Slide tutorial – case 2

68yo male – Whipples resection.

Review the digital slide here

Macroscopic and microscopic images


Spoiler Inside SelectShow

Video tutorial


Case discussion

This is an important case because for the most part the tumour cells are undifferentiated…….but there are morphological clues to get to a diagnosis (at least a preferred diagnosis).

The key features to take away include;

  • This is a malignant tumour with predominantly spindle cell morphology
  • There is localised residual glandular differentiation to indicate epithelial origin…..even without the cytokeratin!
  • Carcinoma of the distal common bile duct can present as undifferentiated spindle cell tumour, and should be included in the DDx of a spindle cell lesion at this site.

Extended learning topics

Outline a DDx, and a solution to diagnosing a spindled / inflammatory ‘lesion’ in the peri-ampullary region
Discuss the macroscopic handling of a Whipple’s specimen.


Drop me a line or call me at TissuPath if you want to discuss any of these cases further


This case has been de-identified and is intended for educational purposes only

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