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Department of Pathology and Laboratory Medicine

Department of Pathology and Laboratory Medicine

Residency Program - Case of the Month

March 2012 - Presented by Enko Kiprilov, M.D.

Answer:

Metastatic carcinoma consistent with lung primary

 

Discussion:

Cancer found outside of the lung may be determined to have arisen within the lung, as lung cancers that metastasize often retain a specific cell marker profile that allows determination of the lung as the primary site of origin. Primary lung cancers of adenocarcinoma histology typically have nuclear immunostaining with TTF-1 (1, 2).

Answer Image 1

 Additional Markers Used as Suggested by Clinical Data (after a Preliminary Workup with CK7 and CK20) Tumor Marker (3).

 

Urothelial carcinoma UROIII, THR, HMWCK
Breast carcinoma GCDFP-15, ER, PR
Lung (mainly adenocarcinoma) TTF-1, surfactant A and B
Medullary thyroid carcinoma TTF-1, Calcitonin
Merkel cell carcinoma CD117
Hepatocellular carcinoma Hep par-1
Prostate carcinoma PSA, PAP
Cholangiocarcinoma CK19
Mesothelioma Calretinin

UROIII: uroplakin III; THR: thrombomodulin; HMWCK: high molecular weight cytokeratin; GCDFP-15: gross cystic disease fluid protein-15; ER: estrogen receptor; PR: progesterone receptor; TTF-1: thyroid transcription factor-1; PSA: prostate-specific antigen; PAP: prostate acid phosphatase.
 

 

References:

  1. Tan D, Zander DS (2008). Immunohistochemistry for Assessment of Pulmonary and Pleural Neoplasms: A Review and Update. Int J Clin Exp Pathol 1 (1): 19–31. PMC 2480532. PMID 18784820.
  2. Park SY, Kim BH, Kim JH, Lee S, Kang GH (2007). Panels of immunohistochemical markers help determine primary sites of metastatic adenocarcinoma. Arch. Pathol. Lab. Med. 131 (10).
  3. Varadhachary GR, Abbruzzese JL, Lenzi R (2004). Diagnostic strategies for unknown primary cancer. Cancer. 2004 May 1;100(9):1776-85.