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Zhang SL, Wang HL. Ancillary tests for hepatobiliary neoplasms: what we know and what we need to know. Hum Pathol 2023; 141:183-200. [PMID: 36775105 DOI: 10.1016/j.humpath.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/29/2023] [Accepted: 02/04/2023] [Indexed: 02/12/2023]
Abstract
Ancillary tests are commonly used in the surgical pathology setting for diagnosing challenging neoplastic diseases of the liver and biliary tract, while histology and clinical correlation remain to be critically important. With continuous discoveries, more and more useful ancillary tests have become available, which can help distinguish between malignant and benign hepatocellular neoplasms, malignant and benign biliary tract entities, and intrahepatic and metastatic carcinomas. This review will focus on existing and emerging biomarkers (such as glutamine synthetase, organic anion transporting polypeptide 1B3, insulin-like growth factor-II mRNA binding protein-3, S100P, SMAD4, enhancer of zeste homolog 2, albumin, hepatocyte nuclear factor-1β, etc.) that can be used for the diagnosis, classification and prognostication of hepatobiliary neoplasms.
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Affiliation(s)
- Sarah L Zhang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine and Ronald Reagan Medical Center, University of California at Los Angeles, Los Angeles, CA, 90095, USA
| | - Hanlin L Wang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine and Ronald Reagan Medical Center, University of California at Los Angeles, Los Angeles, CA, 90095, USA.
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Etiology, Pathogenesis, Diagnosis, and Practical Implications of Hepatocellular Neoplasms. Cancers (Basel) 2022; 14:cancers14153670. [PMID: 35954333 PMCID: PMC9367411 DOI: 10.3390/cancers14153670] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022] Open
Abstract
Hepatocellular carcinoma (HCC), a major global contributor of cancer death, usually arises in a background of chronic liver disease, as a result of molecular changes that deregulate important signal transduction pathways. Recent studies have shown that certain molecular changes of hepatocarcinogenesis are associated with clinicopathologic features and prognosis, suggesting that subclassification of HCC is practically useful. On the other hand, subclassification of hepatocellular adenomas (HCAs), a heterogenous group of neoplasms, has been well established on the basis of genotype–phenotype correlations. Histologic examination, aided by immunohistochemistry, is the gold standard for the diagnosis and subclassification of HCA and HCC, while clinicopathologic correlation is essential for best patient management. Advances in clinico-radio-pathologic correlation have introduced a new approach for the diagnostic assessment of lesions arising in advanced chronic liver disease by imaging (LI-RADS). The rapid expansion of knowledge concerning the molecular pathogenesis of HCC is now starting to produce new therapeutic approaches through precision oncology. This review summarizes the etiology and pathogenesis of HCA and HCC, provides practical information for their histologic diagnosis (including an algorithmic approach), and addresses a variety of frequently asked questions regarding the diagnosis and practical implications of these neoplasms.
