CARCINOMA OF UNKNOWN PRIMARY: DIAGNOSTIC APPROACH USING IMMUNOHISTOCHEMISTRY

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "CARCINOMA OF UNKNOWN PRIMARY: DIAGNOSTIC APPROACH USING IMMUNOHISTOCHEMISTRY"

Transcription

1 CARCINOMA OF UNKNOWN PRIMARY: DIAGNOSTIC APPROACH USING IMMUNOHISTOCHEMISTRY Jason L Hornick, MD, PhD Director of Surgical Pathology Director of Immunohistochemistry Brigham and Women s Hospital Associate Professor of Pathology Harvard Medical School Boston, MA, USA Carcinoma of unknown primary Definition: histologically confirmed metastatic carcinoma for which primary site cannot be identified after standard diagnostic approach: Detailed history and physical examination Blood counts and biochemical analysis Urinalysis and stool occult blood test CT of thorax, abdomen, and pelvis Histologic review including IHC Carcinoma of unknown primary Account for 2-5% of malignancies diagnosed in the US 7 th or 8 th most frequent cancer 4 th or 5 th most common cause of cancer death in both sexes 31,000 new cases in the US in 2012 down from 45,000 new cases in 1995 Improved radiologic imaging Increasingly specific IHC markers Page 1 1

2 Origin of primary tumors (autopsy) Organ Incidence Pancreas 20-25% Lung 15-20% Colon/rectum 5-10% Liver/biliary 5-10% Stomach 5% Kidney 5% Ovary <5% Prostate <5% Breast 2% Other 1% Histologic groups of carcinoma of unknown primary Histology Well or moderately differentiated adenocarcinoma Poorly differentiated adenocarcinoma or undifferentiated carcinoma Frequency 60% 30% Squamous cell carcinoma 5% Undifferentiated malignant neoplasm 5% Overview Distribution of keratin family members in carcinomas Lineage-restricted markers and primary site determination Primary tumors of the liver and mimics Squamous cell carcinomas Primary site determination for metastatic neuroendocrine tumors Page 2 2

3 Keratin family members in carcinomas Low-molecular-weight keratins (CK8, CK18, CAM5.2) Glandular epithelium, hepatocytes High-molecular-weight keratins (CK5, CK14, 34βE12) Squamous epithelium, urothelium, basal cells Keratin family members in carcinomas: CK7 and CK20 CK7 wide distribution in epithelial cells CK20 restricted to lower GI tract epithelium, umbrella cells of the urinary bladder, Merkel cells CK7 and CK20 are they (still) useful? Phenotype Primary sites CK7 / CK20+ Colon/rectum CK7+ / CK20+ Bladder, upper GI, pancreas CK7 / CK20 Uncommon (prostate, HCC) CK7+ / CK20 Nearly everything else Page 3 3

4 Metastatic colonic adenocarcinoma CK20 Metastatic colonic adenocarcinoma CK7 Metastatic colonic adenocarcinoma CK20 Page 4 4

5 IHC for lineage/site specification: cytoplasmic/membranous markers Primary site Bladder Breast Breast Colon/rectum Lung Prostate Prostate Thyroid Marker Uroplakin GCDFP-15 (prolactin-inducible protein) Mammaglobin (SCGB2A1/A2) Villin Napsin A Prostate-specific antigen Prostatic acid phosphatase Thyroglobulin IHC for lineage/site specification: cytoplasmic/membranous markers In general, expression is decreased (or entirely absent) with poor differentiation significant impact on sensitivity Breast carcinoma GCDFP Page 5 5

6 Breast carcinoma GCDFP Breast carcinoma mammaglobin Expression of mammaglobin in other tumor types Tumor type Endometrial endometrioid adenocarcinoma Frequency 20-40% Skin adnexal carcinomas 20-40% Salivary gland neoplasms 20-50% Page 6 6

7 Prostatic adenocarcinoma PSA Lung adenocarcinoma Napsin A Napsin A Warning: napsin A is also positive in most papillary renal cell carcinomas Page 7 7

8 IHC for lineage/site specification: nuclear transcription factors Insights gained from developmental and cell biology research Transcription factors involved in patterning of organ systems, lineage commitment Some are highly specific for particular cell type or visceral organ Others show expression limited to several tissue types Very helpful in determining primary site for CUP IHC for lineage/site specification: nuclear transcription factors 10 years ago, very few were used in surgical pathology practice TTF1, CDX2, MYOG In 2016, over 50 markers with potential diagnostic applications are available Carcinomas, lymphomas, melanoma, germ cell tumors, sarcomas IHC for lineage/site specification: nuclear transcription factors Transcription factor Primary site CDX2 GATA3 NKX3-1 OCT4 PAX8 SALL4 SATB2 SF1 TTF1 (NKX2-1) WT1 Colon/rectum, upper GI Breast, bladder Prostate Seminoma, embryonal carcinoma Thyroid, kidney, Müllerian Germ cell tumors Colon/rectum Adrenal cortex Lung, thyroid Müllerian, mesothelioma Page 8 8

9 IHC for lineage/site specification: nuclear transcription factors In general, even poorly differentiated carcinomas maintain (relatively) diffuse expression in most cases high sensitivity With increasing study, specificity decreases Beware of relying on a single diagnostic marker TTF1 (NKX2-1) Lineage-specific transcription factor long history of use in diagnostic IHC Originally named for role in activating transcription from thyroglobulin promoter Expressed in normal and neoplastic thyroid follicular cells Most widely used application: ascribing lung origin to primary and metastatic adenocarcinomas (and supporting adenocarcinoma over squamous cell carcinoma in poorly differentiated NSCLCA) Lung adenocarcinoma TTF1 Page 9 9

10 Metastatic poorly differentiated lung adenocarcinoma TTF1 Poorly differentiated (insular) thyroid carcinoma TTF1 TTF1 Warning: TTF1 is also positive in a subset of endometrial adenocarcinomas (most common in grade 3 endometrioid and serous) Some variation in sensitivity and specificity based on particular clone Page 10 10

11 Expression of TTF1 in carcinomas I Primary site Positive cases Pulmonary (adenocarcinoma) 70-90% Pulmonary (squamous cell carcinoma) <10% Thyroid (all types) % Cholangiocarcinoma (extrahepatic) 5-25%* Endometrial 5-20%* Ovarian 5-30%* *These cases usually show expression in only a small fraction of tumor cells. Expression of TTF1 in carcinomas II Primary site Positive cases Gastric/esophageal <10% Cervical <5% Pancreatic <5% Breast <5% Urothelial <5% Colorectal <5% Hepatocellular <5% Salivary gland (adenoid cystic) 30-50% Salivary gland (other) <5% Adrenal cortical <5% TTF1: potential diagnostic pitfall Cytoplasmic staining relatively common Diffuse staining in normal hepatocytes and many hepatocellular carcinomas Likely represents cross-reactivity with CPS1 (antigen recognized by HepPar-1 antibody) Subset of adenocarcinomas from various sites (especially foregut) also show cytoplasmic staining Page 11 11

12 Hepatocellular carcinoma TTF1 WT1 Wilms tumor 1 Transcription factor plays diverse roles in cancer depending upon tumor type and biological context Expressed in malignant mesothelioma, serous carcinoma Positive in nearly all serous carcinomas of the ovary; uncommon in serous carcinomas of the endometrium (variable results in different studies) Malignant mesothelioma WT1 Page 12 12

13 Metastatic mesothelioma WT1 Metastatic serous carcinoma WT1 WT1 Among carcinomas, nuclear WT1 relatively specific for ovarian serous tumors Positive in <5% of breast, lung, gastric, colorectal, urothelial carcinomas Cytoplasmic staining detected in subset of other carcinomas and various other tumor types only nuclear staining should be considered positive for ascribing site of origin Page 13 13

14 CDX2 Caudal-type homeobox transcription factor involved in intestinal differentiation Nuclear expression in >90% colorectal adenocarcinomas Somewhat lower sensitivity in high grade and MSI-H carcinomas Widely used to support colorectal origin No significant loss of sensitivity in the metastatic setting Colonic adenocarcinoma CDX2 Metastatic colonic adenocarcinoma CDX2 Page 14 14

