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- FNA of lung mass
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This is a 41-year-old female with one left upper lobe lung mass in June 2008 and now has one new left lower lobe lung mass. The FNA was done in June 2008 in an outside hospital. They used the rapid H&E stain (our pathologist friends in China are more familia with this stain). The patient has a history of a lower leg mass back in 2001 (I don't know the diagnosis and is in the process of getting the slides). The outside pathologist made a diagnosis on the FNA, which is reasonable but I doubt it. The first three pictures are cytology and the last two pictures are the cell block. Should generate some discussion? I will keep you posted.
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×参考诊断
转移性滑膜肉瘤
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OK. I got the outside slides (2001) from this patient's previous soft tissue mass, it is synovial sarcoma. The pictures are shown here. The outside pathologist called this lung mass "neuroendocrine carcinoma, favor atypical carcinoid tumor". They did immunohistochemistry on the current lung nodule (I did not get the IHX slides), it is positive for cytokeratin AE1/AE3 and synaptophisin. the tumor cells are negative for Chromogranin.
Is this metastatic synovial sarcoma or a second primary lung neuroendocrine tumor? What extra-immuno or test you would do to support your diagnosis? or you are so confident that you just want to sign out this case. I ordered some extra tests and will keep you posted tomorrow.
译楼上：好！OK. I got the outside slides (2001) from this patient's previous soft tissue mass, it is synovial sarcoma.我借到了患者在2001年外院的下肢软组织肿块的病理切片，当时诊断滑膜肉瘤。 The pictures are shown here. 如图所示，The outside pathologist called this lung mass "neuroendocrine carcinoma, favor atypical carcinoid tumor".外地病理医生称这个肺的包块是神经内分泌癌，可能是不典型类癌。 They did immunohistochemistry on the current lung nodule (I did not get the IHX slides), it is positive for cytokeratin AE1/AE3 and synaptophisin. the tumor cells are negative for Chromogranin.他们在肺的包块上做了免疫组化（我没有看到片子），他们认为cytokeratin AE1/AE3 and synaptophisin.阳性，Chromogranin阴性。Is this metastatic synovial sarcoma or a second primary lung neuroendocrine tumor?到底是转移性滑膜肉瘤还是又一个原发性肺的神经内分泌肿瘤？ What extra-immuno or test you would do to support your diagnosis?如果不管免疫组化你支持那一个诊断？ or you are so confident that you just want to sign out this case.如果你发报告，你有自信心吗， I ordered some extra tests and will keep you posted tomorrow.我明天再提出一些证据来，请大家继续猜。
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本帖最后由 于 2008-12-19 12:05:00 编辑
re:FNA of lung mass 肺包块细针抽吸活检
I think that this is a metastatic synovial sarcoma.我认为本例为转移性滑膜肉瘤。 Because of the wrong diagnosis, the patient's lung nodule got resected and did NOT go for the appropriate chemotherapy.由于误诊，患者做了肺部包块切徐，并且没有做适当的化疗， But, we need to respect other pathologist's opinion. 但是，我们还是应该尊重其医生的意见。It will be not responsible to just sign this case out without doing any further studies.如果本例不做什么工作，直接发出这样的病理报告，是一种不负责任的行为。 So, I did two more immunostaines on the block:所发以我建议再做点免疫组化。
1) CK19, which should be positive for synovial sarcoma; 1) CK19滑膜肉瘤是阳性， 2) TLE-1: we use that a lot for our soft tissue service to diagnose synvial sarcoma (Terry et al. TLE1 as a diagnostic marker for synovial sarcoma emerging from gene profile study. 2) TLE-1:我们也常用于做为软组织肿瘤，也用于诊断滑膜肉瘤的诊断性标记（美国外科病理杂志） American Journal of Surgical pathology, 31:240-6, 2007): this stain should be nuclear staining. 这种染色是核着色。I also did FISH study on the cell block and it is POSITIVE for SYT gene. 我也用切片做了FISH研究，并且SYT gene基因也是阳性
Final diagnosis: metastatic synovial sarcoma.最后诊断：转移性滑膜肉瘤。
Note: synovial sarcoma can be focally positive for Synaptophysin, when you do immunostains, 注意：滑膜肉瘤免疫组化Synaptophysin阳性，be careful to interprete immunostains, your diagnosis should not be solely depend on 1 or 2 positive immunostains, it has to be correlate with morphology and clinical presentation.一定要认真的去解释免疫组化结果。你的诊断不应该单独依赖于1-2种阳性的免疫组化，必需使临床和形态密切联系。
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I think that this is a metastatic synovial sarcoma. Because of the wrong diagnosis, the patient's lung nodule got resected and did NOT go for the appropriate chemotherapy. But, we need to respect other pathologist's opinion. It will be not responsible to just sign this case out without doing any further studies. So, I did two more immunostaines on the block:
1) CK19, which should be positive for synovial sarcoma; 2) TLE-1: we use that a lot for our soft tissue service to diagnose synvial sarcoma (Terry et al. TLE1 as a diagnostic marker for synovial sarcoma emerging from gene profile study. American Journal of Surgical pathology, 31:240-6, 2007): this stain should be nuclear staining. I also did FISH study on the cell block and it is POSITIVE for SYT gene.
Final diagnosis: metastatic synovial sarcoma.
Note: synovial sarcoma can be focally positive for Synaptophysin, when you do immunostains, be careful to interprete immunostains, your diagnosis should not be solely depend on 1 or 2 positive immunostains, it has to be correlate with morphology and clinical presentation.