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Lennartz M, Gehrig E, Weidemann S, Gorbokon N, Menz A, Büscheck F, Hube-Magg C, Hinsch A, Reiswich V, Höflmayer D, Fraune C, Jacobsen F, Bernreuther C, Lebok P, Sauter G, Wilczak W, Steurer S, Burandt E, Marx AH, Simon R, Krech T, Clauditz TS, Minner S, Dum D, Uhlig R. Large-Scale Tissue Microarray Evaluation Corroborates High Specificity of High-Level Arginase-1 Immunostaining for Hepatocellular Carcinoma. Diagnostics (Basel) 2021; 11:diagnostics11122351. [PMID: 34943588 PMCID: PMC8699869 DOI: 10.3390/diagnostics11122351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/01/2021] [Accepted: 12/09/2021] [Indexed: 12/19/2022] Open
Abstract
Arginase-1 catalyzes the conversion of arginine to ornithine and urea. Because of its predominant expression in hepatocytes, it serves as a marker for hepatocellular carcinoma, although other tumor entities can also express arginase-1. To comprehensively determine arginase-1 expression in normal and neoplastic tissues, tissue microarrays containing 14,912 samples from 117 different tumor types and 608 samples of 76 different normal tissue types were analyzed by immunohistochemistry. In normal tissues, arginase-1 was expressed in the liver, the granular layer of the epidermis, and in granulocytes. Among tumors, a nuclear and cytoplasmic arginase-1 immunostaining was predominantly observed in hepatocellular carcinoma, where 96% of 49 cancers were at least moderately positive. Although 22 additional tumor categories showed occasional arginase immunostaining, strong staining was exceedingly rare in these entities. Staining of a few tumor cells was observed in squamous cell carcinomas of various sites. Staining typically involved maturing cells with the beginning of keratinization in these tumors and was significantly associated with a low grade in 635 squamous cell carcinomas of various sites (p = 0.003). Teratoma, urothelial carcinoma and pleomorphic adenomas sometimes also showed arginase expression in areas with squamous differentiation. In summary, arginase-1 immunohistochemistry is highly sensitive and specific for hepatocellular carcinoma if weak and focal staining is disregarded.
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Affiliation(s)
- Maximilian Lennartz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
| | - Eva Gehrig
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
| | - Sören Weidemann
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
| | - Natalia Gorbokon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
| | - Anne Menz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
| | - Franziska Büscheck
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
| | - Claudia Hube-Magg
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
| | - Andrea Hinsch
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
| | - Viktor Reiswich
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
| | - Doris Höflmayer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
| | - Christoph Fraune
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
| | - Frank Jacobsen
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
| | - Christian Bernreuther
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
| | - Patrick Lebok
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
| | - Guido Sauter
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
| | - Waldemar Wilczak
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
| | - Stefan Steurer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
| | - Eike Burandt
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
| | - Andreas H. Marx
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
- Department of Pathology, Academic Hospital Fuerth, 90766 Fuerth, Germany
| | - Ronald Simon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
- Correspondence: ; Tel.: +49-40-74105-7214
| | - Till Krech
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
- Institute of Pathology, Clinical Center Osnabrueck, 49076 Osnabrueck, Germany
| | - Till S. Clauditz
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
| | - Sarah Minner
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
| | - David Dum
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
| | - Ria Uhlig
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.L.); (E.G.); (S.W.); (N.G.); (A.M.); (F.B.); (C.H.-M.); (A.H.); (V.R.); (D.H.); (C.F.); (F.J.); (C.B.); (P.L.); (G.S.); (W.W.); (S.S.); (E.B.); (A.H.M.); (T.K.); (T.S.C.); (S.M.); (D.D.); (R.U.)
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Dynamic contract-enhanced CT-based radiomics for differentiation of pancreatobiliary-type and intestinal-type periampullary carcinomas. Clin Radiol 2021; 77:e75-e83. [PMID: 34753589 DOI: 10.1016/j.crad.2021.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 09/09/2021] [Indexed: 11/21/2022]
Abstract
AIM To investigate whether computed tomography (CT) radiomics can differentiate pancreatobiliary-type from intestinal-type periampullary carcinomas. MATERIALS AND METHODS CT radiomics of 96 patients (54 pancreatobiliary type and 42 intestinal type) with surgically confirmed periampullary carcinoma were assessed retrospectively. Volumes of interest (VOIs) were delineated manually. Radiomic features were extracted from preoperative CT images. A single-phase model and combined-phase model were constructed. Five-fold cross-validation and five machine-learning algorithms were utilised for model construction. The diagnostic performance of the models was evaluated by receiver operating characteristic (ROC) curves, and indicators included area under the curve (AUC), accuracy, sensitivity, specificity, and precision. ROC curves were compared using DeLong's test. RESULTS A total of 788 features were extracted on each phase. After feature selection using least absolute shrinkage and selection operator (LASSO) algorithm, the number of selected optimal feature was 18 (plain scan), nine (arterial phase), two (venous phase), 23 (delayed phase), 15 (three enhanced phases), and 29 (all phases), respectively. For the single-phase model, the delayed-phase model using the logistic regression (LR) algorithm showed the best prediction performance with AUC, accuracy, sensitivity, specificity, and precision of 0.89, 0.83, 0.80, 0.88, and 0.93, respectively. Two combined-phase models showed better results than the single-phase models. The model of all phases using the LR algorithm showed the best prediction performance with AUC, accuracy, sensitivity, specificity, and precision of 0.96, 0.88, 0.90, 0.93, and 0.92, respectively. CONCLUSION Radiomic models based on preoperative CT images can differentiate pancreatobiliary-type from intestinal-type periampullary carcinomas, in particular, the model of all phases using the LR algorithm.