15 CDX2 Also expressed in carcinomas from other gastrointestinal primary sites associated with intestinal differentiation Esophagus and stomach Pancreas and biliary tree Often more heterogeneous staining in tumors from these other sites Particularly helpful in differential diagnosis between primary (poorly cohesive) gastric carcinoma and metastatic breast carcinoma Gastric adenocarcinoma CDX2 CDX2 Warning: CDX2 can also be positive in mucinous adenocarcinomas from diverse anatomic sites Ovary Lung Pancreas Bladder Page 15 15

16 Expression of CDX2 in carcinomas Primary site Positive cases Colorectal and appendiceal % Gastroesophageal 40-60% Pancreatic/biliary 30-50% Ovarian (mucinous and endometrioid) 40-60% Ovarian (serous) <10% Endometrial 5-10% Pulmonary (mucinous) 70-80% Pulmonary (non-mucinous) <5% Bladder (adenocarcinoma) 30-50% Bladder (urothelial) <5% Prostatic <5% Breast <5% Renal <5% GATA3 Transcription factor originally recognized for role in T-cell function Clinically useful as marker for breast or urothelial origin Positive in >80% of breast and urothelial carcinomas No significant loss of sensitivity in the metastatic setting More recent large surveys revealed expression in wide range of tumor types Bladder urothelial carcinoma GATA3 Page 16 16

17 Bladder urothelial carcinoma GATA3 Breast carcinoma GATA3 Breast carcinoma GATA3 Page 17 17

18 Expression of GATA3 in other tumors Tumor type Frequency Squamous cell carcinoma (skin) 80% Squamous cell carcinoma (cervix) 33% Squamous cell carcinoma (lung) 10% Lung adenocarcinoma 5-10% Skin adnexal carcinomas % Mesothelioma 25-60% Salivary gland tumors 20-50% Pancreatic ductal adenocarcinoma 40% Paraganglioma 80% Choriocarcinoma 100% Chromophobe renal cell carcinoma 50% Potential value of GATA3 in differential diagnosis Positive Negative Metastatic lobular breast carcinoma Gastric signet-ring-cell carcinoma Metastaticductal breast carcinoma Urothelial carcinoma Squamous cell carcinoma of skin Malignantmesothelioma Paraganglioma Choriocarcinoma, yolk sac tumor Lung/GI/ovarianadenocarcinoma Prostatic adenocarcinoma Squamous cell carcinoma of lung Lung adenocarcinoma Other neuroendocrine tumors Embryonalcarcinoma, seminoma Am J Surg Pathol. 38:13-22, 2014 NKX3-1 Homeobox transcription factor, androgendependent Expression limited to prostate Usually more diffusely positive than conventional cytoplasmic markers Helpful to distinguish high grade prostatic adenocarcinoma from urothelial carcinoma Helpful to suggest prostatic origin in metastatic carcinoma Page 18 18

19 Prostatic adenocarcinoma NKX3-1 Expression of NKX3-1 in carcinomas Primary site Positive cases Prostatic % Breast (lobular) 15-30% Breast (ductal) <10% Bladder (urothelial and adenocarcinoma) <5% Pancreatic/biliary <5% Hepatocellular <5% Renal <5% Colorectal <5% Gastroesophageal <5% Pulmonary <5% Thyroid <5% SATB2 More recently described transcription factor expressed in colorectal/appendiceal epithelium Similarly high sensitivity and likely higher specificity than CDX2 Positive in 80-90% of primary and metastatic colorectal adenocarcinomas Higher sensitivity than CDX2 for medullary carcinomas Unlike CDX2, SATB2 rarely expressed in gastroesophageal and pancreaticobiliary adenocarcinomas Page 19 19

20 Colonic adenocarcinoma SATB2 Poorly differentiated colonic adenocarcinoma SATB2 Expression of SATB2 in carcinomas Primary site Positive cases Colorectal and appendiceal % Renal 25-35% Gastroesophageal 10-20%* Pancreatic/biliary 10-20%* Mullerian 10-20%* Pulmonary 10-20%* Bladder (urothelial) 10-20%* Prostatic 5-15%* Breast 5-15%* Thyroid <5%* *These cases show expression in only a small fraction of tumor cells. Page 20 20

21 PAX8 One of the most widely used lineagespecific transcription factors in IHC approach to CUP Highly sensitive for carcinomas originating in ovary, kidney, thyroid >90% serous, endometrioid, and clear cell ovarian carcinomas positive for PAX8 Much lower rate of expression in ovarian mucinous adenocarcinomas PAX2 largely supplanted by PAX8 Expression of PAX8 in carcinomas I Primary site Positive cases Renal 85-95% Thyroid (papillary, follicular, poorly diff) % Thyroid (anaplastic, medullary) 60-80% Ovarian (non-mucinous) % Ovarian (mucinous) 10-40% Endometrial % Cervical % Renal cell carcinoma PAX8 Page 21 21

22 Ovarian clear cell carcinoma PAX8 Metastatic serous carcinoma PAX8 Metastatic serous carcinoma PAX8 Page 22 22

23 Metastatic serous carcinoma TTF1 Papillary thyroid carcinoma PAX8 Poorly differentiated thyroid carcinoma TTF1 PAX8 Page 23 23

24 Metastatic lung adenocarcinoma TTF1 PAX8 Pan-PAX? Widely used polyclonal anti-pax8 antibody not specific for PAX8 Cross-reacts with other PAX family members (PAX5, PAX6, PAX3) Responsible for staining in B lymphocytes (PAX5) Responsible for staining in pancreatic well-differentiated neuroendocrine tumors (PAX6) PAX8-specific monoclonal antibodies available PAX8 PAX5 PAX6 Page 24 24

25 Expression of PAX8 in carcinomas II Primary site Positive cases Thymic (polyclonal antibody) 80-90% Pancreatic/biliary 5-10% Bladder (urothelial) 10-20% Gastric/esophageal 5-10% Colorectal/appendiceal <5% Hepatocellular <5% Breast <5% Pulmonary (adenocarcinoma) <5% Pulmonary (squamous cell carcinoma) 0-30% Head and neck (squamous cell carcinoma) <5% Adrenal cortical <5% Skin (squamous cell carcinoma) <5% SF1 Steroidogenic factor 1 (NR5A1) Recently investigated transcription factor Highly sensitive marker for sex cordstromal tumor Highly sensitive marker for adrenal cortical carcinoma Particularly useful in distinguishing primary adrenal cortical carcinoma from metastatic renal cell carcinoma Adrenal cortical carcinoma SF1 Page 25 25

26 ER and PR In addition to role as predictive biomarkers in breast cancer, can be useful to ascribe primary site in certain contexts Hormone receptor-positive breast carcinomas retain expression in metastatic foci in >90% of cases Most useful in patients with known history of hormone receptor-positive breast cancer and other known or suspected malignancies ER and PR Also commonly expressed in primary carcinomas of gynecologic tract Most ovarian serous carcinomas express ER Can be helpful to distinguish serous from clear cell carcinoma ER and PR ER consistently negative in colorectal, gastroesophageal, hepatocellular, pancreatic/biliary carcinomas ER positive (generally weak/focal) in small subset of lung adenocarcinomas PR less specific: positive in 30% of cholangiocarcinomas; positive in small subset of gastroesophageal, pancreatic, hepatocellular carcinomas Page 26 26

27 Embryonic stem cell transcription factors Transcription factors involved in maintenance of pluripotency Large body of literature on role in embryonic stem cell biology Some of these transcription factors useful in diagnostic IHC OCT4 (also known as OCT3/4) widely used in clinical practice Other markers less often used Expression of embryonic stem cell transcription factors in germ cell tumors Subtype SALL4 OCT4 NANOG SOX2 Seminoma Embryonal carcinoma Yolk sac tumor ++++ Teratoma ++ Choriocarcinoma variable Seminoma OCT4 Page 27 27

