eyas m. hattab, m.d. department of pathology and laboratory medicine scientific committee of the...

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 20

CK 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 -


CK 20 + CK 20 -





Vimentin EMA

CD10 PAX8

Diagnosis?

Metastatic renal cell carcinoma

Soldiers and Sailors Monument on the Circle

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=OWRGCHRWhRePLM&tbnid=fWtIM5emg-IgHM:&ved=0CAUQjRw&url=http://commons.wikimedia.org/wiki/File:Monument_Circle_and_historic_district.jpg&ei=jt17UqbOEem2yAG9-oD4Ag&psig=AFQjCNFslwNkwifKOCkKtLQ9Uunv5Z_s9Q&ust=1383935692727097

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&docid=H8ZiFSW4qHHxGM&tbnid=jdh2N-wLolS0sM:&ved=0CAUQjRw&url=http://en.wikipedia.org/wiki/E_Pluribus_Unum_(Wilson)&ei=Q957Us-8EsfQyAG1rYDYCw&psig=AFQjCNFslwNkwifKOCkKtLQ9Uunv5Z_s9Q&ust=1383935692727097

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 –


CK 20 + 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


CK 20 + CK 20 -





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


CK 20 + CK 20 -





Other immunostains…

TTF1 – Napsin A –


CK 20 + CK 20 -






GATA3 – GCDFP-15 –


CK 20 + CK 20 -






BER-EP4 + MOC-31 +


CK 20 + CK 20 -





Estrogen receptor


CK 20 + CK 20 -






CDX2 +!


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???

eyas m. hattab, m.d. department of pathology and laboratory medicine scientific committee of the...

Documents

thyroglobulin slide

ck20 slide

ck7ck20 slide

psappsap501s slide

cd10pax8 slide

vimentinema slide

p40 slide

circle slide