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dc.contributor.authorEyden, Brian P
dc.contributor.authorChakrabarty, Bipasha
dc.contributor.authorHatimy, Umi
dc.date.accessioned2009-06-05T10:12:37Z
dc.date.available2009-06-05T10:12:37Z
dc.date.issued2009
dc.identifier.citationCarcinoma versus cytokeratin-positive lymphoma: a case report emphasizing the diagnostic role of electron microscopy. 33 (1): 33-8 Ultrastruct Patholen
dc.identifier.issn1521-0758
dc.identifier.pmid19191200
dc.identifier.doi10.1080/01913120802625830
dc.identifier.urihttp://hdl.handle.net/10541/69781
dc.description.abstractLymphoma diagnosis rarely needs electron microscopy (EM), but one area where it can be useful is in the distinction of cytokeratin-positive lymphoma from carcinoma. The authors describe such a case, where difficulties were encountered due to lack of antibody specificity, distinguishing reactive from tumoral cells, and suboptimal sampling for EM. The tumor was in a lymph node next to the right submandibular gland in a 69-year-old man. This was a malignant tumor, composed of sheets of monomorphic large round cells. Interpretation on the part of a team of pathologists who examined this tumor was divided. On histological sections, the differential diagnosis was between carcinoma and lymphoma, which was modified to cytokeratin-positive lymphoma versus carcinoma since tumor cells were found to be cytokeratin-positive. EM of tumor retrieved from formalin showed plasmablastic features, in keeping with lymphoma with plasmablastic differentiation, one of the light microscopy diagnoses. The moderately strong positivity of cytokeratin and the positivity for Ber-EP4, however, supported carcinoma, and further sampling for EM was carried out, specifically on a cytokeratin-positive area of the wax block. Tonofibrils were found, supporting carcinoma. The final diagnosis was undifferentiated carcinoma with unknown primary site. The study emphasizes the need to take into account the imperfect specificity of cytokeratin, which can be found in several hemolymphoid neoplasms, to distinguish reactive from neoplastic cells, and to secure appropriate sampling for EM. This is one of the occasions where dewaxing (of an immunohistochemically defined wax block) offers positive advantages, despite compromised structural preservation, in the search for diagnostically important organelles.
dc.language.isoenen
dc.subjectCanceren
dc.subject.meshAged
dc.subject.meshCarcinoma
dc.subject.meshDiagnosis, Differential
dc.subject.meshHumans
dc.subject.meshImmunohistochemistry
dc.subject.meshKeratins
dc.subject.meshLymph Nodes
dc.subject.meshLymphatic Metastasis
dc.subject.meshLymphoma
dc.subject.meshMale
dc.subject.meshMicroscopy, Electron, Transmission
dc.subject.meshNeoplasms, Unknown Primary
dc.titleCarcinoma versus cytokeratin-positive lymphoma: a case report emphasizing the diagnostic role of electron microscopy.en
dc.typeArticleen
dc.contributor.departmentDepartment of Histopathology, The Christie NHS Foundation Trust, Manchester, UK. brian.eyden@christie.nhs.uken
dc.identifier.journalUltrastructural Pathologyen
html.description.abstractLymphoma diagnosis rarely needs electron microscopy (EM), but one area where it can be useful is in the distinction of cytokeratin-positive lymphoma from carcinoma. The authors describe such a case, where difficulties were encountered due to lack of antibody specificity, distinguishing reactive from tumoral cells, and suboptimal sampling for EM. The tumor was in a lymph node next to the right submandibular gland in a 69-year-old man. This was a malignant tumor, composed of sheets of monomorphic large round cells. Interpretation on the part of a team of pathologists who examined this tumor was divided. On histological sections, the differential diagnosis was between carcinoma and lymphoma, which was modified to cytokeratin-positive lymphoma versus carcinoma since tumor cells were found to be cytokeratin-positive. EM of tumor retrieved from formalin showed plasmablastic features, in keeping with lymphoma with plasmablastic differentiation, one of the light microscopy diagnoses. The moderately strong positivity of cytokeratin and the positivity for Ber-EP4, however, supported carcinoma, and further sampling for EM was carried out, specifically on a cytokeratin-positive area of the wax block. Tonofibrils were found, supporting carcinoma. The final diagnosis was undifferentiated carcinoma with unknown primary site. The study emphasizes the need to take into account the imperfect specificity of cytokeratin, which can be found in several hemolymphoid neoplasms, to distinguish reactive from neoplastic cells, and to secure appropriate sampling for EM. This is one of the occasions where dewaxing (of an immunohistochemically defined wax block) offers positive advantages, despite compromised structural preservation, in the search for diagnostically important organelles.


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