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Undifferentiated Malignant Neoplasms: Case Presentations and Workup

This slide seminar will cover case presentations of undifferentiated malignant neoplasms, discussing the workup and immunostains used for diagnosis. Join us at the ADIAP 25th Annual Congress and the 5th JSP International Conference.

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Undifferentiated Malignant Neoplasms: Case Presentations and Workup

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  1. Scientific Committee of the ADIAP 25th Annual Congress and the 5th JSP International Conference • Slide Seminar – Case Presentation • Workup of Undifferentiated Malignant Neoplasms Eyas M. Hattab, M.D. Department of Pathology and Laboratory Medicine

  2. 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

  3. Immunostains? • TTF-1 • Thyroglobulin

  4. Thyroglobulin TTF-1

  5. Diagnosis? • Metastatic follicular thyroid carcinoma

  6. Indianapolis Central Library

  7. Case #2 • 59 yo M • History of “esophageal surgery” one month ago • Presents with cervical vertebral body “osteomyelitis” • Vertebral body biopsy performed

  8. Immunostains? • Squamous cell carcinoma • CK 5/6 • P63 • ?p40

  9. CK cocktail p63 CK 5/6

  10. Diagnosis? • Metastatic squamous cell carcinoma, of esophageal origin

  11. Indiana State Capitol

  12. 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

  13. 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)

  14. Immunostains? • CK7 + / CK20 -

  15. Cytokeratins 7 and 20

  16. GATA-3 Her2/neu Estrogen Receptor

  17. Diagnosis? • Metastatic breast carcinoma

  18. Indianapolis Museum of Art

  19. 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!

  20. Immunostains? • H&E Dx: carcinoma, likely renal cell • Recommended IHC workup: • CK7/CK20 • Two of the following: • Vimentin • EMA • CD10 • PAX8

  21. Immunostains? • CK7 - / CK20 -

  22. Cytokeratins 7 and 20

  23. Vimentin EMA

  24. CD10 PAX8

  25. Diagnosis? • Metastatic renal cell carcinoma

  26. Soldiers and Sailors Monument on the Circle

  27. 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

  28. Immunostains? • Keratin cocktail • CK7 • CK20

  29. Keratin cocktail

  30. Immunostains? • CK 7 – • CK 20 –

  31. Cytokeratins 7 and 20

  32. PSAP PSA P501S

  33. Diagnosis? • Metastatic prostatic adenocarcinoma

  34. Bankers Life Fieldhouse

  35. Case #6 • 51 yo F • Presented to an outside facility with headache • Imaging studies revealed a right occipital mass with rim enhancement

  36. Immunostains? • Keratin cocktail • CK 7 • CK 20 • TTF-1 • NapsinA • GATA 3

  37. Keratin cocktail

  38. CK7 CK20

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