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Voiculescu VM, Marinescu RM, Dutulescu S, Stăniceanu F. Immunohistochemistry for Skin Cancers: A Comprehensive Approach to the Diagnosis of Squamous Cell Carcinoma. Cancers (Basel) 2025; 17:1629. [PMID: 40427131 PMCID: PMC12110535 DOI: 10.3390/cancers17101629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2025] [Revised: 05/04/2025] [Accepted: 05/05/2025] [Indexed: 05/29/2025] Open
Abstract
BACKGROUND Squamous cell carcinoma (SCC) is a heterogeneous group of epithelial malignancies with varied morphologies and clinical behaviors. While histopathology is the diagnostic gold standard, it can be limited in distinguishing SCC from morphologic mimics. Immunohistochemistry (IHC) has therefore become a critical adjunct, enhancing diagnostic accuracy and providing prognostic insights. OBJECTIVE This narrative review aims to evaluate the diagnostic, differential, and prognostic roles of commonly used IHC markers in SCC, with particular emphasis on their utility in distinguishing SCC from histologic mimickers across different anatomical sites. METHODS One hundred and five peer-reviewed articles were analyzed for their relevance to the immunohistochemical characterization of SCC. Markers were categorized based on their diagnostic function, role in differential diagnosis, and prognostic value. RESULTS Key markers such as p40, p63, CK5/6, and DSG3 consistently demonstrated high sensitivity and specificity for SCC, reinforcing their value in confirming squamous differentiation. Conversely, exclusion markers like Ber-EP4, CK7, TTF-1, S100, and SOX10 were essential in ruling out basal cell carcinoma, adenocarcinoma, and melanoma. Additionally, markers such as Ki-67, p16, and CD44 offered prognostic information regarding tumor aggressiveness, HPV status, and therapy response. These findings confirm the critical role of IHC not only in diagnosing SCC but also in resolving complex differential diagnoses. CONCLUSIONS IHC markers serve as indispensable tools in the diagnostic workup of SCC, particularly in distinguishing it from other neoplasms with overlapping histologic features. The clear correlation between marker expression and diagnostic categories supports the systematic use of IHC to improve diagnostic precision and inform prognosis. Future integration with molecular diagnostics may further refine personalized treatment approaches in SCC.
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Affiliation(s)
- Vlad-Mihai Voiculescu
- Department of Dermatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.-M.V.); (S.D.); (F.S.)
- Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Radu-Marian Marinescu
- Department of Dermatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.-M.V.); (S.D.); (F.S.)
| | - Sorin Dutulescu
- Department of Dermatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.-M.V.); (S.D.); (F.S.)
- Pathology Department, “Matei Bals” National Institute for Infectious Diseases, 021105 Bucharest, Romania
| | - Florica Stăniceanu
- Department of Dermatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (V.-M.V.); (S.D.); (F.S.)
- Pathology Department, “Matei Bals” National Institute for Infectious Diseases, 021105 Bucharest, Romania
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McAlpine SG, Carrasquillo OY, Miedema J, Googe PB. Two Cases of Cutaneous Sarcomatoid Squamous Cell Carcinoma Resembling Cutaneous Giant Cell Tumor of Soft Tissue. Am J Dermatopathol 2024; 46:623-625. [PMID: 38842396 DOI: 10.1097/dad.0000000000002739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
ABSTRACT Cutaneous sarcomatoid squamous cell carcinoma is well-described with histology resembling pleomorphic undifferentiated sarcoma featuring collagenous or myxoid stroma with or without elements of keratinizing squamous carcinoma. This report presents 2 cases of dedifferentiated squamous cell carcinoma (SCC) composed of sheets of malignant mononuclear cells with malignant osteoclast-like multinucleated giant cells, extravasated blood, and hemosiderin resembling cutaneous giant cell tumor (cGCT). In the first case, an exophytic facial mass of a 96-year-old woman removed by shave showing extensive cGCT-like tumor but with microscopic elements of SCC in situ and positivity for cytokeratin 5/6 in the malignant spindle cells and SCC. The second case involved a 32-year-old man with a pedunculated penile mass removed by shave biopsy, displaying malignant cytology resembling cGCT, focal staining for cytokeratin AE1/AE3 and p63, and CD68 highlighting the osteoclast-like giant cells. Molecular analysis revealed CDKN2A, TP53, and TERT. Upon reexcision, case 2 showed focally invasive keratinizing SCC associated with differentiated penile intraepithelial neoplasia and lichen sclerosus. Skin specimens with an exophytic mass histologically resembling cGCT but with malignant cytology should be meticulously evaluated for elements of SCC. Molecular analysis, detecting mutations like H3F3 or HMGA2-NCOR2 fusion, can aid in distinguishing cutaneous sarcomatoid squamous cell carcinoma from GCT bone or GCT soft tissue.
