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Presented by Peter Illei, M.D. and prepared by Hillary Ross, M.D.
Case 6: 80 y.o. male with a history of prostate cancer presenting with a chest wall mass.
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Question 1 of 1
1. Question
Week 459: Case 6
80 y.o. male with a history of prostate cancer presenting with a chest wall mass.images/1alex/11152010case6image1.jpg
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images/1alex/11152010case6image5.jpgCorrect
Answer: Malignant mesothelioma
Histology: The lesional cells demonstrate strong diffuse staining for cytokeratin AE1/AE3, CK7, CK20, and Vimentin while they are negative for CK5/6, TTF-1, CEA, PSA, LCA, melanoma markers (S-100 and Melan-A/Mart-1), and muscle markers (actin, desmin). Additional immunostains performed in our laboratory demonstrate that the neoplastic cells are strongly CK7 positive and partially calretinin positive (with strong nuclear and cytoplasmic staining) and focally CK19 positive.
Additional mesothelial markers (WT-1 and D2-40), TTF-1, p63, are negative. Stains for vascular differentitation (CD31 and CD34), additional prostate markers (p501s/prostein and PSMA), inhibin, PAX-8 and BCL-2 are also negative.
An INI-1 stain shows positive nuclear staining in the tumor cells.
Discussion: These findings favor malignant mesothelioma, biphasic type. Histologically, the differential diagnosis also includes sarcomatoid carcinoma, epithelioid sarcoma and to a lesser degree synovial sarcoma. The diffuse and strong cytokeratin positivity together with the partial calretinin positivity and negative staining for CK5/6 and p63 favors malignant mesothelioma over sarcomatoid carcinoma, while the retention of INI-1 is against epithelioid sarcoma and the negative staining for bcl-2 is against synovial sarcoma.
Incorrect
Answer: Malignant mesothelioma
Histology: The lesional cells demonstrate strong diffuse staining for cytokeratin AE1/AE3, CK7, CK20, and Vimentin while they are negative for CK5/6, TTF-1, CEA, PSA, LCA, melanoma markers (S-100 and Melan-A/Mart-1), and muscle markers (actin, desmin). Additional immunostains performed in our laboratory demonstrate that the neoplastic cells are strongly CK7 positive and partially calretinin positive (with strong nuclear and cytoplasmic staining) and focally CK19 positive.
Additional mesothelial markers (WT-1 and D2-40), TTF-1, p63, are negative. Stains for vascular differentitation (CD31 and CD34), additional prostate markers (p501s/prostein and PSMA), inhibin, PAX-8 and BCL-2 are also negative.
An INI-1 stain shows positive nuclear staining in the tumor cells.
Discussion: These findings favor malignant mesothelioma, biphasic type. Histologically, the differential diagnosis also includes sarcomatoid carcinoma, epithelioid sarcoma and to a lesser degree synovial sarcoma. The diffuse and strong cytokeratin positivity together with the partial calretinin positivity and negative staining for CK5/6 and p63 favors malignant mesothelioma over sarcomatoid carcinoma, while the retention of INI-1 is against epithelioid sarcoma and the negative staining for bcl-2 is against synovial sarcoma.
