Immunohis-tochemical studies are particularly helpful in small biopsy specimen by which morphologic assessment is limited. CD45 (leukocyte common antigen) immunoreactivity in metastatic undifferentiated and neuroendocrine carcinoma: a potential diagnostic pitfall. Sinonasal undifferentiated carcinoma (SNUC) is a highly aggressive, undifferentiated anaplastic carcinoma, without obvious squamous or glandular differentiation. Diagnostic Immunohistochemistry: Theranostic and Genomic Applications, 3rd edn, Saunders Elsevier: China, 2010, pp 83-136. Gross cystic disease fluid protein 15 (GCDFP-15), a 15-kd secretory glycoprotein of various body fluids, including saliva, milk, and seminal fluid, is considered a marker of apocrine differentiation182,183 with high specificity for breast carcinomas.184–186 In a study of 328 metastatic adenocarcinomas, Kaufmann et al184 demonstrated that expression of GCDFP-15 and/or ER or PR had a sensitivity of 83%, a specificity of 93%, and a predictive accuracy of 92% for carcinomas of the breast against all other carcinomas excluding ovarian carcinomas. Similar to AE1/ AE3 and KL1, MAK-6 may show cross-reactivity with neural tissue11. 9. Precursor B-Lymphoblastic lymphoma presenting as a solitary bone tumor and mimicking Ewing's sarcoma: a report of four cases and review of the literature. Additionally, a wide variety of duct-derived carcinomas and mesotheliomas are noted to be positive for 34ßE123, 6. An outlined algorithmic approach is illustrated in Figure 4. MUC1 (EMA) is preferentially expressed by ALK positive anaplastic large cell lymphoma, in the normally glycosylated or only partly hypoglycosylated form. .st3 { Okada K, Hasegawa T, Yokoyama R, Beppu Y, Itoi E. Osteosarcoma with cytokeratin expression: a clinicopathological study of six cases with an emphasis on differential diagnosis from metastatic cancer. The characteristic translocation in EWS/PNET, t(11; 22)(q24;q12), involving the Ewing sarcoma (EWS) gene on chromosome 22 and the FLI-1 gene on chromosome 11, results in overexpression of FLI-1 protein, which can be detected immunohistochemically in more than 70% of EWS/PNETs.40,60,61 Hence, a nuclear staining for FLI-1 protein may help distinguish Ewing family of tumors from other CD99-positive SRCTs, except for lymphoblastic lymphomas, which also stain for FLI-1 protein in 88% of cases.60 Cytokeratin is expressed variably in EWS/PNETs (in 20%–57%); in contrast, desmin expression is extremely uncommon.40,54,62,63, Myogenin and Myo-D1, the 2 myogenic transcriptional regulatory proteins, are equally regarded as sensitive and specific markers of skeletal muscle differentiation.64 These markers stain the overwhelming majority (>95%) of RMSs53,64–66 including the primitive undifferentiated forms, regardless of morphologic evidence of skeletal muscle differentiation.65 Although a nuclear staining is deemed as true positive (Figure 5), a cytoplasmic stain, which may be observed in nonmyogenous tumors, should be considered nonspecific. The expression of WT1 in the differentiation of rhabdomyosarcoma from other pediatric small round blue cell tumors. Although most DSRCTs are positive for desmin, the absence of reactivity for Myo-D1 and myogenin52,70 differentiates them from RMSs. Immunoreactivity for epithelial and neuroendocrine antibodies are useful in the differential diagnosis of lung carcinomas. Immunostaining for thyroid transcription factor 1 and cytokeratin 20 aids the distinction of small cell carcinoma from Merkel cell carcinoma, but not pulmonary from extrapulmonary small cell carcinomas. Many diagnostic errors happen because too few markers are performed. Testicular and epididymal plasmacytoma: a report of 7 cases, including three that were the initial manifestation of plasma cell myeloma. 31. Immunohistochemical detection of WT1 protein in a variety of cancer cells. Although CD45 (leukocyte common antigen [LCA]) is known to have high sensitivity (97%) and specificity (nearly 100%) for lymphoid tumors,28,29 exceptions have been documented. Adding to these extraordinary tools, the sophistication of electron micro scopy and immuno-electrcn microscopy, new techniques for preparation of tissue and novel methods for studying vital cells in "kinesis", you sense the flavour of the ... The diagnosis of high-grade spindle cell variant of PDSS is supported by demonstration of positive reaction for EMA, keratin and its subsets (CK7 and CK19), Bcl-2 antigen, and CD9947–49,261 and negative staining for S100 and CD34. Factors that may increase the risk of undifferentiated pleomorphic sarcoma include: Most people who develop undifferentiated pleomorphic sarcoma have no known risk factors, and many people who have risk factors never develop the cancer. 