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Iwaya M, Riddell R, Asano K, Kobayashi K, Uehara T, Ota H. Alpha-Fetoprotein-Producing Early Gastric Cancer with Intramucosal Hepatoid and Fetal Enteric Differentiation. Case Rep Gastroenterol 2020; 14:426-435. [PMID: 32999644 PMCID: PMC7506198 DOI: 10.1159/000508413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/30/2020] [Indexed: 12/14/2022] Open
Abstract
Alpha-fetoprotein (AFP)-producing gastric carcinomas (AFPGCs) are relatively rare tumors known to have a poor prognosis and commonly found as advanced lesions. Histologically, AFPGCs have been described as having hepatoid and fetal enteric (enteroblastic) morphology and are associated with conventional adenocarcinomas. Prior studies reported a hepatoid component present only in invasive areas and hypothesized that AFPGCs may develop hepatoid features during the process of tumor invasion. We report three cases of AFP-producing early gastric cancer which had an intramucosal hepatoid component. Immunohistochemistry showed that the hepatoid component was diffusely immunoreactive for SALL4, AFP, arginase-1, and HepPar1, and focally for CDX2 and PDX1. An intramucosal transition between the hepatoid component and conventional intramucosal adenocarcinoma was identified. Two patients also had a coexistent fetal enteric component, which was admixed with a hepatoid component. Although at an early stage one patient subsequently developed liver metastasis and a second patient was suspected of having liver metastasis, these were not biopsy-proven. The latter patient had a previous history of hepatocellular carcinoma (HCC) and SALL4 was used on the HCC to distinguish metastatic/further HCC from a gastric metastatic primary with hepatoid differentiation.
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Affiliation(s)
- Mai Iwaya
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Robert Riddell
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Koji Asano
- Department of Pathology, Suwa Central Hospital, Chino, Japan
| | - Kazuo Kobayashi
- Department of Gastroenterology, Kobayashi Hospital, Nagano, Japan
| | - Takeshi Uehara
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto, Japan
| | - Hiroyoshi Ota
- Department of Clinical Laboratory Sciences, School of Health Sciences, Shinshu University, Matsumoto, Japan
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An Algorithmic Immunohistochemical Approach to Define Tumor Type and Assign Site of Origin. Adv Anat Pathol 2020; 27:114-163. [PMID: 32205473 DOI: 10.1097/pap.0000000000000256] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Immunohistochemistry represents an indispensable complement to an epidemiology and morphology-driven approach to tumor diagnosis and site of origin assignment. This review reflects the state of my current practice, based on 15-years' experience in Pathology and a deep-dive into the literature, always striving to be better equipped to answer the age old questions, "What is it, and where is it from?" The tables and figures in this manuscript are the ones I "pull up on the computer" when I am teaching at the microscope and turn to myself when I am (frequently) stuck. This field is so exciting because I firmly believe that, through the application of next-generation immunohistochemistry, we can provide better answers than ever before. Specific topics covered in this review include (1) broad tumor classification and associated screening markers; (2) the role of cancer epidemiology in determining pretest probability; (3) broad-spectrum epithelial markers; (4) noncanonical expression of broad tumor class screening markers; (5) a morphologic pattern-based approach to poorly to undifferentiated malignant neoplasms; (6) a morphologic and immunohistochemical approach to define 4 main carcinoma types; (7) CK7/CK20 coordinate expression; (8) added value of semiquantitative immunohistochemical stain assessment; algorithmic immunohistochemical approaches to (9) "garden variety" adenocarcinomas presenting in the liver, (10) large polygonal cell adenocarcinomas, (11) the distinction of primary surface ovarian epithelial tumors with mucinous features from metastasis, (12) tumors presenting at alternative anatomic sites, (13) squamous cell carcinoma versus urothelial carcinoma, and neuroendocrine neoplasms, including (14) the distinction of pheochromocytoma/paraganglioma from well-differentiated neuroendocrine tumor, site of origin assignment in (15) well-differentiated neuroendocrine tumor and (16) poorly differentiated neuroendocrine carcinoma, and (17) the distinction of well-differentiated neuroendocrine tumor G3 from poorly differentiated neuroendocrine carcinoma; it concludes with (18) a discussion of diagnostic considerations in the broad-spectrum keratin/CD45/S-100-"triple-negative" neoplasm.