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Affiliation(s)
- Sarah G McAlpine
- School of Medicine, University of North Carolina, Chapel Hill, NC; and
| | | | - Jayson Miedema
- Department of Dermatology, University of North Carolina, Chapel Hill, NC
| | - Paul B Googe
- Department of Dermatology, University of North Carolina, Chapel Hill, NC
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Meseguer P, Del Amor R, Naranjo V. MICIL: Multiple-Instance Class-Incremental Learning for skin cancer whole slide images. Artif Intell Med 2024; 152:102870. [PMID: 38663270 DOI: 10.1016/j.artmed.2024.102870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 04/07/2024] [Accepted: 04/08/2024] [Indexed: 05/15/2024]
Abstract
Artificial intelligence (AI) agents encounter the problem of catastrophic forgetting when they are trained in sequentially with new data batches. This issue poses a barrier to the implementation of AI-based models in tasks that involve ongoing evolution, such as cancer prediction. Moreover, whole slide images (WSI) play a crucial role in cancer management, and their automated analysis has become increasingly popular in assisting pathologists during the diagnosis process. Incremental learning (IL) techniques aim to develop algorithms capable of retaining previously acquired information while also acquiring new insights to predict future data. Deep IL techniques need to address the challenges posed by the gigapixel scale of WSIs, which often necessitates the use of multiple instance learning (MIL) frameworks. In this paper, we introduce an IL algorithm tailored for analyzing WSIs within a MIL paradigm. The proposed Multiple Instance Class-Incremental Learning (MICIL) algorithm combines MIL with class-IL for the first time, allowing for the incremental prediction of multiple skin cancer subtypes from WSIs within a class-IL scenario. Our framework incorporates knowledge distillation and data rehearsal, along with a novel embedding-level distillation, aiming to preserve the latent space at the aggregated WSI level. Results demonstrate the algorithm's effectiveness in addressing the challenge of balancing IL-specific metrics, such as intransigence and forgetting, and solving the plasticity-stability dilemma.
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Affiliation(s)
- Pablo Meseguer
- Instituto Universitario de Investigación e Innovación en Tecnología Centarada en el Ser Humano, HUMAN-tech, Universitat Politècnica de València, Valencia, Spain; valgrAI - Valencian Graduate School and Research Network of Artificial Intelligence, Valencia, Spain.
| | - Rocío Del Amor
- Instituto Universitario de Investigación e Innovación en Tecnología Centarada en el Ser Humano, HUMAN-tech, Universitat Politècnica de València, Valencia, Spain
| | - Valery Naranjo
- Instituto Universitario de Investigación e Innovación en Tecnología Centarada en el Ser Humano, HUMAN-tech, Universitat Politècnica de València, Valencia, Spain; valgrAI - Valencian Graduate School and Research Network of Artificial Intelligence, Valencia, Spain
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4
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Taweevisit M, Sutthiruangwong P, Thorner PS. Acantholytic squamous cell carcinoma mimicking epithelioid angiosarcoma: A diagnostic challenge by cytology. Diagn Cytopathol 2024; 52:E76-E79. [PMID: 38069674 DOI: 10.1002/dc.25265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 02/07/2024]
Abstract
Squamous cell carcinoma (SCC) is the most common malignancy of the head and neck region. Most cases present little diagnostic difficulty on fine needle aspiration (FNA), but unusual variants can be problematic. The authors report a case of the acantholytic SCC of the oral cavity in a 36-year-old male. The FNA showed hypercellularity, with malignant cells arranged in isolation, loosely cohesive groups and a linear configuration. Such cells were round to elongated, with vesicular nuclei and prominent nucleoli. Cells possessed occasional intracytoplasmic vacuoles, misinterpreted on FNA to be vasoformative features as seen in malignant endothelial cells. The cytologic diagnosis was "positive for malignancy, suggestive of angiosarcoma". A total excision was performed and by histology, the tumor was diagnosed as acantholytic SCC. The malignant cells were positive by immunostaining for AE1/AE3, p40, p63 and vimentin, but negative for CD31, CD34 and ERG. The intracytoplasmic vacuoles were PAS- and mucin-negative and negative for the above antibodies. Testing for HPV (molecular and p16 immunostaining) was negative. This case highlights the diagnostic challenges on cytology when malignant acantholytic squamous cells show intracytoplasmic vacuoles, and stresses how immunohistochemistry is important for distinguishing acantholytic SCC from other mimics.
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Affiliation(s)
- Mana Taweevisit
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Paul Scott Thorner
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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5
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Del Amor R, Silva-Rodríguez J, Naranjo V. Labeling confidence for uncertainty-aware histology image classification. Comput Med Imaging Graph 2023; 107:102231. [PMID: 37087899 DOI: 10.1016/j.compmedimag.2023.102231] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/23/2023] [Accepted: 03/27/2023] [Indexed: 04/25/2023]
Abstract
Deep learning-based models applied to digital pathology require large, curated datasets with high-quality (HQ) annotations to perform correctly. In many cases, recruiting expert pathologists to annotate large databases is not feasible, and it is necessary to collect additional labeled data with varying label qualities, e.g., pathologists-in-training (henceforth, non-expert annotators). Learning from datasets with noisy labels is more challenging in medical applications since medical imaging datasets tend to have instance-dependent noise and suffer from high inter/intra-observer variability. In this paper, we design an uncertainty-driven labeling strategy with which we generate soft labels from 10 non-expert annotators for multi-class skin cancer classification. Based on this soft annotation, we propose an uncertainty estimation-based framework to handle these noisy labels. This framework is based on a novel formulation using a dual-branch min-max entropy calibration to penalize inexact labels during the training. Comprehensive experiments demonstrate the promising performance of our labeling strategy. Results show a consistent improvement by using soft labels with standard cross-entropy loss during training (∼4.0% F1-score) and increases when calibrating the model with the proposed min-max entropy calibration (∼6.6% F1-score). These improvements are produced at negligible cost, both in terms of annotation and calculation.