28 Don t forget to consider a primary liver tumor! Hepatocellular carcinoma Alpha fetoprotein (AFP) Low sensitivity Polyclonal carcinoembryonic antigen (CEA) Bile canalicular pattern Carbamoyl-phosphate synthase 1 (CPS1) = Hep-Par 1 antibody Urea cycle enzyme Also expressed in 5-10% of adenocarcinomas of diverse sites Arginase 1 (ARG1) Urea cycle enzyme Appears to be most sensitive and specific Hepatocellular carcinoma pcea Page 28 28

29 Hepatocellular carcinoma CPS1/Hep-Par1 Hepatocellular carcinoma ARG1 Potential mimics of HCC Adrenal cortical carcinoma Inhibin Melan-A/MART1 (MLANA) A103 >> M2-7C10 SF1 (steroidogenic factor 1; NR5A1) Renal cell carcinoma RCC (renal cell carcinoma marker) low sensitivity in the metastatic setting PAX2 less sensitive than PAX8 PAX8 highly sensitive marker, also positive in thyroid and Müllerian carcinomas Poorly differentiated cholangiocarcinoma Page 29 29

30 Adrenal cortical carcinoma SF1 Metastatic renal cell carcinoma RCC Metastatic renal cell carcinoma PAX8 Page 30 30

31 Intrahepatic cholangiocarcinoma Radiologic features: Large solitary mass +/- satellite lesions Biliary dilatation Hepatic capsular retraction Delayed enhancement Lobar/segmental atrophy Histology/immunophenotype essentially indistinguishable from pancreatic ductal adenocarcinoma CK7/CK19 positive Loss of SMAD4 (~50%) When you encounter a CK7+ AdCA in the liver, consider cholangiocarcinoma Intrahepatic cholangiocarcinoma Capsular retraction Biliary dilatation Satellite Intrahepatic cholangiocarcinoma Satellite Capsular retraction Page 31 31

32 Intrahepatic cholangiocarcinoma Intrahepatic cholangiocarcinoma Pancreatic ductal carcinoma SMAD4 Page 32 32

33 Metastatic cholangiocarcinoma SMAD4 Adenosquamous carcinoma SMAD4 Squamous cell carcinoma: P63 and P40 Confirmation relatively straightforward P63 (also positive in urothelial and subset of adenocarcinomas; ~20% lung AdCA) P40 (much more specific for squamous cell and urothelial carcinomas) In general, IHC not helpful to determine primary site (other than P16: HPVassociated SCC of oropharynx, cervix, anal canal) In situ hybridization can be helpful (head and neck): EBER nasopharyngeal carcinoma High-risk HPV oropharyngeal carcinomas (tonsil, base of tongue) Page 33 33

34 Lung squamous cell carcinoma P40 Metastatic HPV-associated squamous cell carcinoma P16 Well-differentiated neuroendocrine tumors 10-20% of NET present as metastasis of unknown primary Midgut (ileum) >> pancreas >> other Determination of primary site increasingly important for well-differentiated NET Recent introduction of effective systemic therapies Different efficacies for midgut vs pancreatic origin Page 34 34

35 Systemic therapy for metastatic welldifferentiated neuroendocrine tumors Agent Mechanism Efficacy Midgut Pancreas Octreotide Somatostatin analogue + + Interferon-α Immune activation + + Streptozocin Alkylating agent + Temozolomide Alkylating agent + Everolimus mtor inhibitor +/ + Sunitinib Tyrosine kinase inhibitor + Bellizzi Adv Anat Pathol 2013 Transcription factor expression in welldifferentiated neuroendocrine tumors Transcription factor CDX2 ISL1 ppax8 PDX1 TTF1 Primary sites Midgut (ileum), appendix >> pancreas Pancreas Pancreas, duodenum, rectum Pancreas, duodenum Lung Transcription factor expression in welldifferentiated neuroendocrine tumors Transcription factor CDX2 ISL1 ppax8 PDX1 TTF1 Primary sites Midgut (ileum), appendix >> pancreas Pancreas Pancreas, duodenum, rectum Pancreas, duodenum Lung Page 35 35

36 CDX2 expression in well-differentiated neuroendocrine tumors Primary site Positive Lung <5% Stomach 15-30% Duodenum 30-45% Pancreas 15-20% Jejunum/ileum 90% Appendix 90% Rectum 0-30% CDX2 expression in well-differentiated neuroendocrine tumors Primary site Positive Lung <5% Stomach 15-30% Duodenum 30-45% Pancreas 15-20% Jejunum/ileum 90% Appendix 90% Rectum 0-30% Metastatic well-differentiated neuroendocrine tumor from ileum CDX2 Page 36 36

37 Metastatic well-differentiated neuroendocrine tumor from pancreas CDX2 Polyclonal PAX8 expression in welldifferentiated neuroendocrine tumors Primary site Positive Lung 0-10% Stomach 15% Duodenum 80% Pancreas 55-70% Jejunum/ileum 0% Appendix 15% Rectum 60% Polyclonal PAX8 expression in welldifferentiated neuroendocrine tumors Primary site Positive Lung 0-10% Stomach 15% Duodenum 80% Pancreas 55-70% Jejunum/ileum 0% Appendix 15% Rectum 60% Page 37 37

38 Pancreatic well-differentiated neuroendocrine tumor ppax8 Metastatic well-differentiated neuroendocrine tumor from ileum ppax8 Polyclonal PAX8 antibody PAX8 PAX6 PAX5 Page 38 38

39 Pancreatic well-differentiated neuroendocrine tumor PAX6 PDX1 Pancreatic and duodenal homeobox transcription factor Also known as insulin promoter factor 1 Necessary for pancreatic development Plays role in maturation of islet cells that secrete insulin (β-cells) and somatostatin (δ-cells) In adult pancreas, strong nuclear expression in islet cells, weak staining in centroacinar cells PDX1 expression in well-differentiated neuroendocrine tumors Primary site Positive Lung 0-5% Stomach 60% Duodenum 60% Pancreas 55-80% Jejunum/ileum 0% Appendix 40% Rectum 15% Page 39 39

40 PDX1 expression in well-differentiated neuroendocrine tumors Primary site Positive Lung 0-5% Stomach 60% Duodenum 60% Pancreas 55-80% Jejunum/ileum 0% Appendix 40% Rectum 15% Metastatic pancreatic well-differentiated neuroendocrine tumor PDX1 ISL1 ISLET1 Transcription factor with N-terminal LIM domains and C-terminal homeodomain Plays critical role in develop of pancreatic islets of Langerhans In adults, strong nuclear expression in islets Clinically used antibodies show cytoplasmic staining in perivascular smooth muscle Page 40 40

41 ISL1 expression in well-differentiated neuroendocrine tumors Primary site Positive Lung 10-15% Stomach 0% Duodenum 90% Pancreas 70-85% Jejunum/ileum <5% Appendix 15-20% Rectum 90% ISL1 expression in well-differentiated neuroendocrine tumors Primary site Positive Lung 10-15% Stomach 0% Duodenum 90% Pancreas 70-85% Jejunum/ileum <5% Appendix 15-20% Rectum 90% Pancreas ISL1 Page 41 41

42 Pancreatic well-differentiated neuroendocrine tumor ISL1 Metastatic well-differentiated neuroendocrine tumor from ileum ISL1 Small cell carcinoma Determination of primary site not important All patients treated with cisplatin/carboplatin + etoposide Localized Merkel cell carcinoma treated surgically TTF1 is not specific for lung in this setting TTF1 positive in >90% of small cell carcinoma of lung TTF1 positive in 30-50% of extrapulmonary small cell carcinoma TTF1 rarely positive in Merkel cell carcinoma Page 42 42

43 Metastatic small cell carcinoma TTF1 Other transcription factors in small cell carcinoma Small cell carcinomas show marked transcription factor lineage infidelity! Common to detect expression of 5-10 (or more) different transcription factors in both pulmonary and extrapulmonary small cell carcinomas Important to be aware of this phenomenon to avoid misinterpretation Transcription factor expression in small cell and Merkel cell carcinomas Courtesy of Dr. Andrew Bellizzi Page 43 43

44 Practice points Review radiologic findings (could the biopsy be from a primary liver tumor?) Pay close attention to histologic features Guide judicious panel of IHC markers Increasing range of antibodies directed against transcription factors becoming available Be aware of reported cross-reactivity (i.e., specificity) to avoid misdiagnosis Page 44 44

