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Slide tutorial – case 2
68yo male – Whipples resection.
Review the digital slide here
Macroscopic and microscopic images
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- Macroscopic – Coronal section through ampulla with pancreatic head lesion
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- Close up macroscopic appearance of the lesion
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- Low power of head of pancreas with lesion
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- Lesion surrounding residual pancreatic tissue
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- Tumour surrounding residual pancreatic islets
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- Spindled tumour cells
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- Tumour arranged in vague fascicles
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- Focal residual glandular differentiation
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- Tumour cells showing strong cytokeratin staining (AE1/AE3)
Diagnosis:
Video tutorial
[youtube]http://youtu.be/Vv2_BIVXRRE[/youtube]
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
