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Pathology and Epidemiology
Published in John T. Kemshead, Pediatric Tumors: Immunological and Molecular Markers, 2020
Neuron-specific enolase can also be identified immunohistologically in the cytoplasm of cells of the neuroblastoma lineage. Many investigators find that this antigen is expressed poorly, if at all, in those morphologically undifferentiated tumors where diagnostic assistance is most needed. Tsokos et al.,33 found that this cytoplasmic component was demonstrable in every one of a group of neuroblastomas which they investigated, while it was found in one rhabdomyosarcoma among a large, heterogeneous group of other tumors. A similar criticism can be leveled at S-100 protein in neuroblastoma, in that it is only expressed in the better differentiated tumors, but in this latter group it has proved to be of some diagnostic value. Epithelial-membrane antigen is another marker of considerable value demonstrable immunohistologically on the surface of epithelial-derived tumors such as primary or secondary carcinomas.
Circulating Tumor Cells in Individualizing Breast Cancer Therapy
Published in Brian Leyland-Jones, Pharmacogenetics of Breast Cancer, 2020
James M. Reuben, Massimo Cristofanilli
Tumor cells can be detected in the locoregional lymph nodes of women with early breast cancer, and the presence of these cells has been shown to have a negative effect on long-term prognosis (3,12). Despite evidence of the prognostic value of CTCs in some studies, the detection of micrometastases was never incorporated into cancer-staging protocols or considered a valuable clinical tool. This may be the result of a combination of factors, such as variable antigen expression in poorly differentiated tumors and reports of cytokeratin and epithelial membrane antigen positivity in cells that are not of epithelial origin, which demonstrated a need for more sensitive and specific methods of detection than were available at the time. This need was filled to some degree by sensitive PCR techniques (14,16,17). In the past decade, a few studies have shown that the detection of occult disease by PCR has prognostic significance in some solid tumors (13). However, PCR-based assays for the detection of occult tumor cells have limitations, particularly contamination of samples, specificity of the assays, and inability to quantify tumor cells. Moreover, PCR-based methods cannot be used to perform functional assays. These factors have precluded the widespread use of PCR in in vitro diagnostic applications.
The Non-Hodgkin’s Lymphomas and Plasma Cell Dyscrasias
Published in Harold R. Schumacher, William A. Rock, Sanford A. Stass, Handbook of Hematologic Pathology, 2019
Lynne V. Abruzzo, L. Jeffrey Medeiros
The immunophenotype of plasma cell myeloma and plasmacytoma is similar to benign plasma cells. Like benign plasma cells, the neoplastic cells express cytoplasmic, but not surface, immunoglobulin. However, unlike reactive process, which contains a mixture of kappa-and lambda-positive plasma cells, neoplastic plasma cells express monoclonal immunoglobulin and show a light chain restriction. A population is said to demonstrate a light chain restriction when the ratio of one light chain type to the other exceeds 16:1. Both benign and malignant plasma cells fail to express most B-cell-associated antigens, such as CD19, CD20, and CD22. However, they express the B-cell-associated antigen CD79a, which is also expressed on plasma cells. Like benign plasma cells, the neoplastic cells are usually negative for CD45 (leukocyte common antigen), positive for CD38 and the mature plasma cell antigens, PC-1, and PCA-1. They also may express epithelial membrane antigen (EMA). Neoplastic plasma cells, but not benign plasma cells, stain with the antibody MB2, and also often epxress CD56, an adhesion molecule that is associated with natural killer cell differentiation. A minority of cases express CD10 (CALLA), and markers of myelomonocytic differentiation, such as CD11b, CD11c, CD13, CD15, and CD33.
Sinonasal undifferentiated carcinoma with metastasis to the extradural spine
Published in British Journal of Neurosurgery, 2023
Samuel Jones, Heather O’Connor, Fraser Henderson, Adriana Olar, Sunil Patel
SNUC is diagnosed by histopathological examination. Grossly, these tumors are usually larger than four centimeters with fungating, ill-defined margins. Invasion into adjacent structures and anatomic compartments with bone destruction is common. Histologically, the tumor is characterized by a submucosal cellular proliferation with lobular and trabecular growth patterns predominating. The cellular infiltrate consists of polygonal medium- to large-sized cells with a high nuclear-to-cytoplasmic ratio, eosinophilic cytoplasm, and well-defined borders. The nuclei can be hyperchromatic or vesicular with variably prominent nucleoli. SNUCs have a high mitotic rate with prominent confluent tumor necrosis and individual cell apoptosis. As seen in our case, lymph-vascular and perineural invasion are common.7 These tumors are consistently positive for neuron specific enolase.8 About 50% of cases will also express epithelial membrane antigen.7 We present here the histopathological features of this SNUC tumor (Figure 2) from the original resection specimen (day +8) and the cervical spine metastasis (day +302).