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Bellizzi AM, Montgomery EA, Hornick JL. American Registry of Pathology Expert Opinions: Evaluation of poorly differentiated malignant neoplasms on limited samples - Gastrointestinal mucosal biopsies. Ann Diagn Pathol 2020; 44:151419. [PMID: 31786484 PMCID: PMC7681915 DOI: 10.1016/j.anndiagpath.2019.151419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This review reflects a collaboration between the American Registry of Pathology (the publisher of the Armed Forces Institute of Pathology Fascicles) and Annals of Diagnostic Pathology. It is part of a series of expert recommendations on topics encountered in daily practice. The authors, three pathologists with expertise in gastrointestinal tract pathology and immunohistochemistry, met on 30 July 2019 tasked with developing expert recommendations for evaluating poorly differentiated and undifferentiated malignant neoplasms encountered on mucosal biopsies of the gastrointestinal tract. We focused on esophageal, gastric, small intestinal, colorectal, and anal (i.e., tubal gut) samples. When faced with diagnostic uncertainty on the initial H&E, it is best to begin by trying to assign the broad tumor class with screening markers such as pankeratin, S100 protein or SOX10, and CD20 or CD45. Once a broad tumor class is established, more specific differentiation markers can be pursued (e.g., lineage-restricted transcription factors for adenocarcinoma; p40 for squamous cell carcinoma; chromogranin A and synaptophysin or INSM1 for neuroendocrine neoplasms). Every small biopsy containing tumor should be considered a potential molecular pathology sample; cutting extra unstained slides with this testing in mind is strongly encouraged.
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Affiliation(s)
- Andrew M Bellizzi
- University of Iowa Hospitals and Clinics, Department of Pathology, 200 Hawkins Drive, Iowa City, IA 52242, United States of America.
| | | | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
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Lendvai G, Szekerczés T, Illyés I, Dóra R, Kontsek E, Gógl A, Kiss A, Werling K, Kovalszky I, Schaff Z, Borka K. Cholangiocarcinoma: Classification, Histopathology and Molecular Carcinogenesis. Pathol Oncol Res 2020; 26:3-15. [PMID: 30448973 DOI: 10.1007/s12253-018-0491-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 10/10/2018] [Indexed: 02/06/2023]
Abstract
Cholangiocarcinoma (CC) is the second most common tumor of the liver, originating from the biliary system with increasing incidence and mortality worldwide. Several new classifications review the significance of tumor localization, site of origin, proliferation and biomarkers in the intrahepatic, perihilar and distal forms of the lesion. Based on growth pattern mass-forming, periductal-infiltrating, intraductal, undefined and mixed types are differentiated. There are further subclassifications which are applied for the histological features, in particular for intrahepatic CC. Recognition of the precursors and early lesions of CC including biliary intraepithelial neoplasia (BilIN), intraductal papillary neoplasm of the bile ducts (IPNB), biliary mucinous cystic neoplasm (MCNB) and the candidate precursors, such as bile duct adenoma and von Meyenburg complex is of increasing significance. In addition to the previously used biliary markers detected by immunohistochemistry, several new markers have been added to the differentiation of both the benign and malignant lesions, which can be used to aid in the subclassification in association with the outcome of CC. Major aspects of biliary carcinogenesis have been revealed, yet, the exact way of this diverse process is still unclear. The factors contributing to molecular cholangiocarcinogenesis include various risk factors, different anatomical localizations, multiple cellular origins, genetic and epigenetic alterations, tumor microenvironment, heterogeneity and clonal evolution. Driver mutations have been identified, implying that they are optimal candidates for targeted therapy. The most promising therapeutic candidates have entered clinical trials.
