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Presented by Peter Illei, M.D. and prepared by Mark Samols, M.D., Ph.D.
Case 2: 55 y.o. black male patient with an epidural mass and a recent lung biopsy.
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Question 1 of 1
1. Question
Week 544: Case 2
55 y.o. black male patient with an epidural mass and a recent lung biopsy read as poorly differentiated non-small cell carcinoma with necrosis. The current material is a biopsy of the epidural mass. The tumor exhibits patchy p63 positivity while a mucicarmine stain and immunostains for TTF-1, Napsin-A and p40 are negative.images/samols/0121132a.jpg
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images/samols/0121132e.jpgCorrect
Answer: Metastatic large cell neuroendocrine carcinoma
Histology:
Discussion: There is no histologic evidence of definite squamous or glandular differentiation. The tumor cells have medium to large, round to oval to irregular nuclei with finely dispersed chromatin and small cherry red nucleoli. Areas of geographic necrosis and high mitotic activity are present. Immunostains demonstrate that the tumor cells are negative for lung adenocarcinoma markers (TTF-1 and napsin-A) and the squamous cell carcinoma marker p40. A mucicarmine stain is also negative. A p63 stain shows patchy strong staining and a Ki67 stain shows a proliferative activity of 70-80%. While strong diffuse p63 staining would support squamous differentiation, patchy positivity combined with p40 negativity is best interpreted as non-specific staining. Additional immunostains demonstrate that the tumor cells are positive for neuroendocrine markers (synaptophysin and CD56 positive, chromogranin focally positive). The patient’s prior lung biopsy of poorly differentiated non-small cell carcinoma with necrosis showed similar histology, but no special stains were performed. In summary, the morphologic features and staining pattern in the current material is most consistent with a metastatic large cell neuroendocrine carcinoma of the lung.
Incorrect
Answer: Metastatic large cell neuroendocrine carcinoma
Histology:
Discussion: There is no histologic evidence of definite squamous or glandular differentiation. The tumor cells have medium to large, round to oval to irregular nuclei with finely dispersed chromatin and small cherry red nucleoli. Areas of geographic necrosis and high mitotic activity are present. Immunostains demonstrate that the tumor cells are negative for lung adenocarcinoma markers (TTF-1 and napsin-A) and the squamous cell carcinoma marker p40. A mucicarmine stain is also negative. A p63 stain shows patchy strong staining and a Ki67 stain shows a proliferative activity of 70-80%. While strong diffuse p63 staining would support squamous differentiation, patchy positivity combined with p40 negativity is best interpreted as non-specific staining. Additional immunostains demonstrate that the tumor cells are positive for neuroendocrine markers (synaptophysin and CD56 positive, chromogranin focally positive). The patient’s prior lung biopsy of poorly differentiated non-small cell carcinoma with necrosis showed similar histology, but no special stains were performed. In summary, the morphologic features and staining pattern in the current material is most consistent with a metastatic large cell neuroendocrine carcinoma of the lung.
