Eyas M. Hattab , M.D. Department of Pathology and Laboratory Medicine
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Transcript of Eyas M. Hattab , M.D. Department of Pathology and Laboratory Medicine
Eyas M. Hattab, M.D.Department of Pathology and
Laboratory Medicine
Scientific Committee of the ADIAP 25th Annual Congressand the 5th JSP International Conference
Slide Seminar – Case PresentationWorkup of Undifferentiated
Malignant Neoplasms
Case #1 71 yo M History of partial thyroidectomy one year ago Presents with arm weakness MRI of the spine shows a mass lesion involving C6-
T1 vertebral bodies and secondary pathologic fracture
Immunostains? TTF-1 Thyroglobulin
TTF-1 Thyroglobulin
Diagnosis? Metastatic follicular thyroid carcinoma
Indianapolis Central Library
Case #2 59 yo M History of “esophageal surgery” one month ago Presents with cervical vertebral body
“osteomyelitis” Vertebral body biopsy performed
Immunostains? Squamous cell carcinoma
CK 5/6 P63 ?p40
CK cocktail p63 CK 5/6
Diagnosis? Metastatic squamous cell carcinoma, of esophageal
origin
Indiana State Capitol
Case #3 48 yo F History of breast carcinoma ten years ago Presents with new onset headaches Brain MRI shows a left frontal lobe mass
Immunostains? H&E Dx: PD Carcinoma, likely breast Recommended IHC workup:
CK7/20 GATA-3 GCDFP Mammaglobin ER/PR/Her2 (if requested or diagnostically relevant)
Immunostains? CK7 + / CK20 -
Cytokeratins 7 and 20CK 20 + CK 20 -
CK 7 + Urothelial cell carcinomaOvarian mucinous carcinomaPancreatic adenocarcinoma
Lung adenocarcinomaBreast carcinomaOvarian serous carcinomaEndometrial adenocarcinomaCervical squamous cell caMesothelioma
CK7 - Colorectal carcinomaMerkel cell carcinoma
Hepatocellular carcinomaRenal cell carcinomaProstate adenocarcinomaSquamous cell carcinoma
Estrogen ReceptorHer2/neuGATA-3
Diagnosis? Metastatic breast carcinoma
Indianapolis Museum of Art
Case #4 63 yo F Presents with headache Brain MRI shows a left frontal peripherally
enhancing mass with central necrosis located in the deep white matter
No known history!
Immunostains? H&E Dx: carcinoma, likely renal cell Recommended IHC workup:
CK7/CK20 Two of the following:
Vimentin EMA CD10 PAX8
Immunostains? CK7 - / CK20 -
Cytokeratins 7 and 20CK 20 + CK 20 -
CK 7 + Urothelial cell carcinomaOvarian mucinous carcinomaPancreatic adenocarcinoma
Lung adenocarcinomaBreast carcinomaOvarian serous carcinomaEndometrial adenocarcinomaCervical squamous cell caMesothelioma
CK7 - Colorectal carcinomaMerkel cell carcinoma
Hepatocellular carcinomaRenal cell carcinomaProstate adenocarcinomaSquamous cell carcinoma
Vimentin EMA
CD10 PAX8
Diagnosis? Metastatic renal cell carcinoma
Soldiers and Sailors Monument on the Circle
Case #5 65 yo M Presents with sacroiliitis, retroperitoneal
adenopathy, and abnormal bone marrow signal in T1 and T2
Clinical diagnosis: lymphoma The bone marrow biopsy: initially worked up in
hematopathology
Immunostains? Keratin cocktail CK7 CK20
Keratin cocktail
Immunostains? CK 7 – CK 20 –
Cytokeratins 7 and 20CK 20 + CK 20 -
CK 7 + Urothelial cell carcinomaOvarian mucinous carcinomaPancreatic adenocarcinoma
Lung adenocarcinomaBreast carcinomaOvarian serous carcinomaEndometrial adenocarcinomaCervical squamous cell caMesothelioma
