Oscar Nappi
UOSC di Anatomia patologica
AORN A. Cardarelli - Napoli

Shapira DV, Jarrett AR
The need to consider survival, otcome and expense when evalueting and treating patients with unknown primary carcinoma
Arch Intern Med 155 : 2050-2054, 1995
• 56 pts with CUP
• The average cost to each patient for clinical procedures was 17.973 dollars
• Only in 4 cases the primary tumor was found
• None of the neoplasms was deemed curable and less than 20% of the patients survived more than 12 months after initiation of therapy

• Conventional cyto- histologic studies correlated to clinical setting
• IMMUNOHISTOCHEMICAL STUDIES
• Molecular biomarkers microRNAs
GEP ( gene expression profiling )

M 64 ys
Cerebral mass

Questo è un linfoma maligno anaplastico
Guarda il citoplasma…per me è un sarcoma epiteliode !
Ma..! Le cellule sono incise e macronucleolate. E se fosse un carcinoma ?

Diagnosi finale
Neoplasia maligna, n.a.s., quadro compatibile con carcinoma scarsamente differenziato (origine ignota) metastatico

Metastatic melanoma
S100 HMB45

Polygonal large cell tumor
Immunoistochemical algorytm

• Not diagnosing a malignant lymphoma
• Not diagnosing an endocrine tumor
• Not diagnosing other neoplasias with a favorable
( or relatively favorable ) therapeutical approach

Some neoplasias with a favorable
( or relatively favorable ) therapeutical approach
• Breast
• Prostate
• Extragonadal germ cell
• “Peritoneal carcinoma”
• Others

CD45
Large cell B lymphoma

Cytokeratin expression in hematological neoplasms : a tissue microarray study on 866 lymphoma and leukemia cases
Adams H, Schmid P, et al
Pathol Res Pract 204 : 569- 573, 2008
0,4% HD
0,6% B-LCL
O,7 % Peripheral T cell Lymphoma
0,7% Myeloma
4% Small cell ymphoma
26% Mantle cell lymphoma

Pazient : F ys 46
Clinics and imaging favour a diagnosis of meningioma

CK
CK7
CK 20
LCA
Mammaglobin

HER2
ER

IHC in distinguish SCC and AC in poorly differentiated lung tumours
Type
TTF-1 p63
34betaH11
Napsin A
SCC _ _ _ +++ _ _ _
ADENO +++ _ _ _ +++

• M 47 ys
• Multiple bone metastasis ( 2 vertebral bodies, femur ) and multiple nodules in both lungs
• FNA CAT-guided of a peripheral lung nodule

TTF1
Napsin A

• Metastatic lung adenocarcinoma

Also positive in mesothelioma and in so called Primary peritoneal carcinoma

• M 38 ys
• Axillary lymphadenopathy, retroperitoneal mass
• No other apparent neoplastic lesions found
• A lymphadenectomy is performed

• Immunohistochemical study pan CK positive
CK 7 positive
CK 20 negative
PSA negative
TTF-1 negative napsin A negative villin negative
Adenocarcinoma NOS

CD30
• CD 30 +++
• PLAP ++-
• OCT 4 +++
Germ cell tumor
Embryonal carcinoma

• Male ys 63
• Multiple hepatic nodules
• At a first preliminary screening by CAT no other neoplastic lesions found
?

Preliminary immunohistochemical study :
• CD45 NEGATIVO
• HMB45 NEGATIVO
• S-100 NEGATIVO
• VIMENTINA NEGATIVA
• Pan CK POSITIVA

TTF-1
Poorly differentiated adenocarcinoma of the lung ?
CK7

• Chromogranin A
• Synaptophisin
• CD56
• CD57
Ki67 > 15%
High grade NE large cell carcinoma of the lung
• Negative
• Weakly and Focal +
CD56

Metastatic mimicking primary tumors
• Lung
• Liver
• Ovary
• Thyroid
• Breast
• Any organ

METASTASI ENDOBRONCHIALI:
QUADRI RADIOLOGICI INDISTINGUIBILI DALLA NEOPLASIA POLMONARE PRIMITIVA
Ca sigma
Ca stomaco
METASTASI A LOCALIZZAZIONE ENDOBRONCHIALE DA TUMORI EXTRA-POLMONARI: STUDIO EPIDEMIOLOGICO E CLINICO-PATOLOGICO