https://peir.path.uab.edu/index.php?action=history&feed=atom&title=Cytologically_Yours%3A_Unknowns%3A_201310%3A_Case_1Cytologically Yours: Unknowns: 201310: Case 1 - Revision history2026-04-12T10:47:32ZRevision history for this page on the wikiMediaWiki 1.31.1https://peir.path.uab.edu/index.php?title=Cytologically_Yours:_Unknowns:_201310:_Case_1&diff=2268&oldid=prevSeung Park: 1 revision2014-01-09T19:29:24Z<p>1 revision</p>
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</td></tr></table>Seung Parkhttps://peir.path.uab.edu/index.php?title=Cytologically_Yours:_Unknowns:_201310:_Case_1&diff=2267&oldid=prevSeungPark at 22:28, 13 November 20132013-11-13T22:28:16Z<p></p>
<p><b>New page</b></p><div>==Clinical History==<br />
55 year old male with a right upper lobe lung mass and mediastinal adenopathy.<br />
The patient is a smoker.<br />
<br />
==Cytology==<br />
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===Resident Questions===<br />
* <spoiler text="Diagnosis?">Adenocarcinoma. </spoiler><br />
* <spoiler text="What genetic mutations, if any, are associated with this diagnosis?"><br />
* EGFR testing is performed on these tumors to select patients for tyrosine kinase inhibitor (TKI)therapy (Gefitinib).<br />
* Patients with EML4-ALK fusion, respond to ALK inhibitor (ALKI) (Crizotinib)<br />
** Deletion and inversion on Chromosome 2p<br />
* Patients with KRAS or BRAF mutation do not respond to TKI, ALKI<br />
* KRAS mutations tend to be an adverse prognostic sign<br />
** Seen in mucinous type tumors, smokers and those of non-Asian ancestry<br />
** Most common mutations are in codons 12 and 13 of exon 2<br />
* EGFR<br />
** Point mutation or substitution mutation in the EGFR tyrosine kinase domain<br />
*** Sensitive to EGFR tyrosine kinase inhibitors<br />
**** Exons 19 deletion<br />
**** Exon 21 L858R<br />
**** Exon 18 G719<br />
*** Resistance to EGFR tyrosine kinase inhibitors<br />
**** Exon 20 (insertion V769L, S768I)<br />
**** Exon 19 (D761Y)<br />
</spoiler><br />
* <spoiler text="Why is it important to distinguish between adenocarcinoma and squamous cell carcinoma?"> <br />
* Treatment<br />
** EGFR mutations are found in adenocarcinoma and in some adenosquamous carcinomas<br />
** Bevacizumab is a monoclonal antibody that blocks vascular endothelial growth factor A (VEGF-A), which stimulates angiogenesis in cancer<br />
** Association between fatal hemoptysis in patients with squamous cell carcinoma of the lung treated with Bevacizumab<br />
*** Therefore, Bevacizumab is contraindicated for tumors with squamous cell histology<br />
</spoiler><br />
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==Additional Teaching Points==<br />
===Immunohistochemistry===<br />
* TTF-1 (nuclear stain)<br />
** Thyroid Transcription factor1 regulates transcription of genes specific to the thyroid, lung, and diencephalon<br />
** If metastatic thyroid cancer to the lung is ruled out by morphology or +thyroglobulin; then a +TTF1 supports adenocarcinoma originating from the lung<br />
* P63 (nuclear stain) and 34BE12 (cytoplasmic stain)<br />
** Used for squamous differentiation<br />
* TTF1 is more sensitive than p63<br />
** If a tumor stains for both it is more likely to be adenocarcinoma<br />
* Napsin A(cytoplasmic stain)<br />
** Granular staining pattern<br />
** Marker for adenocarcinoma<br />
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{{Cytologically Yours}}<br />
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[[Category:Unknowns]]<br />
[[Category:Respiratory]]</div>SeungPark