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Garcia-Porrero G, Wood F, Faria S, Kelly PJ, McCluggage WG. "Aberrant" expression of skeletal muscle markers in neuroendocrine carcinomas: a significant diagnostic pitfall. Virchows Arch 2024:10.1007/s00428-024-03838-0. [PMID: 38833174 DOI: 10.1007/s00428-024-03838-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024]
Abstract
In this study, we investigate the expression of muscle markers, including the specific skeletal muscle markers myogenin and myoD1, in neuroendocrine carcinomas (NECs). The study included 23 NECs from various sites (14 small cell NECs and 9 large cell NECs). These were stained with desmin, myogenin and myoD1. Positive staining with at least one muscle marker was observed in 14 cases (61%). 8 (35%), 8 (35%) and 11 (48%) of the cases were positive with desmin, myogenin and myoD1 respectively. In most, but not all, cases positive staining was focal generally involving < 10% of tumour cells. Expression of muscle markers is not uncommon in NECs. This represents an important diagnostic pitfall of which pathologists should be aware. In reporting this phenomenon, we speculate on the pathogenesis of this "aberrant" expression of muscle markers.
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Affiliation(s)
- Guillermo Garcia-Porrero
- Department of Pathology, Belfast Health and Social Care Trus, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Faye Wood
- Department of Pathology, Belfast Health and Social Care Trus, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Sara Faria
- Department of Pathology, Belfast Health and Social Care Trus, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Paul J Kelly
- Department of Pathology, Belfast Health and Social Care Trus, Grosvenor Road, Belfast, BT12 6BA, UK
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trus, Grosvenor Road, Belfast, BT12 6BA, UK.
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Morimoto T, Yamasaki K, Shingu T, Sato T, Uryu T, Jotatsu T, Kato K, Kawabata H, Nishida C, Yatera K. Autopsy case of a patient with rapidly progressive combined small-cell lung carcinoma with spindle-shaped cell tumor. Thorac Cancer 2022; 13:2279-2282. [PMID: 35762505 PMCID: PMC9346181 DOI: 10.1111/1759-7714.14559] [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: 04/19/2022] [Revised: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022] Open
Abstract
A 69-year-old Japanese man visited our hospital because of worsening shortness of breath. His chest computed tomography (CT) showed a giant left lung mass with a massive left pleural effusion. He could not be treated with chemotherapy and eventually died from a rapidly progressive tumor. He was diagnosed with combined small cell lung carcinoma (C-SCLC) with spindle-shaped cell tumor at autopsy. C-SCLC is characterized by pathologically concurrent SCLC and adenocarcinoma or squamous cell carcinoma, or rarely, spindle-shaped cell tumor. The clinical course of C-SCLC with spindle-shaped cell tumor has not previously been determined. Our patient's tumor increased by 2.59-fold in 20 days. The combination of C-SCLC with spindle-shaped cell tumor suggested rapid progression and a poor prognosis.
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Affiliation(s)
- Toshiki Morimoto
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Kei Yamasaki
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Tatsuya Shingu
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Tomoki Sato
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Takumu Uryu
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Takanobu Jotatsu
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Kaori Kato
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Hiroki Kawabata
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Chinatsu Nishida
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Kazuhiro Yatera
- Department of Respiratory Medicine, University of Occupational and Environmental Health, Kitakyushu City, Japan
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Agarwal S, van Zante A, Granados ML. Combined Neuroendocrine and Squamous Cell Carcinoma of the Sinonasal Tract: A Morphologic and Immunohistochemical Analysis and Review of Literature. Head Neck Pathol 2022; 16:1019-1033. [PMID: 35507300 PMCID: PMC9729485 DOI: 10.1007/s12105-022-01457-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/16/2022] [Indexed: 12/16/2022]
Abstract
Sinonasal malignancies constitute 3% of head and neck cancers, with squamous cell carcinoma (SCC) the most common histology. Neuroendocrine carcinomas (NEC) are rare, with a subset showing neuroendocrine carcinoma and a non-neuroendocrine component. The pathogenesis of these combined tumors is largely unknown, and TP53 driver mutations may play a role. A database search for combined NEC was performed across two institutions (UNM and UCSF) spanning 15 years. Excluding NUT midline carcinoma, 3 cases met inclusion criteria. All were morphologically NEC + SCC and underwent a comprehensive immunohistochemical evaluation. Tumors demonstrated two components histologically: moderately to poorly differentiated SCC and high-grade NEC. Divergent differentiation was confirmed with lineage-specific markers. Only one patient received neoadjuvant chemotherapy prior to surgery, with a remarkable response (a marked decrease in the size of the primary lesion and resolution of liver metastases). Immunohistochemical staining for p53 was increased in 2 of 3 cases (both components), suggesting a role in the carcinogenesis of these tumors. Aberrant expression of beta-catenin was not identified. One case tested positive for p16, which can be seen in high grade NECs due to inactivation of Rb gene. Additionally, both cases with a small cell NEC component expressed PD-L1, suggesting that immunotherapy may be an effective treatment. Findings in this study support the role of p53 mutation in a subset of combined NEC + SCC of the sinonasal tract. Recognition of this rare entity is essential for optimal management of these aggressive neoplasms.