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Affiliation(s)
- Gábor Lendvai
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Tímea Szekerczés
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Idikó Illyés
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Réka Dóra
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Endre Kontsek
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Alíz Gógl
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - András Kiss
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
| | - Klára Werling
- 2nd Department of Internal Medicine, Semmelweis University, Budapest, 1085, Hungary
| | - Ilona Kovalszky
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, 1085, Hungary
| | - Zsuzsa Schaff
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary.
| | - Katalin Borka
- 2nd Department of Pathology, Semmelweis University, Üllői út 93, Budapest, H-1091, Hungary
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Koehne de Gonzalez A, Lagana SM. Update on Ancillary Testing in the Evaluation of High-Grade Liver Tumors. Surg Pathol Clin 2018; 11:367-375. [PMID: 29751880 DOI: 10.1016/j.path.2018.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Tissue diagnosis is the gold standard for mass lesions of the liver, but needle core biopsies may sometimes prove challenging. Presented here is a review of a panel of immunohistochemical stains, including hepatocyte in paraffin 1, arginase-1, polyclonal carcinoembryonic antigen, CD10, bile salt export pump, glypican-3, as well as in situ hybridization for albumin RNA, to establish hepatocellular origin in cases in which hepatocellular carcinoma is suspected but the sample is limited or the morphology is challenging, as it may be with cases of scirrhous, fibrolamellar carcinoma, intrahepatic cholangiocarcinoma, and combined hepatocellular-cholangiocarcinoma.
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Affiliation(s)
- Anne Koehne de Gonzalez
- Department of Pathology and Cell Biology, Columbia University, 622 W 168th Street, Vanderbilt Clinic 14-209, New York, NY 10032, USA
| | - Stephen M Lagana
- Department of Pathology and Cell Biology, Columbia University, 622 W 168th Street, Vanderbilt Clinic 14-209, New York, NY 10032, USA.
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10
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Wang HL, Kim CJ, Koo J, Zhou W, Choi EK, Arcega R, Chen ZE, Wang H, Zhang L, Lin F. Practical Immunohistochemistry in Neoplastic Pathology of the Gastrointestinal Tract, Liver, Biliary Tract, and Pancreas. Arch Pathol Lab Med 2017; 141:1155-1180. [PMID: 28854347 DOI: 10.5858/arpa.2016-0489-ra] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
CONTEXT - Immunomarkers with diagnostic, therapeutic, or prognostic values have been increasingly used to maximize the benefits of clinical management of patients with neoplastic diseases of the gastrointestinal tract, liver, biliary tract, and pancreas. OBJECTIVES - To review the characteristics of immunomarkers that are commonly used in surgical pathology practice for neoplasms of the gastrointestinal tract, liver, biliary tract, and pancreas, and to summarize the clinical usefulness of immunomarkers that have been discovered in recent years in these fields. DATA SOURCES - Data sources include literature review, authors' research data, and personal practice experience. CONCLUSIONS - Immunohistochemistry is an indispensable tool for the accurate diagnosis of neoplastic diseases of the gastrointestinal tract, liver, biliary tract, and pancreas. Useful immunomarkers are available to help distinguish malignant neoplasms from benign conditions, determine organ origins, and subclassify neoplasms that are morphologically and biologically heterogeneous. Specific immunomarkers are also available to help guide patient treatment and assess disease aggressiveness, which are keys to the success of personalized medicine. Pathologists will continue to play a critical role in the discovery, validation, and application of new biomarkers, which will ultimately improve patient care.