CK7 - Colorectal carcinomaMerkel cell carcinoma
Hepatocellular carcinomaRenal cell carcinomaProstate adenocarcinomaSquamous cell carcinoma
PSAP PSA P501S
Diagnosis? Metastatic prostatic adenocarcinoma
Bankers Life Fieldhouse
Case #6 51 yo F Presented to an outside facility with headache Imaging studies revealed a right occipital mass with
rim enhancement
Immunostains? Keratin cocktail CK 7 CK 20 TTF-1 Napsin A GATA 3
Keratin cocktail
CK7 CK20
Cytokeratins 7 and 20CK 20 + CK 20 -
CK 7 + Urothelial cell carcinomaOvarian mucinous carcinomaPancreatic adenocarcinoma
Lung adenocarcinomaBreast carcinomaOvarian serous carcinomaEndometrial adenocarcinomaCervical squamous cell caMesothelioma
CK7 - Colorectal carcinomaMerkel cell carcinoma
Hepatocellular carcinomaRenal cell carcinomaProstate adenocarcinomaSquamous cell carcinoma
TTF-1 Napsin A
GATA 3
Diagnosis? Metastatic lung adenocarcinoma
Arial view of IUPUI and Indy
Case #7 57 yo M Presented with a spontaneous intraparenchymal
hemorrhage in the right temporal lobe
Immunostains? H&E Dx: adenocarcinoma, likely papillary thyroid Recommended IHC workup:
CK7/20 TTF1 Napsin A Thyroglobulin Pax8
Immunostains? CK7 + CK 20 –
TTF-1 Napsin A
Immunostains? Thyroglobulin + PAX8 +
Diagnosis? Metastatic papillary thyroid carcinoma
IU Health Pathology Laboratory and the Central Canal
Case #8 56 yo F Limited past medical history, presented to the
county emergency room with heavy vaginal bleeding
Imaging studies revealed a large abdominal mass with extension into and pathologic fracture of the L3 vertebral body
Immunostains? CK 7 CK 20
CK7 CK20
Cytokeratins 7 and 20CK 20 + CK 20 -
CK 7 + Urothelial cell carcinomaOvarian mucinous carcinomaPancreatic adenocarcinoma
Lung adenocarcinomaBreast carcinomaOvarian serous carcinomaEndometrial adenocarcinomaCervical squamous cell caMesothelioma
CK7 - Colorectal carcinomaMerkel cell carcinoma
Hepatocellular carcinomaRenal cell carcinomaProstate adenocarcinomaSquamous cell carcinoma
Cytokeratins 7 and 20CK 20 + CK 20 -
CK 7 + Urothelial cell carcinomaOvarian mucinous carcinomaPancreatic adenocarcinoma
Lung adenocarcinomaBreast carcinomaOvarian serous carcinomaEndometrial adenocarcinomaCervical squamous cell caMesothelioma
CK7 - Colorectal carcinomaMerkel cell carcinoma
Hepatocellular carcinomaRenal cell carcinomaProstate adenocarcinomaSquamous cell carcinoma
Other immunostains… TTF1 – Napsin A –
Cytokeratins 7 and 20CK 20 + CK 20 -
CK 7 + Urothelial cell carcinomaOvarian mucinous carcinomaPancreatic adenocarcinoma
Lung adenocarcinomaBreast carcinomaOvarian serous carcinomaEndometrial adenocarcinomaCervical squamous cell caMesothelioma
CK7 - Colorectal carcinomaMerkel cell carcinoma
Hepatocellular carcinomaRenal cell carcinomaProstate adenocarcinomaSquamous cell carcinoma
Cytokeratins 7 and 20CK 20 + CK 20 -
CK 7 + Urothelial cell carcinomaOvarian mucinous carcinomaPancreatic adenocarcinoma
Lung adenocarcinomaBreast carcinomaOvarian serous carcinomaEndometrial adenocarcinomaCervical squamous cell caMesothelioma
CK7 - Colorectal carcinomaMerkel cell carcinoma
Hepatocellular carcinomaRenal cell carcinomaProstate adenocarcinomaSquamous cell carcinoma
Other immunostains… GATA3 – GCDFP-15 –
Cytokeratins 7 and 20CK 20 + CK 20 -
