Cytologically Yours: Unknowns: 201310: Case 1

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Contents

Clinical History

55 year old male with a right upper lobe lung mass and mediastinal adenopathy. The patient is a smoker.

Cytology


Resident Questions


Additional Teaching Points

Immunohistochemistry

  • TTF-1 (nuclear stain)
    • Thyroid Transcription factor1 regulates transcription of genes specific to the thyroid, lung, and diencephalon
    • If metastatic thyroid cancer to the lung is ruled out by morphology or +thyroglobulin; then a +TTF1 supports adenocarcinoma originating from the lung
  • P63 (nuclear stain) and 34BE12 (cytoplasmic stain)
    • Used for squamous differentiation
  • TTF1 is more sensitive than p63
    • If a tumor stains for both it is more likely to be adenocarcinoma
  • Napsin A(cytoplasmic stain)
    • Granular staining pattern
    • Marker for adenocarcinoma