Template:Undifferentiated malignancy: Difference between revisions

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===Undifferentiated malignancy===
===Undifferentiated malignancy===
An initial panel of cytokeratin (CK, such as by CK AE1/AE3 cocktail), S100, vimentin and LCA (CD45) can be used (see source article for subsequent work-up).<ref name="pmid25427040">{{cite journal| author=Lin F, Liu H| title=Immunohistochemistry in undifferentiated neoplasm/tumor of uncertain origin. | journal=Arch Pathol Lab Med | year= 2014 | volume= 138 | issue= 12 | pages= 1583-610 | pmid=25427040 | doi=10.5858/arpa.2014-0061-RA | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25427040  }} </ref>
[[File:Histopathology of undifferentiated tumor cells.jpg|thumb|220px|Histopathology of a biopsy of a lymph node with cancer of unknown primary origin, showing undifferentiated high-grade tumor cells.]]
An initial panel of '''cytokeratin''' (CK, such as by CK AE1/AE3 cocktail), '''S100''', '''vimentin''' and '''LCA (CD45)''' can be used (see source article for subsequent work-up).<ref name="pmid25427040">{{cite journal| author=Lin F, Liu H| title=Immunohistochemistry in undifferentiated neoplasm/tumor of uncertain origin. | journal=Arch Pathol Lab Med | year= 2014 | volume= 138 | issue= 12 | pages= 1583-610 | pmid=25427040 | doi=10.5858/arpa.2014-0061-RA | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25427040  }} </ref>


Alternatively, a more comprehensive panel can be performed upfront, with the most pertinent panel suggested below (with main associated primary origins in parentheses), but it should be tailored to additional clues from each individual case:<ref>Partly inspired by:<br>{{cite journal| author=Beauchamp K, Moran B, O'Brien T, Brennan D, Crown J, Sheahan K | display-authors=etal| title=Carcinoma of unknown primary (CUP): an update for histopathologists. | journal=Cancer Metastasis Rev | year= 2023 | volume=  | issue=  | pages=  | pmid=37394540 | doi=10.1007/s10555-023-10101-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=37394540  }} </ref>
Alternatively, a more comprehensive panel can be performed upfront, with the most pertinent panel suggested below (with main associated primary origins in parentheses), but it should be tailored to additional clues from each individual case:<ref>Partly inspired by:<br>{{cite journal| author=Beauchamp K, Moran B, O'Brien T, Brennan D, Crown J, Sheahan K | display-authors=etal| title=Carcinoma of unknown primary (CUP): an update for histopathologists. | journal=Cancer Metastasis Rev | year= 2023 | volume=  | issue=  | pages=  | pmid=37394540 | doi=10.1007/s10555-023-10101-6 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=37394540  }} </ref>
*'''Mucicarmine''' (adenocarcinoma)
[[File:Histopathology of signet ring cell carcinoma of urinary bladder on mucicarmine stain.jpg|thumb|220px|Mucicarmine stain showing signet ring cell carcinoma, with the mucin within tumor cells colored pink/red.]]
:*'''CK7 and CK20''', see section below.
*'''Mucicarmine''' or '''Cytokeratin CAM 5.2''' ([[adenocarcinoma]])
:*'''NKX3.1''' in males (prostate) or '''estrogen and progesterone receptor''' in females (reproductive tract).
:*'''CK7 and CK20''' can give a broad indication of the primary site. Still use more specific immunohistochemistry stains instead or in addition where applicable. See image below for main patterns.
:*'''TTF-1''' (thyroid, lung)
:*'''NKX3.1''' in males ([[prostate adenocarcinoma]]), or '''PAX-8''' or '''estrogen and progesterone receptor''' in females ([[Female reproductive system|female reproductive tract]]).
:*'''GATA3''' (urothelial)
:*'''TTF-1''' ([[thyroid]] or [[lung tumor]])
:*'''CDX2''' (gastrointestinal)
:*'''GATA3''' ([[urothelial carcinoma]], [[Breast pathology|breast tumor]])
:*'''CDX2''' (gastro[[Intestine with tumor|intestinal tumor]])
:*'''p63''' ([[squamous cell carcinoma]])
:*'''p63''' ([[squamous cell carcinoma]])
*'''S100''' (neural, melanoma)
*'''S100''' (neural, [[invasive melanoma]])
*'''LCA (CD45)''' (hematopoietic)
*'''LCA (CD45)''' (hematopoietic)
*'''Synaptophysin''' (neuroendocrine)
*'''Synaptophysin''' (neuroendocrine)
 