CK 7 + Urothelial cell carcinomaOvarian mucinous carcinomaPancreatic adenocarcinoma
Lung adenocarcinomaBreast carcinomaOvarian serous carcinomaEndometrial adenocarcinomaCervical squamous cell caMesothelioma
CK7 - Colorectal carcinomaMerkel cell carcinoma
Hepatocellular carcinomaRenal cell carcinomaProstate adenocarcinomaSquamous cell carcinoma
Cytokeratins 7 and 20CK 20 + CK 20 -
CK 7 + Urothelial cell carcinomaOvarian mucinous carcinomaPancreatic adenocarcinoma
Lung adenocarcinomaBreast carcinomaOvarian serous carcinomaEndometrial adenocarcinomaCervical squamous cell caMesothelioma
CK7 - Colorectal carcinomaMerkel cell carcinoma
Hepatocellular carcinomaRenal cell carcinomaProstate adenocarcinomaSquamous cell carcinoma
WT1
Cytokeratins 7 and 20CK 20 + CK 20 -
CK 7 + Urothelial cell carcinomaOvarian mucinous carcinomaPancreatic adenocarcinoma
Lung adenocarcinomaBreast carcinomaOvarian serous carcinomaEndometrial adenocarcinomaCervical squamous cell caMesothelioma
CK7 - Colorectal carcinomaMerkel cell carcinoma
Hepatocellular carcinomaRenal cell carcinomaProstate adenocarcinomaSquamous cell carcinoma
Cytokeratins 7 and 20CK 20 + CK 20 -
CK 7 + Urothelial cell carcinomaOvarian mucinous carcinomaPancreatic adenocarcinoma
Lung adenocarcinomaBreast carcinomaOvarian serous carcinomaEndometrial adenocarcinomaCervical squamous cell caMesothelioma
CK7 - Colorectal carcinomaMerkel cell carcinoma
Hepatocellular carcinomaRenal cell carcinomaProstate adenocarcinomaSquamous cell carcinoma
Other immunostains… BER-EP4 + MOC-31 +
Cytokeratins 7 and 20CK 20 + CK 20 -
CK 7 + Urothelial cell carcinomaOvarian mucinous carcinomaPancreatic adenocarcinoma
Lung adenocarcinomaBreast carcinomaOvarian serous carcinomaEndometrial adenocarcinomaCervical squamous cell caMesothelioma
CK7 - Colorectal carcinomaMerkel cell carcinoma
Hepatocellular carcinomaRenal cell carcinomaProstate adenocarcinomaSquamous cell carcinoma
Cytokeratins 7 and 20CK 20 + CK 20 -
CK 7 + Urothelial cell carcinomaOvarian mucinous carcinomaPancreatic adenocarcinoma
Lung adenocarcinomaBreast carcinomaOvarian serous carcinomaEndometrial adenocarcinomaCervical squamous cell caMesothelioma
CK7 - Colorectal carcinomaMerkel cell carcinoma
Hepatocellular carcinomaRenal cell carcinomaProstate adenocarcinomaSquamous cell carcinoma
Estrogen receptor
Cytokeratins 7 and 20CK 20 + CK 20 -
CK 7 + Urothelial cell carcinomaOvarian mucinous carcinomaPancreatic adenocarcinoma
Lung adenocarcinomaBreast carcinomaOvarian serous carcinomaEndometrial adenocarcinomaCervical squamous cell caMesothelioma
CK7 - Colorectal carcinomaMerkel cell carcinoma
Hepatocellular carcinomaRenal cell carcinomaProstate adenocarcinomaSquamous cell carcinoma
Other immunostains… CDX2 +!
Other immunostains… Caveat: CDX2 may be aberrantly expressed in
endometrial adenocarcinoma!
Diagnosis? Metastatic endometrial adenocarcinoma
THANK YOU!
Case #10 65 yo M Presented with new onset seizures
Immunostains? CK AE1/3 EMA PR CK7 CK20 p63
Anaplastic meningioma (NP852) Reactive Immunostains
Ki67 PR AE1/AE3 P63 EMA
Negative Immunostains Synaptophysin GFAP CDX2 CK5/6 CD45RB S100 protein CK20 CK7 CD34 Napsin A
CK AE1/3
EMA
Progesterone Receptor
CK 7 CK 20
p63
Diagnosis? Metastatic lung squamous cell carcinoma???