A case of spindle cell dominant histiocytic sarcoma showing a complete remission after first-line chemotherapy with doxorubicin and ifosfamide
Published in Journal of Chemotherapy, 2020
Yusuke Nakamura, Akihiro Takemasa, Yoshitomo Kushima, Sayo Soda, Naoya Ikeda, Ryo Arai, Kazuyuki Chibana, Yoshimasa Nakazato, Tomoyuki Yokose, Yasuo Shimizu, Seiji Niho
The needle bone biopsy samples showed atypical spindle and giant cells on hematoxylin-eosin (HE) staining (Figure 2A–B). Trabecular bone was maintained without destruction, suggesting a metastatic tumor. Spindle cells were morphological predominant, positive immunostaining for vimentin, and negative immunostaining for cytokeratin (CK) 7, CK20, anti-pan cytokeratin AE1/3, thyroid transcription factor-1 (TTF-1), anti-tyrosinase antibody (S-100), desmin, smooth muscle actin (SMA), myoglobin, anti-muscle actin (HHF35), factor 8, cluster of differentiation (CD) 34, CD1a, myeloperoxidase (MPO), CD20, CD3, signal transducer and activator of transcription 6 (STAT6), and CD21. Therefore, the initial diagnosis was unclassified soft tissue sarcoma. After two courses chemotherapy, additional immunostainings were performed to make a definitive diagnosis. Tumor cells were positive for CD14, CD68, CD163, epithelial membrane antigen (EMA), CD99, CD4, and lysozyme. Positive immunostaining for CD14, CD68, CD163, and lysozyme were shown in Figure 2C–F (×400). The Ki-67 (Mib-1) proliferative index was low (about 15%) (Figure 2G). Because histiocyte markers were positive, and other diseases had been excluded, the final diagnosis was determined as HS. The programmed death-ligand 1 (PD-L1) tumor proportion score was <1%. The therapeutic biomarkers, real-time polymerase chain reaction (RT-PCR) of epidermal growth factor receptor (EGFR) and echinoderm microtubule-associated protein-like 4 - anaplastic lymphoma kinase (EML4-ALK) fusion gene from frozen storage cells were negative (analyzed by SRL Inc.).
Cranio-spinal Rosai Dorfman disease: case series and literature review
Published in British Journal of Neurosurgery, 2019
Shashank S. Joshi, Shilpa Joshi, Girish Muzumdar, Keki E. Turel, Rajan M. Shah, Indoo Ammbulkar, Muhammad Masood Hussain, Kishor A. Choudhari
Immunohistochemistry-The characteristic RDD histiocytes are strongly positive for S-100 protein (Figure 4(B)) and CD 68 and negative for CD 1a.45,46 Staining for CD 20 and CD 3 show mixed populations of B and T lymphocytes in the background. Kappa and lambda light chain immunohistochemistry show polytypic staining in the plasma cell infiltrates. The stain for epithelial membrane antigen (EMA) decorates plasma cells and meningeal cells. Immunohistochemistry finding in various conditions which can mimic cranial RDD are summarised in Table 3.47 Intracranial Hodgkin’s disease is rare and is typically associated with relapse.48 Classic Reed Sternberg cells can readily distinguish them from RDD histiocytes. Classic Reed Sternberg cells and variants, lack emperipolesis and S-100 immunoreactivity and are typically positive for CD 15 and CD 30.49 Intracranial affection by plasmacytoma is relatively rare but similar to the case of intracranial RDD, these lesions are dural-based. This diagnosis is easily excluded by demonstrating plasma cell infiltrates of plasmacytoma are monoclonal whilst RDD are polyclonal.50,51 Plasma cell granuloma is a discrete, inflammatory mass lesion attached to dura and associated with fibrosis.52–55 Many lesions previously reported as intracranial plasma cell granulomas or inflammatory pseudotumours are in fact RDD.56–58 The various differential diagnoses for craniospinal RDD are summarised in Table 3 and include meningioma, lymphoma, plasmacytoma and chordoma.