Immunocytochemical typing of primary tumors on fine needle aspiration cytologies of the liver and lymph nodes

BACKGROUND: Difficulties with cytologic diagnoses on FNACs of coin-lesion in the liver and of enlarged lymph nodes can be overcome by the application of immunocytochemical panels applied on smears. The aim of this study was to investigate the performance of different panels of monoclonal antibodies in FNACs of the liver for: 1) the differentiation of hepatocellular carcinoma (HCC) from metastatic carcinoma (MC); 2) the identification of the primary sites of MC to the liver; and in FNACs of lymph nodes for: 3) the identification of the primary sites of MC and confirm a cytological and/or clinical suspicion for a metastatic neuroendocrine carcinoma; 4) to differentiate non-Hodgkin lymphoma (NHL) from MC, 5) to confirm a clinical suspicion of a specific primary tumor site, and 6) to try a classification of malignant lymphomas.METHODS: In a validating cohort study, all patients had confirmatory histological and/or clinical follow up. 108 FNACs of coin lesions of the liver and 64 of lymph nodes were routinely evaluated applying immunocytochemistry as an ancillary method. 23 HCCs were analysed for the distinction from metastatic carcinoma applying a panel of HepPar1, alpha-Fetoprotein, BerEP4, CD31, CD68 and Ki67. 85 cases of unknown primary tumors metastatic to the liver and 30 to the lymph nodes were analysed to investigate the suitability of a marker panel consisting of CK5/6, CK7, CK20, CA125, TTF1, and Cdx2, BerEP4, LCA, TTF1, CD56, Chromogranin A and Synaptophysin were used when there was a cytological and/or clinical suspicion for a metastatic neuroendocrine carcinoma. 10 FNACs of lymph nodes were analysed for the differentiation of Non Hodgkin Lymphoma (NHL) from MC, applying BerEp4 and LCA. Using PSA, CD138, RCC, LCA, Uroplakin III, S100, HMB-45, CA15-3, Chromogranin A and Synaptophysin, 16 cases were checked to confirm the clinical suspicion of a specific primary tumor site from lymph nodes metastasis. Finally we tried to classify 8 suspicious cases of malignant lymphomas applying LCA, CD20, CD79a, CD45Ro, CD15 and CD30. RESULTS: Applying immunocytochemistry as an adjuvant method to cytological smears the following diagnostic accuracy could be reached: 1) 100% for the differentiation of HCC from MC; 2) 90.3% for the identification of primary tumor sites from their metastases to the liver in FNACs from coin lesions; 3) 92.3% for the identification of primary tumor site from their metastases to lymph nodes in FNACs; 4) 100% for the differentiation of NHL from MC; 5) 100% to confirm a clinical suspicion of a specific MC to lymph nodes; and 6) 87.5% for typing of NHL. In 23 cases of carcinoma of unknown primary in FNACs of the liver and 7 of lymph nodes, the site of the primary tumor remained clinically unknown. CONCLUSIONS: Application of immunocytochemical panels on the same slide used for microscopic diagnosis is a useful tool in the routine assessment of FNACs of the liver to discriminate HCCs from MC and for the identification of primary tumor sites of MC to the liver. It can also contribute to the routine assessment of FNACs of lymph nodes to discriminate NHL from MC, to confirm a clinical suspicion of a specific MC, and for the identification of primary sites of MC to the lymph nodes. Their performance should be confirmed in a larger series of cases.

Grantor dc:publisher

Publikationsserver der RWTH Aachen University

Year dc:date

2008

Author dc:creator

• Casimiro Onofre, Alexandre Sherlley

Contributors dc:contributor

• Wellmann, Axel

• info:eu-repo/classification/ddc/610
• Immuncytochemie
• Leber
• Lymphknoten
• Medizin
• Immunocytochemistry
• liver
• lymph nodes

Statement dc:rights

• info:eu-repo/semantics/openAccess

Language dc:language

eng

Identifier

https://publications.rwth-aachen.de/search?p=id:%22RWTH-CONV-112551%22

OAI record oai:identifier

https://publications.rwth-aachen.de/oai2d?verb=GetRecord&metadataPrefix=oai_dc&identifier=oai%3Apublications.rwth-aachen.de%3A49985