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Affiliation(s)
- Shweta Agarwal
- Department of Pathology, University of New Mexico School of Medicine, University of New Mexico, MSC08 4640, Albuquerque, NM 87131 USA ,Department of Pathology, University of New Mexico Health Sciences Center, Albuquerque, NM USA
| | - Annemieke van Zante
- Department of Pathology, University of California San Francisco, San Francisco, CA USA
| | - Michaela L. Granados
- Department of Pathology, University of New Mexico School of Medicine, University of New Mexico, MSC08 4640, Albuquerque, NM 87131 USA
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Morphologic and molecular classification of lung neuroendocrine neoplasms. Virchows Arch 2021; 478:5-19. [PMID: 33474631 PMCID: PMC7966641 DOI: 10.1007/s00428-020-03015-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/17/2020] [Accepted: 12/28/2020] [Indexed: 12/14/2022]
Abstract
Neuroendocrine neoplasms (NENs) of the lung encompass neuroendocrine tumors (NETs) composed of typical (TC) and atypical (AC) carcinoids and full-fledged carcinomas (NECs) inclusive of large cell neuroendocrine carcinoma (LCNEC) and small cell carcinoma (SCLC). NETs and NECs are thought to represent distinct and separate lesions with neither molecular overlap nor common developmental continuum. Two perspectives were addressed regarding the morphologic and molecular classification of lung NENs: (i) a supervised approach by browsing the traditional classification, the relevant gene alterations, and their clinical implications; and (ii) an unsupervised approach, by reappraising neoplasms according to risk factors and natural history of disease to construct an interpretation model relied on biological data. We herein emphasize lights and shadows of the current classification of lung NENs and provide an alternative outlook on these tumors focused on what we currently know about the biological determinants and the natural history of disease.
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Asahina M, Fukumura Y, Mamat O, Saito T, Hayashi T, Uekusa T, Suzuki K, Yao T. A case of combined small cell lung carcinoma with unique morphology: Investigation of tumorigenesis. Pathol Int 2018; 68:618-623. [PMID: 30311995 DOI: 10.1111/pin.12726] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/14/2018] [Indexed: 11/30/2022]
Abstract
Small cell lung carcinoma (SCLC) usually grows in a pure form with no other associated histological components. However, combined small cell lung carcinoma (cSCLC), which is accompanied by other histological components (cSCLCs) may sometimes occur. Herein, we analyzed the tumorigenesis of cSCLC containing a demarcated area of pure SCLC. A 76-year-old man had a 25-mm mass in the perihilar portion of his right upper lung. Histologically, the cSCLC contained two relatively demarcated areas: one area composed of pure SCLC cells and another area of SCLC, squamous-like component (SLC), and spindle cell carcinoma (SpCC) cells. Loss of heterozygosity (LOH) was observed at allele 3p in all tumor components and at 22q in the pure SCLC component. Histological and immunohistochemical analysis and LOH study suggested that all components were likely to be monoclonal in origin and revealed that the pure SCLC component was not the precursor of the cSCLC. In the tumorigenesis of this case, the pure SCLC and the cSCLC may have originated from a common pluripotent tumor cell and then diverged, although we cannot state this conclusively. Further studies with more cases are necessary to test this theory.
