade 3 | >20 mitoses/10 HPF or >20% Ki–67 | |||||||
TNM staging system | ||||||||
ENETS (2006) | UICC (7th edition, 2009) | |||||||
T – primary tumor | ||||||||
Tx | Primary tumour cannot be assessed | |||||||
T0 | No evidence of primary tumour | |||||||
T1 | Invasion of lamina propria or submucosa and size ≤ 1 cm | Limited to ampulla of Vater or sphincter of Oddi | ||||||
T2 | Invasion of muscularis propria or size > 1 cm | Invasion of the duodenum wall | ||||||
T3 | Invasion of the pancreas or retroperitoneum | Invasion of the pancreas | ||||||
T4 | Invasion of the peritoneum or other organs | Invasion in peripancreatic soft tissues or other adjacent organs or structures | ||||||
N – regional lymph nodes | ||||||||
Nx | Regional lymph nodes cannot be assessed | |||||||
N0 | No regional lymph node metastasis | |||||||
N1 | Regional lymph node metastasis present | |||||||
M – distant metastasis | ||||||||
Mx | Distant metastasis cannot be assessed | |||||||
M0 | No distant metastasis | |||||||
M1 | Distant metastasis present | |||||||
Staging | Stage I | T1 | N0 | M0 | Stage Ia | T1 | N0 | M0 |
Stage IIa | T2 | N0 | M0 | Stage Ib | T2 | N0 | M0 | |
Stage IIb | T3 | N0 | M0 | Stage IIa | T3 | N0 | M0 | |
Stage IIIa | T4 | N0 | M0 | Stage IIb | T1–3 | N1 | M0 | |
Stage IIIb | Any T | N1 | M0 | Stage III | T4 | Any N | M0 | |
Stage IV | Any T | Any N | M1 | Stage IV | Any T | Any N | M1 |