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Eyas M. Hattab , M.D. Department of Pathology and Laboratory Medicine

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. Case #1. 71 yo M

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Eyas M. Hattab , M.D. Department of Pathology and Laboratory Medicine

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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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