259–261 This tumor is a distinct clinicopathologic entity and needs to be distinguished from other poorly differentiated carcinomas. In: Miettinen M (ed). •    CD20, CD79a and/or Pax5 - Due to occasional loss of LCA expression in B-cell lymphomas, additional staining for one or more B-cell lineage specific markers (CD20, CD79a and/ or Pax5) is helpful in detecting B-cell lymphomas with loss of LCA expression when lymphoid neoplasm cannot be excluded22, 23. Found insideAll of the TNM staging information included in this Sixth Edition is uniform between the AJCC (American Joint Committee on Cancer) and the UICC (International Union Against Cancer). It is important to always keep in mind that there are exceptions to everything. Archives of pathology & laboratory medicine 1987; 111(11):1035-9. Immunohistochemical analysis of nuclear versus cytoplasmic staining of WT1 in malignant mesotheliomas and primary pulmonary adenocarcinomas. A distinct subset of thoracic sarcomas with undifferentiated rhabdoid morphology and SMARCA4 inactivation has recently been described, and potential targeted therapy for SMARC-deficient tumors … Alternative epithelial markers in sarcomatoid carcinomas of the head and neck, lung, and bladder-p63, MOC-31, and TTF-1. 19. It is one of the recent markers that has been recognized as being useful in the diagnosis of melanoma with the sensitivity comparable to S100 in detecting both primary and metastatic melanoma (>90%)17. Value of thyroid transcription factor-1 immunostaining in distinguishing small cell lung carcinomas from other small cell carcinomas. Immunohisto-chemistry plays an important role in elucidating the true nature of the undifferentiated tumor that is crucial for clinical management. Myeloid (granulocytic) sarcomas with little or no evidence of myeloid differentiation may manifest as undifferentiated tumors, sometimes with small round cell morphology. If diffuse CK expression is noted and mesothelioma which has a distinct clinical manifestation is excluded, the differential diagnosis will include certain types of carcinomas that show vimentin co-expression (such as renal cell carcinoma, pulmonary adenocarcinoma, thyroid carcinoma, endometrial adenocarcinoma, and ovarian serous carcinoma) and some sarcomas including epitheloid sarcoma, malignant rhabdoid tumor, chordoma, and parachordoma/ mixed tumor of soft tissue. Applied immunohis-tochemistry & molecular morphology : AIMM / official publication of the Society for Applied Immunohistochemistry 2012; 20(5):445-50. To cope with the expense, time-consumption and workloads, a systematic approach in using the appropriate immunohistochemical markers should be put in consideration. Immunocytochemi-cal evidence suggesting divergent epithelial and mesenchymal differentiation in a primary osseous neoplasm. Definition. Advertising revenue supports our not-for-profit mission. Although ER and PR expression is expected to be associated with hormone-responsive organs and their neoplasms, such as breast, ovary, and endometrium,176 there are frequent examples of unexpected ER or PR expression reported in a variety of other tumors, including those from lung,98,177–179 thyroid,180 stomach,181 and some neuroendocrine tumors.97 Furthermore, given that many high-grade carcinomas arising from hormone-responsive organs such as breast lack ER expression, we discourage sole reliance on ER and PR as determinants of the site of tumor origin, except in selected differential diagnoses and in combination with other immunomarkers. the unsubscribe link in the e-mail. When all the markers in the initial screening panel including vimentin are negative, it is important to check for tumor cell viability. In the lung, large cell neuroendocrine carcinoma must be differentiated from basaloid carcinoma. Hence, caution should be taken to avoid overinterpretation of CK expression as a specific feature of epithelial tumors. If we combine this information with your protected In 2004, based on the previous evidence review, the USPSTF found there was insufficient evidence to either recommend for or against routinely screening asymptomatic persons for lung cancer with either low-dose computed tomography (LDCT), ... For such reason, in this review we apply the term undifferentiated to tumors lacking evidence of lineage differentiation on the basis of routine light microscopic morphology alone. The inset in the left lower corner shows a magnified view of a cell in metaphase of mitosis. Ordonez NG. When dealing with a malignant spindle cell tumor at any site, the possibility of spindle cell melanoma should always be considered. •    CD30 - CD30 should be included in the screening panel of undifferentiated tumors which large cell lymphomas including anaplastic large cell lymphoma and classical Hodgkin lymphoma are in a list of differential diagnosis5, 22 because these tumors are usually negative for LCA. In consideration the expense, time-consumption and workloads, a wide variety of cells... Are noted to be distinguished from other small cell lung carcinomas from other cell... Sinonasal undifferentiated carcinoma ( SNUC ) is preferentially expressed by ALK positive anaplastic large cell lymphoma, in normally. Wt1 in the initial manifestation of plasma cell myeloma be positive for,... Screening panel including vimentin are negative, it is important to always keep in mind there. 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