Possible Pathologic Evaluation of Biopsy Specimens from Patients with Metastatic Cancer of Unknown Primary Site
Evaluation/Findings | Suggested Primary Site or Neoplasm |
---|---|
Histology (hematoxylin and eosin staining) | |
Psammoma bodies, papillary configuration | Ovary, thyroid |
Signet ring cells | Stomach |
Immunohistology | |
Leukocyte common antigen (LCA, CD45) | Lymphoid neoplasm |
Leu-M1 | Hodgkin's disease |
Epithelial membrane antigen | Carcinoma |
Cytokeratin | Carcinoma |
CEA | Carcinoma |
HMB45 | Melanoma |
Desmin | Sarcoma |
Thyroglobulin | Thyroid carcinoma |
Calcitonin | Medullary carcinoma of the thyroid |
Myoglobin | Rhabdomyosarcoma |
PSA/prostatic acid phosphatase | Prostate |
AFP | Liver, stomach, germ cell |
Placental alkaline phosphatase | Germ cell |
β-human chorionic gonadotropin | Germ cell |
B, T cell markers | Lymphoid neoplasm |
S-100 protein | Neuroendocrine tumor, melanoma |
Gross cystic fluid protein | Breast, sweat gland |
Estrogen and progesterone receptors | Breast |
Factor VIII | Kaposi's sarcoma, angiosarcoma |
Thyroid transcription factor 1 (TTF-1) | Lung adenocarcinoma, thyroid |
Calretinin, mesothelin | Mesothelioma |
URO-III, thrombomodulin | Bladder |
Flow Cytometry | |
B, T cell markers | Lymphoid neoplasm |
Ultrastructure | |
Actin-myosin filaments | Rhabdomyosarcoma |
Secretory granules | Neuroendocrine tumors |
Desmosomes | Carcinoma |
Premelanosomes | Melanoma |
Cytogenetics | |
Isochromosome 12p; 12q(-) | Germ cell |
t(11;22) | Ewing's sarcoma, primitive neuroectodermal tumor |
t(8;14)a | Lymphoid neoplasm |
3p(-) | Small cell lung carcinoma; renal cell carcinoma, mesothelioma |
t(X;18) | Synovial sarcoma |
t(12;16) | Myxoid liposarcoma |
t(12;22) | Clear cell sarcoma (melanoma of soft parts) |
t(2;13) | Alveolar rhabdomyosarcoma |
1p(-) | Neuroblastoma |
Receptor Analysis | |
Estrogen/progesterone receptor | Breast |
Molecular Biologic Studies | |
Immunoglobulin, bcl-2, T cell receptor gene rearrangement | Lymphoid neoplasm |
aOr any other rearrangement involving an antigen-receptor gene.
Abbreviations: AFP, α-fetoprotein; CEA, carcinoembryonic antigen; PSA, prostate-specific antigen.