[[File:CK7 and CK20 by body location.svg|thumb|center|500px|CK7 and CK20 expression by various body locations.{{MH}}]]
;CK7 and CK20 in carcinomas of unknown primary site (CUPs)
<noinclude>
'''CK7 and CK20''' can give a broad indication of the primary site. Still use more specific immunohistochemistry stains instead or in addition where applicable.
{| class="wikitable"
|+ Most common CK7 and CK20 patterns in carcinomas of unknown primary site (CUPs)<ref name="pmid29621151">{{cite journal| author=Selves J, Long-Mira E, Mathieu MC, Rochaix P, Ilié M| title=Immunohistochemistry for Diagnosis of Metastatic Carcinomas of Unknown Primary Site. | journal=Cancers (Basel) | year= 2018 | volume= 10 | issue= 4 | pages=  | pmid=29621151 | doi=10.3390/cancers10040108 | pmc=5923363 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29621151  }} </ref>
! colspan="2" rowspan="2" |
! colspan="2" |CK20
|-
|Positive
|Negative
|-
! rowspan="2" |CK7
|Positive
|
*Urothelial carcinoma
*Pancreatic adenocarcinoma
*Ovarian mucinous carcinoma
*Bladder adenocarcinoma
*Gastric adenocarcinoma
*Cholangiocarcinoma
|
*Breast carcinoma
*Lung adenocarcinoma
*Endometrial adenocarcinoma
*Endocervical adenocarcinoma
*Ovarian (serous) carcinoma
*Cholangiocarcinoma
*Small cell lung carcinoma
*Mesothelioma
*Thyroid carcinoma
*Salivary gland tumours
*Kidney (papillary)
*Urothelial carcinoma (subset)
*Pancreatic adenocarcinoma
*Gastric adenocarcinoma
*Esophageal adenocarcinoma<ref>{{cite web|url=https://www.pathologyoutlines.com/topic/esophagusadenocarcinoma.html|title=Esophagus - Carcinoma - Adenocarcinoma|author=Elliot Weisenberg, M.D.|website=Pathology Outlines}} Last author update: 1 June 2013. Last staff update: 31 October 2022</ref>
|-
|Negative
|
*Colorectal adenocarcinoma
*Merkel cell carcinoma
*Gastric adenocarcinoma
|
*Prostate adenocarcinoma
*Renal (clear cells)
*Hepatocellular carcinoma
*Adrenocortical carcinoma
*Non-seminoma germ cell tumours
*Mesothelioma
*Small cell lung carcinoma
*Gastric adenocarcinoma
|}<noinclude>
{{Bottom}}
{{Bottom}}
</noinclude>
</noinclude>

Latest revision as of 17:59, 6 May 2025

Undifferentiated malignancy

Histopathology of a biopsy of a lymph node with cancer of unknown primary origin, showing undifferentiated high-grade tumor cells.

An initial panel of cytokeratin (CK, such as by CK AE1/AE3 cocktail), S100, vimentin and LCA (CD45) can be used (see source article for subsequent work-up).[1]

Alternatively, a more comprehensive panel can be performed upfront, with the most pertinent panel suggested below (with main associated primary origins in parentheses), but it should be tailored to additional clues from each individual case:[2]

Mucicarmine stain showing signet ring cell carcinoma, with the mucin within tumor cells colored pink/red.
  • S100 (neural, invasive melanoma)
  • LCA (CD45) (hematopoietic)
  • Synaptophysin (neuroendocrine)
CK7 and CK20 expression by various body locations.[image 1]

Notes


Main page

References

  1. ↑ Lin F, Liu H (2014). "Immunohistochemistry in undifferentiated neoplasm/tumor of uncertain origin. ". Arch Pathol Lab Med 138 (12): 1583-610. doi:10.5858/arpa.2014-0061-RA. PMID 25427040. Archived from the original. . 
  2. ↑ Partly inspired by:
    Beauchamp K, Moran B, O'Brien T, Brennan D, Crown J, Sheahan K (2023). "Carcinoma of unknown primary (CUP): an update for histopathologists. ". Cancer Metastasis Rev. doi:10.1007/s10555-023-10101-6. PMID 37394540. Archived from the original. . 

Image sources

  1. ↑ Image(s) by: Mikael Häggström, M.D. Public Domain
    - Author info
    - Reusing images
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