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R. Pramanik
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P3.01 - Poster Session with Presenters Present (ID 469)
- Event: WCLC 2016
- Type: Poster Presenters Present
- Track: Biology/Pathology
- Presentations: 1
- Moderators:
- Coordinates: 12/07/2016, 14:30 - 15:45, Hall B (Poster Area)
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P3.01-012 - P40 in Metastatic Pulmonary Trophoblastic Tumour: Potential Diagnostic Pitfall with Pulmonary Squamous Cell Carcinoma (ID 4931)
14:30 - 14:30 | Author(s): R. Pramanik
- Abstract
Background:
p40, one of the two isomers of p63, is nowadays widely used for diagnosis of squamous cell carcinoma, especially in subtyping non-small cell carcinoma on lung biopsies.
Methods:
We describe a case in which lung tumour was misdiagnosed as squamous cell carcinoma due to p40 immunopositivity.
Results:
A 36-year-old lady presented with cough and left sided chest pain for 2 months duration. Chest imaging revealed a lesion in left lower lobe of lung and biopsy was suggestive of squamous cell carcinoma (Fig1). However, past history revealed amputation of great toe for non-healing discharging ulcer which on histopathology was diagnosed as choriocarcinoma. She developed similar nodules and ulcers over the left arm, followed by a gradually worsening dry cough and progressive shortness of breath. On imaging, she was found to have a septated left sided pleural effusion. A positron emission tomography–computed tomography (PET-CT) revealed a large hypermetabolic soft tissue mass in left lower lobe with bilateral lung metastases and multiple liver deposits. On reviewing obstetric history, she also had a history of hysterectomy five years ago, details of which were not available. Post-amputation β-hCG levels were high and she had been treated with multimodality chemotherapy for choriocarcinoma. She had good response to chemotherapy initially, however became resistant later on. Review of lung biopsy in the light of the past history along with extensive literature review led to the final diagnosis of metastatic trophoblastic tumour to lung. Figure 1- The lung biopsy shows an invasive tumour (A) (H&E, 10x); composed of polygonal cells with moderate amount of eosinophilic cytoplasm, round to oval nuclei and inconspicuous nucleoli (B) (H&E, 20x). Hyaline eosinophilic material is seen amid tumour cells with mitotic activity (C) (H&E, 20x). These tumour cells show strong nuclear immunopositivity for p40 in approximately half of the tumour cells (D) (IHC, 20x).
Conclusion:
Hence, awareness that p40 immunopositivity can be seen in trophoblastic tumours is essential to avoid misdiagnosis, especially in sites like lung where squamous cell carcinoma is common.