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Affiliation(s)
- Rocío Del Amor
- Instituto Universitario de Investigación en Tecnología Centrada en el Ser Humano, Universitat Politècnica de València, Valencia, Spain.
| | | | - Valery Naranjo
- Instituto Universitario de Investigación en Tecnología Centrada en el Ser Humano, Universitat Politècnica de València, Valencia, Spain.
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Szczepanski JM, Siddiqui J, Patel RM, Harms PW, Hrycaj SM, Chan MP. Expression of SATB2 in primary cutaneous sarcomatoid neoplasms: a potential diagnostic pitfall. Pathology 2023; 55:350-354. [PMID: 36732203 DOI: 10.1016/j.pathol.2022.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/13/2022] [Accepted: 10/21/2022] [Indexed: 01/12/2023]
Abstract
SATB2 can be used as an immunohistochemical marker for osteoblastic differentiation. The differential diagnosis of a cutaneous sarcomatoid neoplasm sometimes includes osteosarcoma when the tumour concomitantly involves the skin, soft tissue, and bone, or when there is a past medical history of osteosarcoma. As the utility of SATB2 immunohistochemistry in these scenarios was unclear, we aimed to determine the frequency and the pattern of SATB2 expression in a variety of cutaneous sarcomatoid neoplasms. SATB2 expression by immunohistochemistry was evaluated by intensity (0-3) and extent (0-100%) of staining to generate an h-score for each case. Expression levels were classified into high-positive (h-score ≥100), low-positive (20-99), and negative (<20) groups. Positive SATB2 expression was observed in 18/23 (78%) atypical fibroxanthomas (AFX), 10/19 (53%) pleomorphic dermal sarcomas, 9/20 (45%) cutaneous sarcomatoid squamous cell carcinomas, 14/39 (36%) sarcomatoid melanomas, 2/13 (15%) poorly differentiated cutaneous angiosarcomas, 10/17 (59%) high-grade cutaneous leiomyosarcomas, and 7/8 (88%) osteosarcoma controls. With the exception of AFX, all cutaneous neoplasms showed significantly lower average h-scores than osteosarcoma. AFX gave the highest average h-score (71) and percentage of high-positive cases (48%) among all examined cutaneous neoplasms. Only two (1.5%) of all cutaneous cases showed strong intensity of staining. Common SATB2 expression in various cutaneous sarcomatoid neoplasms poses a potential diagnostic pitfall when the differential diagnosis includes osteosarcoma. Requirement of strong staining and a high-positive h-score improves the specificity of SATB2 in differentiating these tumours from osteosarcoma.
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Affiliation(s)
| | - Javed Siddiqui
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Rajiv M Patel
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - Paul W Harms
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - Steven M Hrycaj
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - May P Chan
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA; Department of Dermatology, University of Michigan, Ann Arbor, MI, USA.
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7
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Santos IR, Raiter J, Lamego ÉC, Bandinelli MB, Dal Pont TP, Siqueira KF, Almeida BA, Panzeira W, Sonne L, Driemeier D, Pavarini SP. Feline pulmonary carcinoma: Gross, histological, metastatic, and immunohistochemical aspects. Vet Pathol 2023; 60:8-20. [PMID: 36112908 DOI: 10.1177/03009858221122517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Feline pulmonary carcinoma (FPC) is an uncommon neoplasm with unique morphological features. We describe the gross, histological, metastatic, and immunohistochemical aspects of FPC, based on postmortem examinations from an 11-year retrospective study. Thirty-nine cases were selected. Predispositions were observed in senior (P < .001) and Persian (P = .039) cats. There were three gross patterns of the pulmonary tumors: (a) a large nodule and additional smaller nodules, (b) a solitary nodule, and (c) small, multifocal to coalescent nodules. Extrapulmonary metastases were present in 22/39 cases (56.4%), mainly in the regional lymph nodes (17/39, 43.5%), skeletal muscles (9/39, 23%), kidneys (6/39, 15.3%), and parietal pleura (4/39, 10.2%). The primary tumor size was correlated with the occurrence of extrapulmonary metastases (P = .002). Histologically, the tumors were classified as papillary adenocarcinoma (19/39, 48.7%), adenosquamous carcinoma (ADS) (8/39, 20.5%), acinar adenocarcinoma (6/39, 15.3%), solid adenocarcinoma (3/39, 7.6%), lepidic adenocarcinoma (2/39, 5.1%), and micropapillary adenocarcinoma (1/39, 2.5%). By immunohistochemistry, 39/39 cases (100%) were positive for pancytokeratin, 34/39 (87.1%) for thyroid transcription factor-1, and 8/39 (20.5%) for vimentin. Immunoreactivity for p40 was detected in the squamous component of all ADSs (8/8, 100%) and occasionally in the glandular component of adenocarcinomas (10/31, 32.2%). Napsin A expression was absent in all feline tissue tested. The results indicate that a modified and simplified histological classification based on current human and domestic animal systems is appropriate for cats. Additionally, this study highlights the utility of p40 as an immunohistochemical marker for the diagnosis of FPC with squamous differentiation.
