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- 61 year old man with right lung nodule
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stevenshen 离线
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| 姓 名： | ××× | 性别： | Male | 年龄： | 61 |
| 标本名称： | Right upper lobe lung nodule | ||||
| 简要病史： | |||||
| 肉眼检查： | 1.5 cm | ||||
Frozen section diagnosis and differential diagnoses?
Answer will be posted after Chinese New Year.
Happy New Year!
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本帖最后由 于 2010-02-04 08:51:00 编辑
×参考诊断
Metastatic melanoma
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stevenshen 离线
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stevenshen 离线
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Malignant for sure.
Malignant melanoma (metastatic much more likely than primary) is my first choice. Large cell carcinoma remains likely and needs to be ruled out. Dendritic cell sarcoma is much less likely. I cannot exclude a rare metastatic thymic carcinoma.
Confirm with at least two of melanocytic markers (S100, Melan A, HMB45, MITF) and AE1 first. If AE1 is positive and melanocytic markers are negative, add TTF-1, CD5 and CD117. If only S100 is positive and the other melanocytic markers and AE1 are negative, add CD68 and two of follicular dendritic cell markers (CD21, CD23, CD35).
This is not paraganglioma, meningioma, thymoma or carcinoid tumor.
聞道有先後,術業有專攻
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Malignant for sure. Malignant melanoma (metastatic much more likely than primary) is my first choice. Large cell carcinoma remains likely and needs to be ruled out. Dendritic cell sarcoma is much less likely. I cannot exclude a rare metastatic thymic carcinoma. Confirm with at least two of melanocytic markers (S100, Melan A, HMB45, MITF) and AE1 first. If AE1 is positive and melanocytic markers are negative, add TTF-1, CD5 and CD117. If only S100 is positive and the other melanocytic markers and AE1 are negative, add CD68 and two of follicular dendritic cell markers (CD21, CD23, CD35). This is not paraganglioma, meningioma, thymoma or carcinoid tumor. |
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stevenshen 离线
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- It is metastic melanoma (hope Dr. Ma can comment again).
- S100 and HMB 45 were positive and cytokeratin was negative.
- On frozen, we will need to keep a wide differential (such as Dr. Jin's list).
- Look for features that will favor non-neoplastic (granuloma), benign vs. malignant, primary vs. metastatic.
- On this case, I thought the touch prep cytology is very helpful (epithelioid spindle cells with nucleoli).
