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

 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

 TTF-1  Thyroglobulin

TTF-1 Thyroglobulin

 Metastatic follicular thyroid carcinoma

Indianapolis Central Library

 59 yo M  History of “esophageal surgery” one month ago  Presents with cervical vertebral body “osteomyelitis”  Vertebral body biopsy performed

 Squamous cell carcinoma  CK 5/6  P63  ?p40

CK cocktailp63CK 5/6

 Metastatic squamous cell carcinoma, of esophageal origin

 48 yo F  History of breast carcinoma ten years ago  Presents with new onset headaches  Brain MRI shows a left frontal lobe mass

 H&E Dx: PD Carcinoma, likely breast  Recommended IHC workup:  CK7/20  GATA-3  GCDFP  Mammaglobin  ER/PR/Her2 (if requested or diagnostically relevant)

 CK7 + / CK20 -

CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

Estrogen ReceptorHer2/neuGATA-3

 Metastatic breast carcinoma

 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!

 H&E Dx: carcinoma, likely renal cell  Recommended IHC workup:  CK7/CK20  Two of the following:  Vimentin  EMA  CD10  PAX8

 CK7 - / CK20 -

CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

VimentinEMA

CD10PAX8

 Metastatic renal cell carcinoma

Soldiers and Sailors Monument on the Circle

 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

 Keratin cocktail  CK7  CK20

Keratin cocktail

 CK 7 –  CK 20 –

CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

PSAPPSAP501S

 Metastatic prostatic adenocarcinoma

Bankers Life Fieldhouse

 51 yo F  Presented to an outside facility with headache  Imaging studies revealed a right occipital mass with rim enhancement

 Keratin cocktail  CK 7  CK 20  TTF-1  Napsin A  GATA 3

Keratin cocktail

CK7CK20

CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

TTF-1Napsin A

GATA 3

 Metastatic lung adenocarcinoma

 57 yo M  Presented with a spontaneous intraparenchymal hemorrhage in the right temporal lobe

 H&E Dx: adenocarcinoma, likely papillary thyroid  Recommended IHC workup:  CK7/20  TTF1  Napsin A  Thyroglobulin  Pax8

 CK7 +  CK 20 –

TTF-1Napsin A

 Thyroglobulin +  PAX8 +

 Metastatic papillary thyroid carcinoma

 56 yo F  Limited past medical history, presented to the county emergency room with heavy vaginal bleeding  Imaging studies revealed a large abdominal mass with extension into and pathologic fracture of the L3 vertebral body

 CK 7  CK 20

CK7CK20

CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

 TTF1 –  Napsin A –

CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

 GATA3 –  GCDFP-15 –

CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

WT1

CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

 BER-EP4 +  MOC-31 +

CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

Estrogen receptor

CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

 CDX2 +!

 Caveat: CDX2 may be aberrantly expressed in endometrial adenocarcinoma!

 Metastatic endometrial adenocarcinoma

 65 yo M  Presented with new onset seizures

 CK AE1/3  EMA  PR  CK7  CK20  p63

 Reactive Immunostains  Ki67  PR  AE1/AE3  P63  EMA  Negative Immunostains  Synaptophysin  GFAP  CDX2  CK5/6  CD45RB  S100 protein  CK20  CK7  CD34  Napsin A

CK AE1/3

EMA

Progesterone Receptor

CK 7CK 20

p63

 Metastatic lung squamous cell carcinoma???