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Affiliation(s)
- Miki Asahina
- Department of Human Pathology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Yuki Fukumura
- Department of Human Pathology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Osman Mamat
- Department of Human Pathology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Tsuyoshi Saito
- Department of Human Pathology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Takuo Hayashi
- Department of Human Pathology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Toshimasa Uekusa
- Department of Diagnostic Pathology, Kanto Rosai Hospital, 1-1kizukisumiyoshi-cho, Nakahara-ku, Kawasaki City, Kanagawa 211-8510, Japan
| | - Kenji Suzuki
- Department of General Thoracic Surgery, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
| | - Takashi Yao
- Department of Human Pathology, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-8421, Japan
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Pelosi G, Scarpa A, Forest F, Sonzogni A. The impact of immunohistochemistry on the classification of lung tumors. Expert Rev Respir Med 2016; 10:1105-21. [PMID: 27617475 DOI: 10.1080/17476348.2017.1235975] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION To highlight the role of immunohistochemistry to lung cancer classification on the basis of existing guidelines and future perspectives. AREAS COVERED Four orienting key-issues were structured according to an extensive review on the English literature: a) cancer subtyping; b) best biomarkers and rules to follow; c) negative and positive profiling; d) suggestions towards an evidence-based proposal for lung cancer subtyping. A sparing material approach based on a limited number of specific markers is highly desirable. It includes p40 for squamous cell carcinoma ('no p40, no squamous'), TTF1 for adenocarcinoma, synaptophysin for neuroendocrine tumors and vimentin for sarcomatoid carcinoma. A close relationship between genotype and phenotype also supports a diagnostic role for negative profiles. Expert commentary: Highly specific and sensitive IHC markers according to positive and negative diagnostic algorithms seem appropriate for individual patients' lung cancer subtyping.
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Affiliation(s)
- Giuseppe Pelosi
- a Department of Oncology and Hemato-Oncology , Università degli Studi di Milano , Milan , Italy
| | - Aldo Scarpa
- b Department of Pathology and Diagnostics , University and Hospital Trust of Verona , Verona , Italy.,c ARC-Net Research Centre , University and Hospital Trust of Verona , Verona , Italy
| | - Fabien Forest
- d Department of Pathology , University Hospital Center (CHU), North Hospital , Saint Etienne , France
| | - Angelica Sonzogni
- e Department of Pathology and Laboratory Medicine , Fondazione IRCCS Istituto Nazionale Tumori , Milan , Italy
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Cai X, Sheng J, Tang C, Nandakumar V, Ye H, Ji H, Tang H, Qin Y, Guan H, Lou F, Zhang D, Sun H, Dong H, Zhang G, Liu Z, Dong Z, Guo B, Yan H, Yan C, Wang L, Su Z, Li Y, Jones L, Huang XF, Chen SY, Wu T, Lin H. Frequent mutations in EGFR, KRAS and TP53 genes in human lung cancer tumors detected by ion torrent DNA sequencing. PLoS One 2014; 9:e95228. [PMID: 24760004 PMCID: PMC3997391 DOI: 10.1371/journal.pone.0095228] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 03/25/2014] [Indexed: 11/25/2022] Open
Abstract
Lung cancer is the most common malignancy and the leading cause of cancer deaths worldwide. While smoking is by far the leading cause of lung cancer, other environmental and genetic factors influence the development and progression of the cancer. Since unique mutations patterns have been observed in individual cancer samples, identification and characterization of the distinctive lung cancer molecular profile is essential for developing more effective, tailored therapies. Until recently, personalized DNA sequencing to identify genetic mutations in cancer was impractical and expensive. The recent technological advancements in next-generation DNA sequencing, such as the semiconductor-based Ion Torrent sequencing platform, has made DNA sequencing cost and time effective with more reliable results. Using the Ion Torrent Ampliseq Cancer Panel, we sequenced 737 loci from 45 cancer-related genes to identify genetic mutations in 76 human lung cancer samples. The sequencing analysis revealed missense mutations in KRAS, EGFR, and TP53 genes in the breast cancer samples of various histologic types. Thus, this study demonstrates the necessity of sequencing individual human cancers in order to develop personalized drugs or combination therapies to effectively target individual, breast cancer-specific mutations.
