B. Rychlý Cytopathos, Bratislava

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Presentation transcript:

B. Rychlý Cytopathos, Bratislava SDIAP Case 481 B. Rychlý Cytopathos, Bratislava

Clinical information 43-year-old man 4-month history of headache, double vision, dizziness, unsteady gait MRI solid-cystic brain TU F, on both sides, perifocal edema shift of the midline structures preoperative dg.: glioblastoma susp. radical operation

MRI

?

AE1/3

CK8/18

CK5/6 M903

GFAP

GFAP other markers negative: CHA, SY, NeuN (also in small cells), SMA, Dezmin, HHF35 retained INI1

?

after exclusion of carcinoma to glioma MTS Our dg. True epithelial differentiation in the sarcomatoid / small cell glioblastoma after exclusion of carcinoma to glioma MTS

Clinical work-up chest, abdomen skiagraphy sonography CT: chest, abdomen, pelvis whole body PET scan ... all negative patient died 4 month after operation from tumor progression microdissection and CGH from both components? (but we extracted only 300bp DNA fragments from paraffin material...)

Glioblastoma most malignant brain tumor treatment median OS 12 month surgery Stupp regiment (concomitant RT and CHT + adjuvant CHT temozolomide (MGMT promoter methylation) median OS 12 month

Special types of glioblastoma gliosarcoma giant cell small cell epitheloid epithelial with oligo component MG-PNET prognostic relevance?

Epithelial glioblastoma very rare true epithelial differentiation (morphology, IHC, EM) features of glioblastoma along with epithelial differentiation showing the formation of squamous nests and/or glands staining for EMA, cytokeratin CAM 5.2, E-cadherin, cytokeratin AE1/AE3, cytokeratin 7, pCEA, cytokeratin 5/6 and cytokeratin 20

Epithelial glioblastoma molecular alterations: P53, p21, EGFR, chromosome loss: 10q22-26, 17p13 mean OS: 7 months glial and epithelial components are clonal (microdissection)

Carcinoma to glioma MTS? in very advanced cancer glioblastoma with epithelial differentiation? florid / atypical reactive gliosis around MTS?

Summary glioblastomas with true epithelial differentiation are very rare mostly diagnosed as MTS carcinoma clinicopathologic correlation Thank you for your attention.