Download - 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 -

Vimentin EMA

CD10 PAX8

Diagnosis? Metastatic renal cell carcinoma

Soldiers and Sailors Monument on the Circle

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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 –

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

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

Other immunostains… TTF1 – Napsin A –

Other immunostains… GATA3 – GCDFP-15 –

Other immunostains… BER-EP4 + MOC-31 +

Estrogen receptor

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

Progesterone Receptor

CK 7 CK 20

Diagnosis? Metastatic lung squamous cell carcinoma???