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Slide tutorial – case 2

68yo male – Whipples resection.

Review the digital slide here

Macroscopic and microscopic images

Diagnosis:

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

Andrew

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


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