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Affiliation(s)
- Igor R Santos
- Setor de Patologia Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Jacqueline Raiter
- Setor de Patologia Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Éryca C Lamego
- Setor de Patologia Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcele B Bandinelli
- Setor de Patologia Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Tainah P Dal Pont
- Setor de Patologia Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Kalvin F Siqueira
- Setor de Patologia Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Bruno A Almeida
- Setor de Patologia Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Welden Panzeira
- Setor de Patologia Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Luciana Sonne
- Setor de Patologia Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - David Driemeier
- Setor de Patologia Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Saulo P Pavarini
- Setor de Patologia Veterinária, Faculdade de Veterinária, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Challenging Metastatic Melanoma to the Lung With p40 Expression: A Diagnostic Pitfall, Case Report. Appl Immunohistochem Mol Morphol 2023; 31:64-67. [PMID: 36315473 DOI: 10.1097/pai.0000000000001083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 09/12/2022] [Indexed: 12/13/2022]
Abstract
p40 immunohistochemistry is a cornerstone of histopathological examination for non-small cell lung carcinoma. p40 is an isoform of p63 and is reported to be highly specific for the diagnosis of squamous cell carcinoma. Very rare pitfalls are reported for this antibody, and p40 is typically negative in melanoma. A 66-year-old patient was admitted for multiple hemorrhagic brain tumors evocative of secondary tumors. On imaging, a 26 mm lung tumor was detected, and a biopsy of the lung tumor was performed. The tumor was stained by melanic markers and diffusely stained by p40 and p63. Molecular analysis found a somatic p.Asn581Ser (c.1742A>G) point mutation in exon 15 of BRAF and a p.Arg80Ter (c.238C>T) germline variant of CDKN2A , a predisposing mutation to melanoma. This case report highlights the importance of clinical, pathologic, and molecular correlation.
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Immunohistochemical Characteristics of Atypical Fibroxanthoma and Pleomorphic Dermal Sarcoma: A Systematic Review and Meta-Analysis. Am J Dermatopathol 2022; 44:913-920. [DOI: 10.1097/dad.0000000000002305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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10
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Murali Mohan R, Sahu KK, Suresh PK. Immunohistochemical comparison of p63 and p40 in head and neck Spindle Cell Carcinoma. Pathol Res Pract 2022; 229:153733. [DOI: 10.1016/j.prp.2021.153733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 11/15/2022]
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Nicholas V, Say B, Aasi SZ, Rieger KE, Brown RA. TTF-1 expression in a case of cutaneous sarcomatoid squamous cell carcinoma. J Cutan Pathol 2021; 48:821-823. [PMID: 33458834 DOI: 10.1111/cup.13963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/30/2020] [Accepted: 01/08/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Veronica Nicholas
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Brandon Say
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Sumaira Z Aasi
- Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA
| | - Kerri E Rieger
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.,Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA
| | - Ryanne A Brown
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA.,Department of Dermatology, Stanford University School of Medicine, Stanford, California, USA.,Pathology and Laboratory Services Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
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Aso K, Ito K, Takemura N, Inagaki F, Mihara F, Kokudo N. Transverse colon invasion from intrahepatic cholangiocarcinoma with lymph node metastasis in the regional mesocolon: a case report. Surg Case Rep 2020; 6:248. [PMID: 33000392 PMCID: PMC7527392 DOI: 10.1186/s40792-020-01010-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/19/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Intrahepatic cholangiocarcinoma (ICC) is an aggressive cancer with high frequency of extrahepatic metastasis at diagnosis. However, there have been very few reports of direct invasion to transverse mesocolon with lymph node metastasis in the regional mesocolon. CASE PRESENTATION A 71-year-old man presented to our hospital with anorexia and weight loss. Abdominal computed tomography (CT) revealed enlarged gallbladder wall with intrahepatic tumor extended from the gallbladder. The transverse colon was located adjacent to the gallbladder and its wall was thickened, indicating tumor invasion. Some enlarged lymph nodes were observed in the transverse mesocolon, suggesting metastatic or inflammatory lymph node swelling. Percutaneous liver biopsy detected poorly differentiated adenocarcinoma. After confirming the absence of remote metastasis and peritoneal dissemination, surgical resection including right hepatectomy and right hemicolectomy was performed. The pathological diagnosis was adenosquamous carcinoma of the liver and lymph node metastasis in the transverse mesocolon. The surgical margins were negative and R0 resection was achieved. Although adjuvant chemotherapy was administered, follow-up CT detected multiple metastases to the lung 4 months after surgery. The patient died 12 months after the operation. CONCLUSIONS Direct colon invasion from ICC may cause lymph node metastasis in the regional mesocolon. Careful assessment is necessary for the diagnosis of enlarged lymph nodes in ICC with direct colon invasion.
