Transcript Slide seminar-Hattab - IAP-AD

Scientific Committee of the ADIAP 25th Annual Congress
and the 5th JSP International Conference
Eyas M. Hattab, M.D.
Department of Pathology and
Laboratory Medicine
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71 yo M
History of partial thyroidectomy one year ago
Presents with arm weakness
MRI of the spine shows a mass lesion involving C6T1 vertebral bodies and secondary pathologic
fracture
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TTF-1
Thyroglobulin
TTF-1
Thyroglobulin
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Metastatic follicular thyroid carcinoma
Indianapolis
Central Library
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59 yo M
History of “esophageal surgery” one month ago
Presents with cervical vertebral body
“osteomyelitis”
Vertebral body biopsy performed
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Squamous cell carcinoma
CK 5/6
 P63
 ?p40
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CK cocktail
p63
CK 5/6
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Metastatic squamous cell carcinoma, of esophageal
origin
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48 yo F
History of breast carcinoma ten years ago
Presents with new onset headaches
Brain MRI shows a left frontal lobe mass
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H&E Dx: PD Carcinoma, likely breast
Recommended IHC workup:
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CK7/20
GATA-3
GCDFP
Mammaglobin
ER/PR/Her2 (if requested or diagnostically relevant)
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CK7 + / CK20 -
CK 20 +
CK 20 -
CK 7 +
Urothelial cell carcinoma
Lung adenocarcinoma
Ovarian mucinous carcinoma Breast carcinoma
Pancreatic adenocarcinoma
Ovarian serous carcinoma
Endometrial adenocarcinoma
Cervical squamous cell ca
Mesothelioma
CK7 -
Colorectal carcinoma
Merkel cell carcinoma
Hepatocellular carcinoma
Renal cell carcinoma
Prostate adenocarcinoma
Squamous cell carcinoma
GATA-3
Her2/neu
Estrogen Receptor
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Metastatic breast carcinoma
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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!
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H&E Dx: carcinoma, likely renal cell
Recommended IHC workup:
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CK7/CK20
Two of the following:
 Vimentin
 EMA
 CD10
 PAX8
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CK7 - / CK20 -
CK 20 +
CK 20 -
CK 7 +
Urothelial cell carcinoma
Lung adenocarcinoma
Ovarian mucinous carcinoma Breast carcinoma
Pancreatic adenocarcinoma
Ovarian serous carcinoma
Endometrial adenocarcinoma
Cervical squamous cell ca
Mesothelioma
CK7 -
Colorectal carcinoma
Merkel cell carcinoma
Hepatocellular carcinoma
Renal cell carcinoma
Prostate adenocarcinoma
Squamous cell carcinoma
Vimentin
EMA
CD10
PAX8
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Metastatic renal cell carcinoma
Soldiers and Sailors Monument on the Circle
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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
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Keratin cocktail
CK7
CK20
Keratin cocktail
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CK 7 –
CK 20 –
CK 20 +
CK 20 -
CK 7 +
Urothelial cell carcinoma
Lung adenocarcinoma
Ovarian mucinous carcinoma Breast carcinoma
Pancreatic adenocarcinoma
Ovarian serous carcinoma
Endometrial adenocarcinoma
Cervical squamous cell ca
Mesothelioma
CK7 -
Colorectal carcinoma
Merkel cell carcinoma
Hepatocellular carcinoma
Renal cell carcinoma
Prostate adenocarcinoma
Squamous cell carcinoma
PSAP
PSA
P501S
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Metastatic prostatic adenocarcinoma
Bankers Life Fieldhouse
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51 yo F
Presented to an outside facility with headache
Imaging studies revealed a right occipital mass with
rim enhancement
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Keratin cocktail
CK 7
CK 20
TTF-1
Napsin A
GATA 3
Keratin cocktail
CK7
CK20
CK 20 +
CK 20 -
CK 7 +
Urothelial cell carcinoma
Lung adenocarcinoma
Ovarian mucinous carcinoma Breast carcinoma
Pancreatic adenocarcinoma
Ovarian serous carcinoma
Endometrial adenocarcinoma
Cervical squamous cell ca
Mesothelioma
CK7 -
Colorectal carcinoma
Merkel cell carcinoma
Hepatocellular carcinoma
Renal cell carcinoma
Prostate adenocarcinoma
Squamous cell carcinoma
TTF-1
Napsin A
GATA 3
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Metastatic lung adenocarcinoma
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57 yo M
Presented with a spontaneous intraparenchymal
hemorrhage in the right temporal lobe
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H&E Dx: adenocarcinoma, likely papillary thyroid
Recommended IHC workup:
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CK7/20
TTF1
Napsin A
Thyroglobulin
Pax8
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CK7 +
CK 20 –
TTF-1
Napsin A
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Thyroglobulin +
PAX8 +
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Metastatic papillary thyroid carcinoma
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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
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CK 7