Carcinoma of Unknown Primary (CUP)

Carcinoma of Unknown Primary (CUP) Metasta c Carcinoma of Unknown Primary: Diagnos c Approach Using Immunohistochemistry James R. Conner, MD, PhD Mount Sinai Hospital Toronto, ON Carcinoma of Unknown Primary (CUP) 3-5% of all new malignant

More information

Carcinoma of unknown primary origin (CUP) is defined

Carcinoma of unknown primary origin (CUP) is defined REVIEW ARTICLE Metastatic Carcinoma of Unknown Primary: Diagnostic Approach Using Immunohistochemistry James R. Conner, MD, PhD and Jason L. Hornick, MD, PhD Abstract: Carcinoma of unknown primary origin

More information

Differential diagnosis of HCC

Differential diagnosis of HCC Hepatocellular Carcinoma Quest for an Ideal Immunohistochemical Panel Sanjay Kakar, MD UCSF Differential diagnosis of HCC Hepatocellular lesions Adenoma, FNH, HG dysplasia Adenocarcinoma CholangioCA, metastasis

More information

Reporting of carcinoma of unknown primary tumour (CUP)

Reporting of carcinoma of unknown primary tumour (CUP) Reporting of carcinoma of unknown primary tumour (CUP) Prof John Schofield Kent Oncology Centre with grateful thanks to Dr Karin Oien University of Glasgow Royal College of Pathologists Cancer datasets

More information

Histopathological diagnosis of CUP

Histopathological diagnosis of CUP Histopathological diagnosis of CUP Dr Karin Oien karin.oien@glasgow.ac.uk Disclosure slide Dr Karin Oien has no financial interests in any company mentioned in this presentation. Dr Karin Oien is conducting

More information

Cutaneous metastases. Thaddeus Mully. University of California, San Francisco Professor, Departments of Pathology and Dermatology

Cutaneous metastases. Thaddeus Mully. University of California, San Francisco Professor, Departments of Pathology and Dermatology Cutaneous metastases Thaddeus Mully University of California, San Francisco Professor, Departments of Pathology and Dermatology DISCLOSURE OF RELATIONSHIPS WITH INDUSTRY Thaddeus Mully Course C005 Essential

More information

NEW IHC A n t i b o d i e s

NEW IHC A n t i b o d i e s NEW IHC Antibodies TABLE OF CONTENTS NEW IHC ANTIBODIES from Cell Marque CITED1 (5H6).... 1 Claudin 7 (5D10F3).... 1 GATA1 (4F5).... 1 Transgelin (2A10C2).... 1 NEW IHC ANTIBODIES using RabMAb Technology

More information

New Developments in Immunohistochemistry for Gynecologic Pathology

New Developments in Immunohistochemistry for Gynecologic Pathology New Developments in Immunohistochemistry for Gynecologic Pathology Michael T. Deavers, M.D. Professor, Departments of Pathology and Gynecologic Oncology Immunohistochemistry in Gynecologic Pathology Majority

More information

Diagnostic IHC of endocrine, renal, prostate and germ cell tumor pathology

Diagnostic IHC of endocrine, renal, prostate and germ cell tumor pathology Diagnostic IHC of endocrine, renal, prostate and germ cell tumor pathology Mogens Vyberg Professor of Clinical Pathology Director of NordiQC Aalborg University Hospital, Aalborg, Denmark Markers for endocrine

More information

How to Recognize Gynecologic Cancer Cells from Pelvic Washing and Ascetic Specimens

How to Recognize Gynecologic Cancer Cells from Pelvic Washing and Ascetic Specimens How to Recognize Gynecologic Cancer Cells from Pelvic Washing and Ascetic Specimens Wenxin Zheng, M.D. Professor of Pathology and Gynecology University of Arizona zhengw@email.arizona.edu http://www.zheng.gynpath.medicine.arizona.edu/index.html

More information

List of Available TMAs in the PRN

List of Available TMAs in the PRN TMA RPCI_BrainCa01 RPCI_BrCa03 RPCI_BrCa04 RPCI_BrCa05 RPCI_BrCa0 RPCI_BrCa07 RPCI_BrCa08 RPCI_BrCa15 RPCI_BrCa1 RPCI_BrCa17 RPCI_BrCa18 RPCI_BrCa19 RPCI_BrCa20 RPCI_BrCa21 RPCI_BrCa24 RPCI_BrCa25 RPCI_BrCa2

More information

Tumour Markers. For these reasons, only a handful of tumour markers are commonly used by most doctors.

Tumour Markers. For these reasons, only a handful of tumour markers are commonly used by most doctors. Tumour Markers What are Tumour Markers? Tumour markers are substances that can be found in the body when cancer is present. They are usually found in the blood or urine. They can be products of cancer

More information

Adnexal primary or Melanocy+c prolifera+ons in sundamaged metastatic carcinoma?

Adnexal primary or Melanocy+c prolifera+ons in sundamaged metastatic carcinoma? Adnexal primary or Melanocy+c prolifera+ons in sundamaged metastatic carcinoma? skin Jane L. Messina, MD Interna0onal Melanoma Pathology Working Group 4 th annual mee0ng Tampa, Florida November 14, 2011

More information

Section 14 Other Cancers. Cancer of Unknown 113 Primary Site INTRODUCTION PATHOLOGIC EVALUATION

Section 14 Other Cancers. Cancer of Unknown 113 Primary Site INTRODUCTION PATHOLOGIC EVALUATION Section 14 Other Cancers Cancer of Unknown 113 Primary Site F. Anthony Greco and John D. Hainsworth INTRODUCTION Cancer of unknown primary (CUP) site is a clinical syndrome that includes many types of

More information

What I Learned from 3 Cases and 3 Antibodies

What I Learned from 3 Cases and 3 Antibodies What I Learned from 3 Cases and 3 Antibodies Melinda Sanders, M.D Vanderbilt University Medical Center Professor of Pathology Consultant in Breast Pathology Disclosure of Relevant Financial Relationships

More information

ISSN X (Print) Original Research Article. DOI: /sjams

ISSN X (Print) Original Research Article. DOI: /sjams DOI: 10.21276/sjams.2016.4.7.33 Scholars Journal of Applied Medical Sciences (SJAMS) Sch. J. App. Med. Sci., 2016; 4(7C):2468-2473 Scholars Academic and Scientific Publisher (An International Publisher

More information

Urinary Bladder: WHO Classification and AJCC Staging Update 2017

Urinary Bladder: WHO Classification and AJCC Staging Update 2017 Urinary Bladder: WHO Classification and AJCC Staging Update 2017 Houston Society of Clinical Pathologists 58 th Annual Spring Symposium Houston, TX April 8, 2017 Jesse K. McKenney, MD Classification

More information

Conflict of interest. Gynecologic Pathology. Gynecologic Pathology

Conflict of interest. Gynecologic Pathology. Gynecologic Pathology The role of immunohistochemistry in surgical pathology of the uterine corpus and cervix, vagina and vulva Conflict of interest None (but the ovary is my favorite organ) Ålborg, June 10, 2015 Prof. Ben

More information

Malignant neoplasms of the gastrointestinal (GI) tract,

Malignant neoplasms of the gastrointestinal (GI) tract, Special Section First Chinese American Pathologists Association Diagnostic Pathology Course, Part II Practical Immunohistochemistry in Neoplastic Pathology of the Gastrointestinal Tract, Liver, Biliary

More information

FNA Cytology of Metastatic Malignancies of Unknown Primary Site

FNA Cytology of Metastatic Malignancies of Unknown Primary Site FNA Cytology of Metastatic Malignancies of Unknown Primary Site Tarik M. Elsheikh Jan F. Silverman Pathologic Diagnosis of Metastasis Smaller specimens, less invasive techniques FNA cytology is highly

More information

4/12/2018. MUSC Pathology Symposium Kiawah Island April 18, Jesse K. McKenney, MD