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Affiliation(s)
- Kenta Aso
- Department of Surgery, Hepato-Biliary-Pancreatic Surgery Division, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan
| | - Kyoji Ito
- Department of Surgery, Hepato-Biliary-Pancreatic Surgery Division, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan
| | - Nobuyuki Takemura
- Department of Surgery, Hepato-Biliary-Pancreatic Surgery Division, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan
| | - Fuyuki Inagaki
- Department of Surgery, Hepato-Biliary-Pancreatic Surgery Division, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan
| | - Fuminori Mihara
- Department of Surgery, Hepato-Biliary-Pancreatic Surgery Division, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan
| | - Norihiro Kokudo
- Department of Surgery, Hepato-Biliary-Pancreatic Surgery Division, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655 Japan
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Lamant L, Tournier E. Cas 1 : tumeurs épithéliales cutanées. Ann Pathol 2020; 40:347-350. [DOI: 10.1016/j.annpat.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 11/16/2022]
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A genomic survey of sarcomas on sun-exposed skin reveals distinctive candidate drivers and potentially targetable mutations. Hum Pathol 2020; 102:60-69. [PMID: 32540221 DOI: 10.1016/j.humpath.2020.06.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 12/22/2022]
Abstract
Sarcomas on photodamaged skin vary in prognosis and management, but can display overlapping microscopic and immunophenotypic features. Improved understanding of molecular alterations in these tumors may provide diagnostic and therapeutic insights. We characterized 111 cutaneous sarcomatoid malignancies and their counterparts, including primary cutaneous angiosarcoma (n = 7), atypical fibroxanthoma (AFX) (n = 21), pleomorphic dermal sarcoma (PDS) (n = 17), extracutaneous undifferentiated pleomorphic sarcoma (n = 8), cutaneous leiomyosarcoma (LMS) (n = 5), extracutaneous LMS (n = 9), sarcomatoid squamous cell carcinoma (spindle cell squamous cell carcinoma) (S-SCC) (n = 24), and conventional cutaneous squamous cell carcinoma (SCC) (n = 20), by next-generation sequencing (NGS) using the StrataNGS panel for copy number variations, mutations, and/or fusions in more than 60 cancer-related genes. TP53 mutations were highly recurrent in most groups. Angiosarcoma displayed previously reported MYC amplifications, as well as CCND1 gains. RB1 mutations were relatively restricted to cutaneous LMS. As previously reported, PIK3CA mutations occurred in AFX, whereas RAS activation was more frequent in PDS. CDKN2A mutations were recurrent in AFX and S-SCC, whereas PDS displayed frequent CDKN2A deletion. S-SCC displayed mutational similarity to conventional SCC. BRCA1/2 mutations were specific to tumors with disease progression. In a subset, we detected potential driver events novel to these tumor types: activating mutations in IDH2 (PDS), MAP2K1 (angiosarcoma, PDS), and JAK1 (S-SCC) and copy gains in FGFR1 (angiosarcoma, S-SCC), KIT (AFX), MET (PDS), and PDGFRA (PDS). Our findings confirm and expand the spectrum of known genomic aberrations, including potential targetable drivers, in cutaneous sarcomatoid malignancies. In addition, certain events are relatively specific to particular tumors within this differential diagnosis and hence might be diagnostically informative.
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15
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Lefferts JA, Loehrer AP, Yan S, Green DC, Deharvengt SJ, LeBlanc RE. CD10 and p63 expression in a sarcomatoid undifferentiated melanoma: A cautionary (and molecularly annotated) tale. J Cutan Pathol 2020; 47:541-547. [PMID: 31943331 PMCID: PMC10727035 DOI: 10.1111/cup.13646] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/20/2022]
Abstract
Undifferentiated melanoma should be considered in the differential diagnosis of sarcomatoid cutaneous malignancies to ensure that patients receive the correct treatment. Dermatopathologists should recognize the pitfalls of relying too heavily on immunohistochemistry to establish this diagnosis and consider ancillary tests, including single-nucleotide polymorphism (SNP) copy number arrays and targeted next-generation sequencing (NGS), when a definitive diagnosis cannot be rendered on a primary or metastatic tumor. This technology can also help to exclude a collision of melanoma and sarcoma when both differentiated and undifferentiated components are juxtaposed. We describe an exceedingly rare, illustrative example of undifferentiated sarcomatoid melanoma presenting as a pedunculated nodule. The clinical context and presence of a small differentiated component helped to establish the diagnosis; however, the transition from differentiated to undifferentiated melanoma was accompanied by an abrupt loss of S100, Sox10, MITF, MelanA, and HMB45 with gain of CD10 and p63 staining. SNP copy number array and NGS revealed shared chromosomal copy number changes and overlapping mutations with additional aberrances detected exclusively in the sarcomatoid component, thereby excluding a collision tumor and confirming our putative impression of melanoma with progression to an undifferentiated sarcomatoid phenotype.
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Affiliation(s)
- Joel A Lefferts
- Department of Pathology and Laboratory Medicine, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756
| | - Andrew P Loehrer
- Department of Surgery, Section of Surgical Oncology, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756
| | - Shaofeng Yan
- Department of Pathology and Laboratory Medicine, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756
| | - Donald C. Green
- Department of Pathology and Laboratory Medicine, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756
| | - Sophie J. Deharvengt
- Department of Pathology and Laboratory Medicine, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756
| | - Robert E. LeBlanc
- Department of Pathology and Laboratory Medicine, Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756
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16
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Smirnov A, Anemona L, Novelli F, Piro CM, Annicchiarico-Petruzzelli M, Melino G, Candi E. p63 Is a Promising Marker in the Diagnosis of Unusual Skin Cancer. Int J Mol Sci 2019; 20:E5781. [PMID: 31744230 PMCID: PMC6888618 DOI: 10.3390/ijms20225781] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/07/2019] [Accepted: 11/15/2019] [Indexed: 01/02/2023] Open
Abstract
Skin cancer is the most common type of cancer worldwide. Ozone depletion and climate changes might cause a further increase in the incidence rate in the future. Although the early detection of skin cancer enables it to be treated successfully, some tumours can evolve and become more aggressive, especially in the case of melanoma. Therefore, good diagnostic and prognostic markers are needed to ensure correct detection and treatment. Transcription factor p63, a member of the p53 family of proteins, plays an essential role in the development of stratified epithelia such as skin. In this paper, we conduct a comprehensive review of p63 expression in different types of skin cancer and discuss its possible use in the diagnosis and prognosis of cutaneous tumours.
