Presented by Dr. Pedram Argani and prepared by Dr. Katelynn Davis
This is a 15 year old male with mediastinal mass
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1. Question
This is a 15 year old male with mediastinal mass
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Answer: NUT midline carcinoma
Histologic Description: This is a small round cell tumor. The neoplastic cells have coarse chromatin, thick nuclear membranes, and are associated with necrosis. The neoplastic cells demonstrated focal labeling for cytokeratin and p63, and diffuse nuclear labeling for NUT protein, supporting the diagnosis.
Differential Diagnosis: Ewing sarcomas would have finer chromatin, and would label for CD99. Lymphoblastic lymphomas would have finely dispersed chromatin along with angulated nuclei, and would label for markers such as CD43 and TdT. HPV-related squamous cell carcinomas would typically arise in the oropharynx, and would demonstrate high risk HPV by in situ hybridization. NUT midline carcinomas are typically undifferentiated small round cell tumors harboring NUT gene fusion that may show up focal abrupt squamous differentiation. There prognosis is poor, with the mean survival less than one year.
Incorrect
Answer: NUT midline carcinoma
Histologic Description: This is a small round cell tumor. The neoplastic cells have coarse chromatin, thick nuclear membranes, and are associated with necrosis. The neoplastic cells demonstrated focal labeling for cytokeratin and p63, and diffuse nuclear labeling for NUT protein, supporting the diagnosis.
Differential Diagnosis: Ewing sarcomas would have finer chromatin, and would label for CD99. Lymphoblastic lymphomas would have finely dispersed chromatin along with angulated nuclei, and would label for markers such as CD43 and TdT. HPV-related squamous cell carcinomas would typically arise in the oropharynx, and would demonstrate high risk HPV by in situ hybridization. NUT midline carcinomas are typically undifferentiated small round cell tumors harboring NUT gene fusion that may show up focal abrupt squamous differentiation. There prognosis is poor, with the mean survival less than one year.
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