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11
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Arora K, Bal M, Shih A, Moy A, Zukerberg L, Brown I, Liu X, Kelly P, Oliva E, Mullen J, Ahn S, Kim KM, Deshpande V. Fetal-type gastrointestinal adenocarcinoma: a morphologically distinct entity with unfavourable prognosis. J Clin Pathol 2017; 71:221-227. [PMID: 28814568 DOI: 10.1136/jclinpath-2017-204535] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 06/14/2017] [Accepted: 06/19/2017] [Indexed: 12/19/2022]
Abstract
AIMS This multi-institutional study and a re-evaluation of the TCGA cohort explores the morphological spectrum, genetics and outcome of GI (gastrointestinal) hepatoid tumours, tumours expressing alpha-fetoprotein (AFP) and fetal-type (FT) GI adenocarcinomas. METHODS 44 tumours with evidence of hepatocellular differentiation were evaluated for morphology as well as by immunohistochemistry for AFP, HepPar1, glypican-3 and arginase-1 and by in situ hybridisation for albumin. Three categories were defined: type I (hepatoid: morphological evidence of hepatocellular differentiation), type II (FT GI adenocarcinoma: tubular profiles and subnuclear vacuolisation, resembling fetal intestine) and type III: positive for at least two hepatocyte-specific markers but lacking morphological evidence of hepatocellular differentiation. GI adenocarcinomas in the TCGA cohort were also evaluated (n=829). RESULTS 18 cases were classified as type I, 19 as FT GI adenocarcinomas and 7 as type III (resembling conventional gastrointestinal carcinomas). Serum AFP was elevated in 92% of cases. 93% of tumours were positive for glypican-3, 90% for albumin and 89% for AFP. Arginase-1 was restricted to 35% of type 1 tumours. TCGA gastric tumours with elevated AFP expression showed morphological features of FT GI adenocarcinoma (70%) and were exclusively MSI stable. TCGA gastric adenocarcinomas with high AFP expression showed inferior survival on univariate and multivariate analysis. CONCLUSIONS FT GI adenocarcinomas show a distinctive morphological and immunohistochemical profile. Gastric adenocarcinomas with elevated expression of AFP morphologically resemble FT GI adenocarcinomas, demonstrate aggressive behaviour, independent of grade and stage, and a distinct genetic profile.
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Affiliation(s)
- Kshitij Arora
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Munita Bal
- Department of Pathology, Tata Memorial Centre, Mumbai, India
| | - Angela Shih
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrea Moy
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lawerence Zukerberg
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ian Brown
- Envoi Pathology Unit, Kelvin Grove, Queensland, Australia
| | - Xiuli Liu
- Cleveland Clinic, Cleveland, Ohio, USA
| | - Paul Kelly
- Institute of Pathology, Royal Victoria Hospital, Belfast, Ireland
| | - Esther Oliva
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John Mullen
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Soomin Ahn
- Department of Pathology & Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
| | - Kyoung-Mee Kim
- Department of Pathology & Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, The Republic of Korea
| | - Vikram Deshpande
- Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts, USA
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Giedl J, Büttner-Herold M, Wach S, Wullich B, Hartmann A, Agaimy A. Hepatocyte differentiation markers in adenocarcinoma of the prostate: hepatocyte paraffin 1 but not arginase-1 is specifically expressed in a subset of prostatic adenocarcinoma. Hum Pathol 2016; 55:101-7. [DOI: 10.1016/j.humpath.2016.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/04/2016] [Accepted: 04/22/2016] [Indexed: 11/26/2022]
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