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Affiliation(s)
- Artem Smirnov
- Department of Experimental Medicine, TOR, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Lucia Anemona
- Department of Experimental Medicine, TOR, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Flavia Novelli
- Department of Experimental Medicine, TOR, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Cristina M. Piro
- Department of Experimental Medicine, TOR, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | | | - Gerry Melino
- Department of Experimental Medicine, TOR, University of Rome “Tor Vergata”, 00133 Rome, Italy
- MRC-Toxicology Unit, University of Cambridge, Cambridge CB2 1QP, UK
| | - Eleonora Candi
- Department of Experimental Medicine, TOR, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Istituto Dermopatico dell’Immacolata-IRCCS, 00163 Rome, Italy
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17
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de Araújo AB, Serrano TLI, Pedroso MCM, Mariano FV, Altemani A, Gripp FM, Crespo AN, Chone CT. Clinicopathologic Diagnostic and Prognostic Factors of Spindle Cell Carcinoma of Upper Airway. Pathol Oncol Res 2019; 26:1097-1104. [PMID: 31069711 DOI: 10.1007/s12253-019-00654-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 03/25/2019] [Indexed: 11/24/2022]
Abstract
Spindle cell carcinoma (SpCC) is a rare tumor, which occurs in upper respiratory tract, mainly in larynx. This study aimed to review the clinical and pathological characteristics for diagnosis and prognosis. Retrospective cohort study. All patients with SpCC in upper respiratory tract treated for curative intent was included. All patients were reviewed in search of epithelial component and immunohistochemistry when not found. It was evaluated rate of recurrence and disease-free survival with univariate and multivariate analysis with Kaplan Meier and Cox Regression model adjusted to propensity score indexes (PSI) according to age, gender, site of tumor, stage, surgical treatment, status of margins of surgical resection, lymphatic invasion. There were 16 cases of SpCC.31% were diagnosed with light microscopy and others with immunohistochemistry for epithelial marker. Disease-free survival was higher in early stage disease in univariate and multivariate analysis, as the main prognostic factor. Surgical treatment increases in 2.54 the rate of survival. The SpCC is a rare tumor considered a highly malignant variant of squamous cell carcinoma. It has male predominance and tobacco use as risk factors. Its treatment should follow the same recommendations for squamous cell carcinoma, with surgery as the maintain treatment. Immunohistochemistry is an adjuvant important tool for diagnosis of SpCC.
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Affiliation(s)
- Amanda Bueno de Araújo
- Department of Otorhinolaryngology, Head Neck, University of Campinas, UNICAMP, PO BOX 6111, Campinas, São Paulo, Postal Code: 13081-970, Brazil.
| | - Thiago Luís Infanger Serrano
- Department of Otorhinolaryngology, Head Neck, University of Campinas, UNICAMP, PO BOX 6111, Campinas, São Paulo, Postal Code: 13081-970, Brazil
| | - Maria Cláudia Mota Pedroso
- Department of Otorhinolaryngology, Head Neck, University of Campinas, UNICAMP, PO BOX 6111, Campinas, São Paulo, Postal Code: 13081-970, Brazil
| | | | - Albina Altemani
- Department of Surgical Pathology, University of Campinas, UNICAMP, Campinas, São Paulo, Brazil
| | - Flavio Mignone Gripp
- Department of Otorhinolaryngology, Head Neck, University of Campinas, UNICAMP, PO BOX 6111, Campinas, São Paulo, Postal Code: 13081-970, Brazil
| | - Agrício Nubiato Crespo
- Department of Otorhinolaryngology, Head Neck, University of Campinas, UNICAMP, PO BOX 6111, Campinas, São Paulo, Postal Code: 13081-970, Brazil
| | - Carlos Takahiro Chone
- Department of Otorhinolaryngology, Head Neck, University of Campinas, UNICAMP, PO BOX 6111, Campinas, São Paulo, Postal Code: 13081-970, Brazil
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18
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Cutaneous Sarcomatoid Squamous Cell Carcinoma of the Ear and the Use of Immunohistochemical Staining as a Diagnostic Aid. Dermatol Surg 2019; 45:1100-1102. [PMID: 30672857 DOI: 10.1097/dss.0000000000001742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Samaan S, Quddus MR, Matoso A. "Man in Istanbul" Lesions of the Urinary Tract (Known Entities in an Unusual Context): Melanoma, Carcinoid Tumors, Epithelioid Angiosarcoma. Surg Pathol Clin 2018; 11:825-836. [PMID: 30447844 DOI: 10.1016/j.path.2018.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Certain tumors are more difficult to recognize when they present in an unusual location. Within the urinary tract, primary melanomas, carcinoid tumors, or epithelioid angiosarcoma could present diagnostic challenges due to their infrequent occurrence. This article emphasizes the clinical and histopathologic features of these entities and their differential diagnoses including the immunophenotype and their prognoses.
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Affiliation(s)
- Sameh Samaan
- Department of Pathology, The Johns Hopkins Medical Institutions, Johns Hopkins Hospital, Weinberg 2242, 401 North Broadway, Baltimore, MD 21231-2410, USA
| | - M Ruhul Quddus
- Department of Pathology, Women and Infants Hospital of Rhode Island, 101 Dudley Street, Providence, RI 02903, USA
| | - Andres Matoso
- Department of Pathology, The Johns Hopkins Medical Institutions, Johns Hopkins Hospital, Weinberg 2242, 401 North Broadway, Baltimore, MD 21231-2410, USA; Department of Urology, The Johns Hopkins Medical Institutions, Johns Hopkins Hospital, Weinberg 2242, 401 North Broadway, Baltimore, MD 21231-2410, USA; Department of Oncology, The Johns Hopkins Medical Institutions, Johns Hopkins Hospital, Weinberg 2242, 401 North Broadway, Baltimore, MD 21231-2410, USA.