4/12/2018. MUSC Pathology Symposium Kiawah Island April 18, Jesse K. McKenney, MD MUSC Pathology Symposium Kiawah Island April 18, 2018 Jesse K. McKenney, MD 1 Urothelial Carcinoma with Alternative Differentiation 2 Urothelial Carcinoma with Alternative Differentiation Recognition as

More information

NICHOLAS PAVLIDIS, MD, PhD, FRCP (Edin)

NICHOLAS PAVLIDIS, MD, PhD, FRCP (Edin) CANCER OF UNKNOWN PRIMARY A Complex Disease NICHOLAS PAVLIDIS, MD, PhD, FRCP (Edin) PROFESSOR OF MEDICAL ONCOLOGY Bogota, May-June 2016 WHAT IS CANCER OF UNKNOWN PRIMARY (CUP)? Is a clinical disorder where

More information

IHC Panels as an Aid in Diagnostic Decision Making

IHC Panels as an Aid in Diagnostic Decision Making IHC Antibody Test Selection Using a Panel Approach Steven Westra B.S. Reagent Product Specialist Leica Biosystems IHC Panels as an Aid in Diagnostic Decision Making Diagnostic Use of Tumors Using Algorithms

More information

Other Sites. Table 2 Continued. MPH Rules 11/8/07. NAACCR Webinar Series 1

Other Sites. Table 2 Continued. MPH Rules 11/8/07. NAACCR Webinar Series 1 MPH s 11/8/07 Other s 1 Table 2 Continued Use this two-page table to select combination histology codes. Compare the terms in the diagnosis to the terms in Columns 1 and 2. If the terms match, code the

More information

INTERPRETATION OF IMMUNOHISTOCHEMICAL STAINS - DIFFICULTIES AND PITFALLS. Gabor Fischer Diagnostic Services Manitoba University of Manitoba

INTERPRETATION OF IMMUNOHISTOCHEMICAL STAINS - DIFFICULTIES AND PITFALLS. Gabor Fischer Diagnostic Services Manitoba University of Manitoba INTERPRETATION OF IMMUNOHISTOCHEMICAL STAINS - DIFFICULTIES AND PITFALLS Gabor Fischer Diagnostic Services Manitoba University of Manitoba IHC INTERPRETATIONS LOCAL DATA Diagnostic Services Manitoba Number

More information

Neuroendocrine Carcinoma. Lebanon Neuroendocrine Neoplasms of H&N Nov /7/2011. Broad Classification:

Neuroendocrine Carcinoma. Lebanon Neuroendocrine Neoplasms of H&N Nov /7/2011. Broad Classification: H&N Neuroendocrine Neoplasms: Classification and Diagnostic Considerations Adel K. El-Naggar, M.D., Ph.D. The University of Texas MD Anderson Cancer Center, Houston, Texas Broad Classification: A. Epithelial:

More information

Yolk Sac Tumor. Yolk Sac Surprise! Ovarian and Extraovarian Pelvic Yolk Sac Tumors in Women

Yolk Sac Tumor. Yolk Sac Surprise! Ovarian and Extraovarian Pelvic Yolk Sac Tumors in Women Yolk Sac Surprise! Ovarian and Extraovarian Pelvic s in Women Charles Zaloudek, M.D. Professor, Department of Pathology University of California, San Francisco 505 Parnassus Ave., M563 San Francisco, CA

More information

Case 18. M75. Excision of mass on scalp. Clinically SCC. The best diagnosis is:

Case 18. M75. Excision of mass on scalp. Clinically SCC. The best diagnosis is: Case 18 M75. Excision of mass on scalp. Clinically SCC. The best diagnosis is: A. Pilomatrical carcinoma B. Adnexal carcinoma NOS C. Metastatic squamous cell carcinoma D.Primary squamous cell carcinoma

More information

Video Microscopy Tutorial 8

Video Microscopy Tutorial 8 Video Microscopy Tutorial 8 Common and Uncommon Lesions of the Liver Gladwyn Leiman, MD There are no disclosures necessary. Common and Uncommon Lesions in Liver FNA Gladwyn Leiman University of Vermont

More information

- Ovarian cancer accounts for 3% of all cancers in females - About 80% of ovarian tumors are benign, and these occur mostly in young women between

- Ovarian cancer accounts for 3% of all cancers in females - About 80% of ovarian tumors are benign, and these occur mostly in young women between Ovarian Tumors - Ovarian cancer accounts for 3% of all cancers in females - About 80% of ovarian tumors are benign, and these occur mostly in young women between the ages of 20 and 45 years and may be

More information

Enterprise Interest Nothing to declare

Enterprise Interest Nothing to declare Enterprise Interest Nothing to declare Update of mixed tumours of the GI tract, the pancreas and the liver Introduction to the concept of mixed tumours and clinical implication Jean-Yves SCOAZEC Surgical

More information

3/28/2017. Disclosure of Relevant Financial Relationships. Clinical History. Pathology

3/28/2017. Disclosure of Relevant Financial Relationships. Clinical History. Pathology Disclosure of Relevant Financial Relationships Monalisa Sur MBBS, FCPath(S.A), MMED(WITS), FRCPath(U.K), FRCP( C) Professor, Department of Pathology and Molecular Medicine Division of Anatomical Pathology

More information

Effusion Cytology: Diagnostic Challenges

Effusion Cytology: Diagnostic Challenges Effusion Cytology: Diagnostic Challenges Tarik M. Elsheikh, MD Professor and Medical Director, Anatomic Pathology Cleveland Clinic Outside Consult Case 45 year old woman, presented with nausea, dyspnea,

More information

FNA Cytology of Metastatic Malignancies of Unknown Primary Site

FNA Cytology of Metastatic Malignancies of Unknown Primary Site FNA Cytology of Metastatic Malignancies of Unknown Primary Site Tarik M. Elsheikh Cleveland Clinic Jan F. Silverman Alleghany Hospitals Pathologic Diagnosis of Metastasis Smaller specimens, less invasive

More information

Wendy L Frankel. Chair and Distinguished Professor

Wendy L Frankel. Chair and Distinguished Professor 1 Wendy L Frankel Chair and Distinguished Professor Case 1 59 y/o woman Abdominal pain No personal or family history of cancer History of colon polyps Colonoscopy Polypoid rectosigmoid mass Biopsy 3 4

More information

PATOLOGIA MOLECULAR DEL CANCER DE ORIGEN DESCONOCIDO? Xavier Matias-Guiu Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLLEIDA.

PATOLOGIA MOLECULAR DEL CANCER DE ORIGEN DESCONOCIDO? Xavier Matias-Guiu Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLLEIDA. PATOLOGIA MOLECULAR DEL CANCER DE ORIGEN DESCONOCIDO? Xavier Matias-Guiu Hospital Universitari Arnau de Vilanova, Universitat de Lleida, IRBLLEIDA. CANCER UNKNOWN PRIMARY 3-5 % of diagnosed cancers Variability

More information

Tumor Immunology. Tumor (latin) = swelling

Tumor Immunology. Tumor (latin) = swelling Tumor Immunology Tumor (latin) = swelling benign tumor malignant tumor Tumor immunology : the study of the types of antigens that are expressed by tumors how the immune system recognizes and responds to

More information

Mody. AIS vs. Invasive Adenocarcinoma of the Cervix

Mody. AIS vs. Invasive Adenocarcinoma of the Cervix Common Problems in Gynecologic Pathology Michael T. Deavers, M.D. Houston Methodist Hospital, Houston, Texas Common Problems in Gynecologic Pathology Adenocarcinoma in-situ (AIS) of the Cervix vs. Invasive

More information

Coordinate Expression of Cytokeratins 7 and 20 in Prostate Adenocarcinoma and Bladder Urothelial Carcinoma

Coordinate Expression of Cytokeratins 7 and 20 in Prostate Adenocarcinoma and Bladder Urothelial Carcinoma Anatomic Pathology / CYTOKERATINS 7 AND 20 IN PROSTATE AND BLADDER CARCINOMAS Coordinate Expression of Cytokeratins 7 and 20 in Prostate Adenocarcinoma and Bladder Urothelial Carcinoma Nader H. Bassily,

More information

ACCME/Disclosures. Case History 4/13/2016. USCAP GU Specialty Conference Case 3. Ann Arbor, MI

ACCME/Disclosures. Case History 4/13/2016. USCAP GU Specialty Conference Case 3. Ann Arbor, MI USCAP GU Specialty Conference Case 3 March 2016 L. Priya Kunju, M.D. University of Michigan Health System Ann Arbor, MI University of Michigan Health System ACCME/Disclosures The USCAP requires that anyone

More information

Adenocarcinoma of the Cervix

Adenocarcinoma of the Cervix Question 1. Each of the following statements about cervical adenocarcinoma is true except: Adenocarcinoma of the Cervix SAMS a) A majority of women with cervical adenocarcinoma have stage I tumors at diagnosis.