CK 20
CK7
CK20
CK 20 +
CK 20 -
CK 7 +
Urothelial cell carcinoma
Lung adenocarcinoma
Ovarian mucinous carcinoma Breast carcinoma
Pancreatic adenocarcinoma
Ovarian serous carcinoma
Endometrial adenocarcinoma
Cervical squamous cell ca
Mesothelioma
CK7 -
Colorectal carcinoma
Merkel cell carcinoma
Hepatocellular carcinoma
Renal cell carcinoma
Prostate adenocarcinoma
Squamous cell carcinoma
CK 20 +
CK 20 -
CK 7 +
Urothelial cell carcinoma
Lung adenocarcinoma
Ovarian mucinous carcinoma Breast carcinoma
Pancreatic adenocarcinoma
Ovarian serous carcinoma
Endometrial adenocarcinoma
Cervical squamous cell ca
Mesothelioma
CK7 -
Colorectal carcinoma
Merkel cell carcinoma
Hepatocellular carcinoma
Renal cell carcinoma
Prostate adenocarcinoma
Squamous cell carcinoma
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TTF1 –
Napsin A –
CK 20 +
CK 20 -
CK 7 +
Urothelial cell carcinoma
Lung adenocarcinoma
Ovarian mucinous carcinoma Breast carcinoma
Pancreatic adenocarcinoma
Ovarian serous carcinoma
Endometrial adenocarcinoma
Cervical squamous cell ca
Mesothelioma
CK7 -
Colorectal carcinoma
Merkel cell carcinoma
Hepatocellular carcinoma
Renal cell carcinoma
Prostate adenocarcinoma
Squamous cell carcinoma
CK 20 +
CK 20 -
CK 7 +
Urothelial cell carcinoma
Lung adenocarcinoma
Ovarian mucinous carcinoma Breast carcinoma
Pancreatic adenocarcinoma
Ovarian serous carcinoma
Endometrial adenocarcinoma
Cervical squamous cell ca
Mesothelioma
CK7 -
Colorectal carcinoma
Merkel cell carcinoma
Hepatocellular carcinoma
Renal cell carcinoma
Prostate adenocarcinoma
Squamous cell carcinoma
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GATA3 –
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GCDFP-15 –
CK 20 +
CK 20 -
CK 7 +
Urothelial cell carcinoma
Lung adenocarcinoma
Ovarian mucinous carcinoma Breast carcinoma
Pancreatic adenocarcinoma
Ovarian serous carcinoma
Endometrial adenocarcinoma
Cervical squamous cell ca
Mesothelioma
CK7 -
Colorectal carcinoma
Merkel cell carcinoma
Hepatocellular carcinoma
Renal cell carcinoma
Prostate adenocarcinoma
Squamous cell carcinoma
CK 20 +
CK 20 -
CK 7 +
Urothelial cell carcinoma
Lung adenocarcinoma
Ovarian mucinous carcinoma Breast carcinoma
Pancreatic adenocarcinoma
Ovarian serous carcinoma
Endometrial adenocarcinoma
Cervical squamous cell ca
Mesothelioma
CK7 -
Colorectal carcinoma
Merkel cell carcinoma
Hepatocellular carcinoma
Renal cell carcinoma
Prostate adenocarcinoma
Squamous cell carcinoma
WT1
CK 20 +
CK 20 -
CK 7 +
Urothelial cell carcinoma
Lung adenocarcinoma
Ovarian mucinous carcinoma Breast carcinoma
Pancreatic adenocarcinoma
Ovarian serous carcinoma
Endometrial adenocarcinoma
Cervical squamous cell ca
Mesothelioma
CK7 -
Colorectal carcinoma
Merkel cell carcinoma
Hepatocellular carcinoma
Renal cell carcinoma
Prostate adenocarcinoma
Squamous cell carcinoma
CK 20 +
CK 20 -
CK 7 +
Urothelial cell carcinoma
Lung adenocarcinoma
Ovarian mucinous carcinoma Breast carcinoma
Pancreatic adenocarcinoma
Ovarian serous carcinoma
Endometrial adenocarcinoma
Cervical squamous cell ca
Mesothelioma
CK7 -
Colorectal carcinoma
Merkel cell carcinoma
Hepatocellular carcinoma
Renal cell carcinoma
Prostate adenocarcinoma
Squamous cell carcinoma
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BER-EP4 +
MOC-31 +
CK 20 +
CK 20 -
CK 7 +
Urothelial cell carcinoma
Lung adenocarcinoma
Ovarian mucinous carcinoma Breast carcinoma
Pancreatic adenocarcinoma
Ovarian serous carcinoma
Endometrial adenocarcinoma
Cervical squamous cell ca
Mesothelioma
CK7 -
Colorectal carcinoma
Merkel cell carcinoma
Hepatocellular carcinoma
Renal cell carcinoma
Prostate adenocarcinoma
Squamous cell carcinoma
CK 20 +
CK 20 -
CK 7 +
Urothelial cell carcinoma
Lung adenocarcinoma
Ovarian mucinous carcinoma Breast carcinoma
Pancreatic adenocarcinoma
Ovarian serous carcinoma
Endometrial adenocarcinoma
Cervical squamous cell ca
Mesothelioma
CK7 -
Colorectal carcinoma
Merkel cell carcinoma
Hepatocellular carcinoma
Renal cell carcinoma
Prostate adenocarcinoma
Squamous cell carcinoma
Estrogen receptor
CK 20 +
CK 20 -
CK 7 +
Urothelial cell carcinoma
Lung adenocarcinoma
Ovarian mucinous carcinoma Breast carcinoma
Pancreatic adenocarcinoma
Ovarian serous carcinoma
Endometrial adenocarcinoma
Cervical squamous cell ca
Mesothelioma
CK7 -
Colorectal carcinoma
Merkel cell carcinoma
Hepatocellular carcinoma
Renal cell carcinoma
Prostate adenocarcinoma
Squamous cell carcinoma
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CDX2 +!
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Caveat: CDX2 may be aberrantly expressed in
endometrial adenocarcinoma!
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Metastatic endometrial adenocarcinoma
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65 yo M
Presented with new onset seizures
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CK AE1/3
EMA
PR
CK7
CK20
p63
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Reactive Immunostains
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Ki67
PR
AE1/AE3
P63
EMA
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Negative Immunostains
Synaptophysin
 GFAP
 CDX2
 CK5/6
 CD45RB
 S100 protein
 CK20
 CK7
 CD34
 Napsin A
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CK AE1/3
EMA
Progesterone Receptor
CK 7
CK 20
p63
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Metastatic lung squamous cell carcinoma???