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20
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Abstract
Cutaneous squamous cell carcinoma (cSCC) is a malignant neoplasm of the skin characterized by an aberrant proliferation of keratinocytes. Cutaneous SCC is the second most common malignancy globally, and usually arises in the chronically sun-damaged skin of elderly white individuals. From a pathologist's perspective, it is important to differentiate cSCC from the benign and reactive squamoproliferative lesions and identify the high-risk features associated with aggressive tumor behavior. In this article, we provide an up-to-date overview of cSCC along with its precursor lesions and important histologic variants, with a particular emphasis on the histopathologic features and molecular pathogenesis.
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21
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Cutaneous Squamous Cell Carcinoma: Review of the Eighth Edition of the American Joint Committee on Cancer Staging Guidelines, Prognostic Factors, and Histopathologic Variants. Adv Anat Pathol 2017; 24:171-194. [PMID: 28590951 DOI: 10.1097/pap.0000000000000157] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Cutaneous squamous cell carcinoma is the second most common form of nonmelanoma skin cancer after basal cell carcinoma and accounts for the majority of nonmelanoma skin cancer-related deaths. In 2017, the American Joint Committee on Cancer revised the staging guidelines of cutaneous squamous cell carcinoma to reflect recent evidence concerning high-risk clinicopathologic features. This update reviews the literature on prognostic features and staging, including the eighth edition of the American Joint Committee on Cancer Staging Manual. A wide range of histopathologic variants of cutaneous squamous cell carcinoma exists, several of which are associated with aggressive behavior. A review of cutaneous squamous cell carcinoma variants, emphasizing diagnostic pitfalls, immuhistochemical findings and prognostic significance, is included. Of note, the eighth edition of the American Joint Committee on Cancer Staging Manual refers to squamous cell carcinoma of the head and neck only.
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22
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Belden SE, Uppalapati CK, Pascual AS, Montgomery MR, Leyva KJ, Hull EE, Averitte RL. Establishment of a Clinic-based Biorepository. J Vis Exp 2017:55583. [PMID: 28605380 PMCID: PMC5608153 DOI: 10.3791/55583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The incidence of skin cancer (e.g., squamous cell carcinoma, basal cell carcinoma, and melanoma) has been increasing over the past several years. It is expected that there will be a parallel demand for cutaneous tumor samples for biomedical research studies. Tissue availability, however, is limited due the cost of establishing a biorepository and the lack of protocols available for obtaining clinical samples that do not interfere with clinical operations. A protocol was established to collect and process cutaneous tumor and associated blood and saliva samples that has minimal impact on routine clinical procedures on the date of a Mohs surgery. Tumor samples are collected and processed from patients undergoing their first layer of Mohs surgery for biopsy-proven cutaneous malignancies by the Mohs histotechnologist. Adjacent normal tissue is collected at the time of surgical closure. Additional samples that may be collected are whole-blood and buccal swabs. By utilizing tissue samples that are normally discarded, a biorepository was generated that offers several key advantages by being based in the clinic versus the laboratory setting. These include a wide range of collected samples; access to de-identified patient records, including pathology reports; and, for the typical donor, access to additional samples during follow-up visits.
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Affiliation(s)
- Sarah E Belden
- Affiliated Dermatology & Affiliated Laboratories, Midwestern University Osteopathic Postdoctoral Training Institute, Midwestern University
| | - Chandana K Uppalapati
- Department of Microbiology & Immunology, Arizona College of Osteopathic Medicine, Midwestern University
| | - Agnes S Pascual
- Biomedical Sciences Program, College of Health Sciences, Midwestern University
| | - McKale R Montgomery
- Biomedical Sciences Program, College of Health Sciences, Midwestern University
| | - Kathryn J Leyva
- Department of Microbiology & Immunology, Arizona College of Osteopathic Medicine, Midwestern University
| | - Elizabeth E Hull
- Biomedical Sciences Program, College of Health Sciences, Midwestern University;
| | - Richard L Averitte
- Affiliated Dermatology & Affiliated Laboratories, Midwestern University Osteopathic Postdoctoral Training Institute, Midwestern University
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23
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P40 Immunostain Does Not Outperform p63 as a Myoepithelial Cell Marker in the Daily Practice of Breast Pathology. Appl Immunohistochem Mol Morphol 2017; 26:599-604. [PMID: 28549030 DOI: 10.1097/pai.0000000000000507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
P40 antibody has been shown to be a more specific squamous and basal cell marker compared with p63. As detection of myoepithelial cells (MECs) plays a critical role in breast pathology, and the fact that p40 targets an isoform of p63, this study was designed to compare these antibodies in a variety of lesions, especially those with an sclerotic stroma and carcinoma in situ. All studied lesions were selected from the daily cases of the 3 authors and stained with p63, p40, and calponin immunohistochemical stains. Thirty-four cases (and 19 internal controls) were included. Seventy percent constituted sclerotic lesions (12 cases) and ductal carcinoma in situ (12 cases). P40 and p63 stained all lesions and showed a similar patchy staining pattern in 50% of ductal carcinoma in situ and sclerotic lesions. Compared with internal controls, p40 and p63 demonstrated decreased staining intensity in up to 70% and 8% of all cases, respectively, with no cross-reactivity with mesenchymal cells and minor cross-reactivity with epithelial cells. In our study, p40 did not outperform p63 as a MEC marker. p40 showed a decreased intensity in a higher number of cases (P<0.0001). In our opinion, p63 continues to be the best nuclear marker for the detection of MECs in the daily practice of breast pathology.