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Affiliation(s)
- Xin Cai
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Jianhui Sheng
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | | | - Vijayalakshmi Nandakumar
- Norris Comprehensive Cancer Center, Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California Los Angeles, Los Angeles, California, United States of America
| | - Hua Ye
- San Valley Biotechnology Incorporated, Beijing, China
| | - Hong Ji
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Haiying Tang
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Yu Qin
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Hongwei Guan
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Feng Lou
- San Valley Biotechnology Incorporated, Beijing, China
| | - Dandan Zhang
- San Valley Biotechnology Incorporated, Beijing, China
| | - Hong Sun
- San Valley Biotechnology Incorporated, Beijing, China
| | - Haichao Dong
- San Valley Biotechnology Incorporated, Beijing, China
| | | | - Zhiyuan Liu
- San Valley Biotechnology Incorporated, Beijing, China
| | - Zhishou Dong
- San Valley Biotechnology Incorporated, Beijing, China
| | - Baishuai Guo
- San Valley Biotechnology Incorporated, Beijing, China
| | - He Yan
- San Valley Biotechnology Incorporated, Beijing, China
| | - Chaowei Yan
- San Valley Biotechnology Incorporated, Beijing, China
| | - Lu Wang
- San Valley Biotechnology Incorporated, Beijing, China
| | - Ziyi Su
- San Valley Biotechnology Incorporated, Beijing, China
| | - Yangyang Li
- San Valley Biotechnology Incorporated, Beijing, China
| | - Lindsey Jones
- Norris Comprehensive Cancer Center, Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California Los Angeles, Los Angeles, California, United States of America
| | - Xue F. Huang
- Norris Comprehensive Cancer Center, Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California Los Angeles, Los Angeles, California, United States of America
| | - Si-Yi Chen
- Norris Comprehensive Cancer Center, Department of Molecular Microbiology and Immunology, Keck School of Medicine, University of Southern California Los Angeles, Los Angeles, California, United States of America
| | - Taihua Wu
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Hongli Lin
- The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
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Franchi A, Rocchetta D, Palomba A, Degli Innocenti DR, Castiglione F, Spinelli G. Primary combined neuroendocrine and squamous cell carcinoma of the maxillary sinus: report of a case with immunohistochemical and molecular characterization. Head Neck Pathol 2013; 9:107-13. [PMID: 24327102 PMCID: PMC4382489 DOI: 10.1007/s12105-013-0513-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 12/03/2013] [Indexed: 12/23/2022]
Abstract
Neuroendocrine neoplasms represent a rare subset of tumors in the sinonasal tract. Combined tumors, with an endocrine and a non-neuroendocrine component, are exceedingly rare, and mainly consist of a combination of neuroendocrine carcinoma with adenocarcinomas. We present the clinico-pathologic and immunohistochemical features of a neuroendocrine carcinoma combined with squamous cell carcinoma, arising in the maxillary sinus. In addition, we evaluated the clonal origin of the two components through analysis of TP53 gene status. Both components were positive for cytokeratins AE1/AE3, while the squamous cell carcinoma was positive for cytokeratin 5/6 and p63, and the neuroendocrine carcinoma showed immunoreactivity for neuron specific enolase, chromogranin, synaptophysin and CD56. In situ hybridization for human papilloma virus and Epstein-Barr virus were negative in both components. A missense mutation in TP53 exon 7 (c.734G>C) and strong nuclear immunostaining for p53 were detected only in the neuroendocrine carcinoma. This suggests that the tumor either derived from one precursor cell with squamous differentiation, which underwent TP53 mutation and acquisition of a neuroendocrine phenotype, or it derived from two separate clones, one with mutated TP53 and neuroendocrine differentiation, and the other with wild type TP53 and squamous differentiation (collision tumor).
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Affiliation(s)
- Alessandro Franchi
- Section of Anatomic Pathology, Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy,
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