More information

WT1, Estrogen Receptor, and Progesterone Receptor as Markers for Breast or Ovarian Primary Sites in Metastatic Adenocarcinoma to Body Fluids

WT1, Estrogen Receptor, and Progesterone Receptor as Markers for Breast or Ovarian Primary Sites in Metastatic Adenocarcinoma to Body Fluids Anatomic Pathology / WT1, ESTROGEN RECEPTOR, AND PROGESTERONE RECEPTOR IN CYTOLOGY OF BODY FLUIDS WT1, Estrogen Receptor, and Progesterone Receptor as Markers for Breast or Ovarian Primary Sites in Metastatic

More information

Single and Multiplex Immunohistochemistry

Single and Multiplex Immunohistochemistry Single and Multiplex Immunohistochemistry Steve Westra, BS Reagent Product Specialist Leica Biosystems IHC Theory Polyclonal vs Monoclonal Polyclonal reagents Detect a multitude of epitopes Batch to batch

More information

TUMOR M ARKERS MARKERS

TUMOR M ARKERS MARKERS TUMOR MARKERS M.Shekarabi IUMS Definition Many cancers are associated with the abnormal production of some molecules l which h can be measured in plasma. These molecules are known as tumor markers. A good

More information

When Immunostains Can Get You in Trouble: Gynecologic Pathology p16: Panacea or Pandora s Box?

When Immunostains Can Get You in Trouble: Gynecologic Pathology p16: Panacea or Pandora s Box? When Immunostains Can Get You in Trouble: Gynecologic Pathology p16: Panacea or Pandora s Box? Teri A. Longacre, MD Stanford Medicine Stanford California pi6 in Gynecologic Pathology: Panacea or Pandora

More information

Tissue-based Immunohistochemical Biomarker Expression in Malignant Glandular Lesions of the Uterine Cervix: a Systematic Review

Tissue-based Immunohistochemical Biomarker Expression in Malignant Glandular Lesions of the Uterine Cervix: a Systematic Review Tissue-based Immunohistochemical Biomarker Expression in Malignant Glandular Lesions of the Uterine Cervix: a Systematic Review Sandra Lee MD, FRCPC 1 *, Vikrant V. Sahasrabuddhe, MBBS, DrPH 2 *, Diana

More information

MATURE TERATOMAS. 30% Ovarian tumors Mostly dermoid cysts

MATURE TERATOMAS. 30% Ovarian tumors Mostly dermoid cysts MATURE TERATOMAS 30% Ovarian tumors Mostly dermoid cysts May be seen at any age Complications: infection, torsion, rupture with pseudomalignant change outside ovary, melanosis peritonei, hemolytic anemia,

More information

Serous effusion Objectives. Cytology of Serous Effusions From basics to challenges

Serous effusion Objectives. Cytology of Serous Effusions From basics to challenges Cytology of Serous Effusions From basics to challenges Cytology of Serous Effusions From basics to challenges Pınar Fırat, MD, MIAC Department of Pathology, İstanbul University, İstanbul Faculty of Medicine,

More information

Appendix 4: WHO Classification of Tumours of the pancreas 17

Appendix 4: WHO Classification of Tumours of the pancreas 17 S3.01 The WHO histological tumour type must be recorded. CS3.01a The histological type of the tumour should be recorded based on the current WHO classification 17 (refer to Appendices 4-7). Appendix 4:

More information

Renal tumours: use of immunohistochemistry & molecular pathology. Dr Lisa Browning John Radcliffe Hospital Oxford

Renal tumours: use of immunohistochemistry & molecular pathology. Dr Lisa Browning John Radcliffe Hospital Oxford Renal tumours: use of immunohistochemistry & molecular pathology Dr Lisa Browning John Radcliffe Hospital Oxford Renal tumours: the use of immunohistochemistry & molecular pathology Classification of RCC

More information

Testicular Germ Cell Tumors; A Simplistic Approach

Testicular Germ Cell Tumors; A Simplistic Approach Testicular Germ Cell Tumors; A Simplistic Approach Merce Jorda, MD, PhD, MBA Professor and Vice Chair, Director of Anatomic Pathology Director of Genitourinary Pathology Service Interim Director of Cytopathology

More information

Cholangiocarcinoma. Judy Wyatt Dundee November 2010

Cholangiocarcinoma. Judy Wyatt Dundee November 2010 Cholangiocarcinoma Judy Wyatt Dundee November 2010 Making sense of cholangiocarcinoma Difficulties with diagnostic criteria How many entities within cholangiocarcinoma? Rapidly evolving Intrahepatic cholangiocarcinoma

More information

Pathology of the Urachus

Pathology of the Urachus Pathology of the Urachus Gladell P. Paner, MD, (BS) MT Departments of Pathology and Surgery, Section of Urology University of Chicago, Chicago, IL USA Gladell.paner@uchospitals.edu Updates in Epithelial

More information

Liver Tumors Selected Topics Romil Saxena, MD

Liver Tumors Selected Topics Romil Saxena, MD Liver Tumors Selected Topics Romil Saxena, MD Hepatocellular carcinoma 90% of all liver tumors Large cells with abundant eosinophilic cytoplasm that grow in a trabecular pattern 1 Case 1 55 male PET -

More information

Oncocytic-Appearing Salivary Gland Tumors. Oncocytic, Cystic, Mucinous, and High Grade Salivary Gland Tumors SALIVARY GLAND FNA: PART II

Oncocytic-Appearing Salivary Gland Tumors. Oncocytic, Cystic, Mucinous, and High Grade Salivary Gland Tumors SALIVARY GLAND FNA: PART II William C. Faquin, MD, PhD Professor of Pathology Harvard Medical School Director of Head and Neck Pathology Massachusetts Eye and Ear Massachusetts General Hospital SALIVARY GLAND FNA: PART II Oncocytic,

More information

Synonyms. Nephrogenic metaplasia Mesonephric adenoma

Synonyms. Nephrogenic metaplasia Mesonephric adenoma Nephrogenic Adenoma Synonyms Nephrogenic metaplasia Mesonephric adenoma Definition Benign epithelial lesion of urinary tract with tubular, glandular, papillary growth pattern Most frequently in the urinary

More information

Effective January 1, 2018 ICD O 3 codes, behaviors and terms are site specific

Effective January 1, 2018 ICD O 3 codes, behaviors and terms are site specific Effective January 1, 2018 codes, behaviors and terms are site specific /N 8551/3 Acinar adenocarcinoma (C34. _) Lung primaries diagnosed prior to 1/1/2018 use code 8550/3 For prostate (all years) see 8140/3

More information

Effective January 1, 2018 ICD O 3 codes, behaviors and terms are site specific

Effective January 1, 2018 ICD O 3 codes, behaviors and terms are site specific Effective January 1, 2018 codes, behaviors and terms are site specific Status /N 8010/3 Urachal carcinoma (C65.9, C66.9, C67. _, C68._) 8013/3 Combined large cell neuroendocrine carcinoma (C34. _, C37.9)

More information

ROLE OF TTF-1, CK20, AND CK7 IMMUNOHISTOCHEMISTRY FOR DIAGNOSIS OF PRIMARY

ROLE OF TTF-1, CK20, AND CK7 IMMUNOHISTOCHEMISTRY FOR DIAGNOSIS OF PRIMARY Y.C. Su, Y.C. Hsu, and C.Y. Chai ROLE OF TTF-1, CK20, AND CK7 IMMUNOHISTOCHEMISTRY FOR DIAGNOSIS OF PRIMARY AND SECONDARY LUNG ADENOCARCINOMA Yue-Chiu Su 1, Yu-Chang Hsu 2, and Chee-Yin Chai 1,3 Departments

