Pancreatic Neuroendocrine Tumor (NET) Synoptic Report — CAP elements with AJCC 9th Edition (auto stage)
Case / Specimen
Tumor / Pathologic features
AJCC 9 (pancreas NET) pT summary (expanded): - pT1: Tumor ≤2 cm limited to pancreas. - pT2: Tumor >2–4 cm limited to pancreas. - pT3: Tumor >4 cm OR tumor of any size extending beyond pancreas (peripancreatic soft tissue) without involvement of celiac axis or SMA. - pT4: Tumor involves the celiac axis or superior mesenteric artery (unresectable arterial involvement).
Notes specific to NETs: - Grading (mitotic count, Ki‑67) critically affects prognosis but does not alter anatomic T. - Small (<2 cm) well-differentiated NETs may have excellent prognosis; nonetheless report exact size, nodal status, and grade. - For enucleations, margin assessment and tumor relation to main pancreatic duct should be detailed.
Resection margins / specimen orientation
Regional lymph nodes
AJCC 9 (pancreas NET) pN summary: - pN0: No regional lymph node metastasis. - pN1: Regional lymph node metastasis present (record number positive and total examined).
Notes: - Nodal metastasis in NETs has prognostic significance; report number of positive nodes, size of deposits, and ENE. - For certain NETs (midgut vs pancreas), nodal disease patterns differ; document stations sampled.
Distant metastasis
AJCC 9 (pancreas NET) pM summary: - pM0: No distant metastasis identified. - pM1: Distant metastasis present (biopsy-proven when possible).
Any M1 = Stage IV. - In NETs, liver metastases are common and may be numerous; document sites (liver, bone, lung), number and size of lesions, and method of confirmation. - For some well-differentiated NETs, presence of metastasis may not preclude long survival—document burden and resectability.
AJCC 9 Stage Group Guidance (expanded)
Simplified AJCC 9 anatomic stage grouping for pancreatic NET (guidance — confirm with AJCC 9 tables): - Stage I: pT1–pT2, N0, M0 (small organ‑confined tumors). - Stage II: pT3, N0, M0 OR pT1–T3 with limited nodal disease (site-specific combinations apply). - Stage III: pT4 and/or more extensive regional nodal disease (site-dependent). - Stage IV: Any M1 (distant metastasis).
Notes: - Grade (WHO) and functional status are major prognostic determinants for NETs; prognostic staging often incorporates grade separate from anatomic stage. - Use AJCC 9 tables for exact substage combination.