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24
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Jackson CR, Minca EC, Kapil JP, Smith SC, Billings SD. Superficial malignant peripheral nerve sheath tumor with overlying intradermal melanocytic nevus mimicking spindle cell melanoma. J Cutan Pathol 2016; 43:1220-1225. [DOI: 10.1111/cup.12834] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 09/19/2016] [Accepted: 09/25/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | - Eugen C. Minca
- Robert J. Tomsich Pathology and Laboratory Medicine Institute; Cleveland Clinic; Cleveland OH USA
| | - Jyoti P. Kapil
- Department of Pathology; VCU School of Medicine; Richmond VA USA
| | | | - Steven D. Billings
- Robert J. Tomsich Pathology and Laboratory Medicine Institute; Cleveland Clinic; Cleveland OH USA
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25
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Harms PW, Fullen DR, Patel RM, Chang D, Shalin SC, Ma L, Wood B, Beer TW, Siddiqui J, Carskadon S, Wang M, Palanisamy N, Fisher GJ, Andea A. Cutaneous basal cell carcinosarcomas: evidence of clonality and recurrent chromosomal losses. Hum Pathol 2015; 46:690-7. [PMID: 25704628 DOI: 10.1016/j.humpath.2015.01.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 01/03/2015] [Indexed: 10/24/2022]
Abstract
Cutaneous carcinosarcomas are heterogeneous group of tumors composed of malignant epithelial and mesenchymal components. Although mutation analyses have identified clonal changes between these morphologically disparate components in some subtypes of cutaneous carcinosarcoma, few cases have been analyzed thus far. To our knowledge, copy number variations (CNVs) and copy-neutral loss of heterozygosity (CN-LOH) have not been investigated in cutaneous carcinosarcomas. We analyzed 4 carcinosarcomas with basal cell carcinoma and osteosarcomatous components for CNVs/CN-LOH by comparative genomic hybridization/single-nucleotide polymorphism array, TP53 hot spot mutations by polymerase chain reaction and Sanger sequencing, and TP53 genomic rearrangements by fluorescence in situ hybridization. All tumors displayed multiple CNV/CN-LOH events (median, 7.5 per tumor). Three of 4 tumors displayed similar CNV/CN-LOH patterns between the epithelial and mesenchymal components within each tumor, supporting a common clonal origin. Recurrent changes included allelic loss at 9p21 (CDKN2A), 9q (PTCH1), and 17p (TP53). Allelic losses of chromosome 16 including CDH1 (E-cadherin) were present in 2 tumors and were restricted to the sarcomatous component. TP53 mutation analysis revealed an R248L mutation in both epithelial and mesenchymal components of 1 tumor. No TP53 rearrangements were identified. Our findings indicate that basal cell carcinosarcomas harbor CNV/CN-LOH changes similar to conventional basal cell carcinoma, with additional changes including recurrent 9p21 losses and a relatively high burden of copy number changes. In addition, most cutaneous carcinosarcomas show evidence of clonality between epithelial and mesenchymal components.
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Affiliation(s)
- Paul W Harms
- Department of Pathology, University of Michigan Health System, Ann Arbor MI 48109; Department of Dermatology, University of Michigan Health System, Ann Arbor MI 48109; Michigan Center for Translational Pathology, University of Michigan Health System, Ann Arbor MI 48109.
| | - Douglas R Fullen
- Department of Pathology, University of Michigan Health System, Ann Arbor MI 48109; Department of Dermatology, University of Michigan Health System, Ann Arbor MI 48109
| | - Rajiv M Patel
- Department of Pathology, University of Michigan Health System, Ann Arbor MI 48109; Department of Dermatology, University of Michigan Health System, Ann Arbor MI 48109
| | - Dannie Chang
- Department of Dermatology, University of Michigan Health System, Ann Arbor MI 48109
| | - Sara C Shalin
- Departments of Pathology and Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR 72205
| | - Linglei Ma
- Miraca Life Sciences, Glen Burnie, MD 21061
| | - Benjamin Wood
- School of Pathology and Laboratory Medicine, University of Western Australia, Perth, WA 6009, Australia
| | - Trevor W Beer
- CliniPath Pathology, Osborne Park, WA 6017, Australia
| | - Javed Siddiqui
- Department of Pathology, University of Michigan Health System, Ann Arbor MI 48109; Michigan Center for Translational Pathology, University of Michigan Health System, Ann Arbor MI 48109
| | | | - Min Wang
- Department of Pathology, University of Michigan Health System, Ann Arbor MI 48109
| | - Nallasivam Palanisamy
- Department of Pathology, University of Michigan Health System, Ann Arbor MI 48109; Michigan Center for Translational Pathology, University of Michigan Health System, Ann Arbor MI 48109; Department of Urology, Henry Ford Health System, Detroit, MI 48202; King Saud University, Riyadh, Saudi Arabia 11362
| | - Gary J Fisher
- Department of Dermatology, University of Michigan Health System, Ann Arbor MI 48109
| | - Aleodor Andea
- Department of Pathology, University of Michigan Health System, Ann Arbor MI 48109; Department of Dermatology, University of Michigan Health System, Ann Arbor MI 48109
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