More information

Ascitic Fluid and Use of Immunocytochemistry. Mercè Jordà, University of Miami

Ascitic Fluid and Use of Immunocytochemistry. Mercè Jordà, University of Miami Ascitic Fluid and Use of Immunocytochemistry Mercè Jordà, University of Miami Is It Malignant? Yes? No Ascitic Fluid Cytomorphologic Useful Findings Tight clusters with smooth borders Cellular and nuclear

More information

Carcinoembryonic Antigen

Carcinoembryonic Antigen Other Names/Abbreviations CEA 190.26 - Carcinoembryonic Antigen Carcinoembryonic antigen (CEA) is a protein polysaccharide found in some carcinomas. It is effective as a biochemical marker for monitoring

More information

Carcinoembryonic Antigen

Carcinoembryonic Antigen Other Names/Abbreviations CEA 190.26 - Carcinoembryonic Antigen Carcinoembryonic antigen (CEA) is a protein polysaccharide found in some carcinomas. It is effective as a biochemical marker for monitoring

More information

Fast, automated, precise

Fast, automated, precise Thermo Scientific B R A H M S / NSE Immunodiagnostic Assays Fast, automated, precise Neuroendocrine tumor markers on KRYPTOR Systems First and only fully automated CgA assay worldwide Shortest time to

More information

ANATOMY AND BASIC FUNCTION OF THE ENDOCRINE GLANDS

ANATOMY AND BASIC FUNCTION OF THE ENDOCRINE GLANDS ANATOMY AND BASIC FUNCTION OF THE ENDOCRINE GLANDS Know these endocrine organs of the cat: thymus, thyroid, pancreas, adrenal glands, ovaries, and testes. Review and know microslides, hormones, and structures

More information

Tumor Markers Yesterday, Today & Tomorrow. Steven E. Zimmerman M.D. Vice President & Chief Medical Director

Tumor Markers Yesterday, Today & Tomorrow. Steven E. Zimmerman M.D. Vice President & Chief Medical Director Tumor Markers Yesterday, Today & Tomorrow Steven E. Zimmerman M.D. Vice President & Chief Medical Director Tumor Marker - Definition Substances produced by cancer cells or other cells in response to cancer

More information

Truman Medical Center-Hospital Hill Cancer Registry 2014 Statistical Summary Incidence

Truman Medical Center-Hospital Hill Cancer Registry 2014 Statistical Summary Incidence Truman Medical Center-Hospital Hill Cancer Registry 2014 Statistical Summary Incidence In 2014, there were 452 new cancer cases diagnosed and or treated at Truman Medical Center- Hospital Hill and an additional

More information

Dr. Shari Srinivasan, Consultant Chemical Pathologist, Tallaght Hospital, Dublin 24, Ireland

Dr. Shari Srinivasan, Consultant Chemical Pathologist, Tallaght Hospital, Dublin 24, Ireland Draft Laboratory Testing for Tumour Markers V1.0 Authors Dr. Shari Srinivasan, Consultant Chemical Pathologist, Tallaght Hospital, Dublin 24, Ireland Dr. Gerard Boran, Consultant Chemical Pathologist,

More information

Immunohistochemistry and Gastrointestinal Carcinomas

Immunohistochemistry and Gastrointestinal Carcinomas Cell Marque Tissue Diagnostics Immunohistochemistry and Gastrointestinal Carcinomas Mike Lacey, M.D. Gastrointestinal (GI) Pathology The life science business of Merck KGaA, Darmstadt, Germany operates

More information

Quiz The main functions of the ovaries are a. To produce oocytes b. To produce estrogen c. To produce progesterone d.

Quiz The main functions of the ovaries are a. To produce oocytes b. To produce estrogen c. To produce progesterone d. 1. The main functions of the ovaries are a. To produce oocytes b. To produce estrogen c. To produce progesterone d. All of the above Quiz 1 2. Which part of the broad ligament suspends the ovaries? a.

More information

Primary enteric adenocarcinoma with predominantly signet ring features of the lung: A case report with clinicopathological and molecular findings

Primary enteric adenocarcinoma with predominantly signet ring features of the lung: A case report with clinicopathological and molecular findings CASE REPORT Primary enteric adenocarcinoma with predominantly signet ring features of the lung: A case report with clinicopathological and molecular findings Makoto Nagashima 1, Ayako Moriyama 1, Yasuo

More information

- Selected Tumors of the Skin Appendages - Primary vs. Metastasis

- Selected Tumors of the Skin Appendages - Primary vs. Metastasis - Selected Tumors of the Skin Appendages - Primary vs. Metastasis Napa Valley 2018 Victor G. Prieto, MD, PhD Chair of Pathology UT MD Anderson Cancer Center vprieto@mdanderson.org Napa Valley in May Introduction

More information

Mesothelioma: diagnostic challenges from a pathological perspective. Naseema Vorajee August 2016

Mesothelioma: diagnostic challenges from a pathological perspective. Naseema Vorajee August 2016 Mesothelioma: diagnostic challenges from a pathological perspective Naseema Vorajee August 2016 Naseema.vorajee@nhls.ac.za Pleural diseases (whether neoplastic, reactive or infective) may have similar

More information

Clinical indications for positron emission tomography

Clinical indications for positron emission tomography Clinical indications for positron emission tomography Oncology applications Brain and spinal cord Parotid Suspected tumour recurrence when anatomical imaging is difficult or equivocal and management will

More information

PNET 3/7/2015. GI and Pancreatic NETs. The Postgraduate Course in Breast and Endocrine Surgery. Decision Tree. GI and Pancreatic NETs.

PNET 3/7/2015. GI and Pancreatic NETs. The Postgraduate Course in Breast and Endocrine Surgery. Decision Tree. GI and Pancreatic NETs. GI and Pancreatic NETs The Postgraduate Course in Breast and Endocrine Surgery Disclosures Ipsen NET Advisory Board Marines Memorial Club and Hotel San Francisco, CA Eric K Nakakura San Francisco, CA March

More information

Hyperchromatic Crowded Groups: What is Your Diagnosis? Session 3000

Hyperchromatic Crowded Groups: What is Your Diagnosis? Session 3000 Hyperchromatic Crowded Groups: What is Your Diagnosis? Session 3000 Thomas A. Bonfiglio, M.D. Professor Emeritus, Pathology and Laboratory Medicine University of Rochester Disclosures In the past 12 months,

More information

DEPARTMENT OF ONCOLOGY ELECTIVE

DEPARTMENT OF ONCOLOGY ELECTIVE DEPARTMENT OF ONCOLOGY ELECTIVE 2015-2016 www.uwo.ca/oncology Oncology Elective Program Administrator: Ms. Kimberly Trudgeon Room A4-901C (Admin) LHSC London Regional Cancer Centre (Victoria Campus) Phone:

More information

What s New for 8 th Edition

What s New for 8 th Edition What s New for 8 th Edition KCR 2018 SPRING TRAINING Overview What s New New Chapters for 8 th Editions Chapters That Split in 8 th Edition Merged 8 th Edition Chapters Blanks vs Xs How to Navigate Through

More information

Oncology 101. Cancer Basics

Oncology 101. Cancer Basics Oncology 101 Cancer Basics What Will You Learn? What is Cancer and How Does It Develop? Cancer Diagnosis and Staging Cancer Treatment What is Cancer? Cancer is a group of more than 100 different diseases

More information

Fig. 59 Malignant phaeochromocytoma, hepatic metastasis.

Fig. 59 Malignant phaeochromocytoma, hepatic metastasis. Fig. 59 Malignant phaeochromocytoma, hepatic metastasis. X 120 Hyperte nsion Fig. 60 Malignant sympathetic paraganglioma, lymph node metastasis Primary in bladder. x 1 20 Hypertension Fig. 61 Malignant

More information

2016 New Antibodies and Products for Molecular Pathology

2016 New Antibodies and Products for Molecular Pathology 2016 New Antibodies and Products for Molecular Pathology Bio SB is excited to introduce over 50 new IVD biomarkers for use in Immunohistochemistry. All antibodies are available in concentrate and convenient

More information

Format Of ICD-O Terms In Numerical List Each topographic and morphologic term appears only once The first listed term in Bold Type is the Preferred Te

Format Of ICD-O Terms In Numerical List Each topographic and morphologic term appears only once The first listed term in Bold Type is the Preferred Te Florida Cancer Data System International Classification of Diseases for Oncology ICD-O-3 1 Basic Concepts Primary Site/Topography Histology/Morphology Behavior Grade/Immunophenotype 2 ICD-O 3 Structure/Format

More information

Pancreatitis: A Potential Pitfall in Endoscopic Ultrasound Guided Pancreatic FNA

Pancreatitis: A Potential Pitfall in Endoscopic Ultrasound Guided Pancreatic FNA Pancreatitis: A Potential Pitfall in Endoscopic Ultrasound Guided Pancreatic FNA Jack Yang, MD Department of Pathology, Medical University of South Carolina Objectives Understand the indication of EUS

More information

SCOPE OF PRACTICE PGY-5

SCOPE OF PRACTICE PGY-5 Recognize normal cytomorphology of cells derived from the respiratory, gastrointestinal, and genitourinary tracts, and body fluid (Cerebrospinal fluid, pleural and peritoneal fluid) Recognize normal cytomorphology

More information

2018 SEER Solid Tumor Manual 2018 KCR SPRING TRAINING

2018 SEER Solid Tumor Manual 2018 KCR SPRING TRAINING 2018 SEER Solid Tumor Manual 2018 KCR SPRING TRAINING Eight Groups are Revised for 2018 Head & Neck Colon (includes rectosigmoid and rectum for cases diagnosed 1/1/2018 forward) Lung (2018 Draft not yet

More information

Metastatic cancers can be difficult to diagnose in a. CDH17 Is a More Sensitive Marker for Gastric Adenocarcinoma Than CK20 and CDX2

Metastatic cancers can be difficult to diagnose in a. CDH17 Is a More Sensitive Marker for Gastric Adenocarcinoma Than CK20 and CDX2 CDH17 Is a More Sensitive Marker for Gastric Adenocarcinoma Than CK20 and CDX2 David Altree-Tacha, PhD; Jillian Tyrrell, PhD; Thomas Haas, DO Context. CDH17, which is expressed in the intestinal epithelium,

More information

Introduction. Results. Discussion. Histopathologic and immunohistochemical findings. Results. conclusions,

Introduction. Results. Discussion. Histopathologic and immunohistochemical findings. Results. conclusions, 1/5 2/5 Carcinoma distinctive carcinoma. form erysipeloides (CE), metastasis. which clinically Itfrom has resembles been termed erysipelas, is an uncommon, but may extend It164 toclassically back, presents

More information

Zyto-Facts Editorial. News for Pathology and Immunohistochemistry. +++ Newsflash +++ Newsflash +++

Zyto-Facts Editorial. News for Pathology and Immunohistochemistry. +++ Newsflash +++ Newsflash +++ Zyto-Facts 1-2016 News for Pathology and Immunohistochemistry Editorial The primary site of a tumor is not known in about 3 % to 5 % of all cancer diagnoses. Patients, whose primary site could be identified,

More information

Serous Effusions. Spasenija Savic Prince, MD Pathology, University Hospital Basel, Switzerland

Serous Effusions. Spasenija Savic Prince, MD Pathology, University Hospital Basel, Switzerland Serous Effusions Spasenija Savic Prince, MD Pathology, University Hospital Basel, Switzerland Serous membrane Body cavities: Pleural Pericardial Peritoneal Effusion = Excess of fluid 80% Benign 20% Malignant

More information

*

* Introduction Cancer is complex, can have many possible causes, and is increasingly common. For the U.S. population, 1 in 2 males and 1 in 3 females is at risk of developing cancer in their lifetime. The

More information

2018 Surgical Pathology Update: Diagnostic Pearls for the Practicing Pathologist - Volume II

2018 Surgical Pathology Update: Diagnostic Pearls for the Practicing Pathologist - Volume II Release Date: January 1, 15.25 AMA PRA Category 1 Credit(s) TM About This CME Teaching Activity This CME Activity is designed to provide a comprehensive review of soft tissue, gastrointestinal, genitourinary,

More information

Uncommon secondary tumour of the stomach

Uncommon secondary tumour of the stomach Uncommon secondary tumour of the stomach B. Bancel, Hôpital CROIX ROUSSE LYON Bucharest Nov 2013 Case report 33-year old man Profound mental retardation and motor disturbances (sequelae of neonatal meningeal

More information

What s new in breast pathology? Penny Barnes MD, FRCP(C) May 17, 2016

What s new in breast pathology? Penny Barnes MD, FRCP(C) May 17, 2016 What s new in breast pathology? Penny Barnes MD, FRCP(C) May 17, 2016 Outline IHC markers of metastatic carcinoma of breast origin Uses and limitations of e-cadherin IHC Breast neoplasms with limited metastatic

More information

Merck Oncology Overview. The Development of MSI-H Cancer Therapy. Development of Anti-Cancer Drugs Forum Tokyo, Japan, 18, February 2017

Merck Oncology Overview. The Development of MSI-H Cancer Therapy. Development of Anti-Cancer Drugs Forum Tokyo, Japan, 18, February 2017 Merck Oncology Overview The Development of MSI-H Cancer Therapy Development of Anti-Cancer Drugs Forum Tokyo, Japan, 18, February 217 Andrew Joe, MD Executive Director, Late Stage Oncology Merck & Co.,

More information

Bladder Case 1 SURGICAL PATHOLOGY REPORT. Procedure: Cystoscopy, transurethral resection of bladder tumor (TURBT)

Bladder Case 1 SURGICAL PATHOLOGY REPORT. Procedure: Cystoscopy, transurethral resection of bladder tumor (TURBT) Bladder Case 1 February 17, 2007 Specimen (s) received: Bladder Tumor Pre-operative Diagnosis: Bladder Cancer Post operative Diagnosis: Bladder Cancer Procedure: Cystoscopy, transurethral resection of

More information

Case 3 - GYN. History: 66 year old, routine Pap test. Dr. Stelow

Case 3 - GYN. History: 66 year old, routine Pap test. Dr. Stelow Case 3 - GYN History: 66 year old, routine Pap test Dr. Stelow Case 3 66 year year old woman Routine Pap Test Cytologic Features 3 dimensional clusters of cells with small to moderate amount of

More information

Cancer of Unknown Primary Site: Evolving Understanding and Management of Patients

Cancer of Unknown Primary Site: Evolving Understanding and Management of Patients Cancer of Unknown Primary Site: Evolving Understanding and Management of Patients F. Anthony Greco, MD Dr. Greco is the Director of the Sarah Cannon Cancer Center in Nashville, Tennessee and a member of

More information

DIAGNOSIS A. RIGHT OVARY: Krukenberg tumor (20 cm in maximum dimension, see comment). B. LEFT OVARY: Krukenberg tumor (8.5 cm in maximum dimension, see comment). C. UTERUS (130 Grams): Cervix: Metastatic

More information

of 20 to 80 and subsequently declines [2].

of 20 to 80 and subsequently declines [2]. - - According to the 2014 World Health Organization (WHO) classification and tumor morphology, primary ovarian tumors are subdivided into three categories: epithelial (60%), germ cell (30%), and sex-cord

More information

Thyroid pathology Practical part

Thyroid pathology Practical part Thyroid pathology Practical part My Algorithm After a good macroscopy and a microscopic overview of the lesion, I especially look at the capsule and the thyroid just above and just beneath the capsule.

More information

Chapter 3 Metastases and Mimics of Colorectal Carcinoma

Chapter 3 Metastases and Mimics of Colorectal Carcinoma Chapter 3 Metastases and Mimics of Colorectal Carcinoma Abstract Secondary involvement of the colon by other malignant neoplasms may mimic primary colorectal carcinoma and results from direct extension,

More information