Difference between revisions of "Metastases"
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'''Metastases''' are usually an ominous finding. They are not always obvious when | [[Image:Metastatic adenocarcinoma - cerebellum - intermed mag.jpg|right|250px|A [[brain metastasis]]. [[H&E stain]].]] | ||
'''Metastases''' are usually an ominous finding. They are not always obvious when encountered; thus, ''metastasis'' should be considered with every diagnosis of a [[cancer|malignant tumour]]. | |||
'''''[[Cancers of unknown primary]]''''' are dealt with in the ''[[cancer]]'' article. A general approach to undifferentiated tumours is given in the ''[[basics]]'' article under the heading '''''[[modified general morphologic DDx of malignancy]]'''''. | '''''[[Cancers of unknown primary]]''''' are dealt with in the ''[[cancer]]'' article. A general approach to undifferentiated tumours is given in the ''[[basics]]'' article under the heading '''''[[modified general morphologic DDx of malignancy]]'''''. | ||
Revision as of 05:32, 9 November 2014
Metastases are usually an ominous finding. They are not always obvious when encountered; thus, metastasis should be considered with every diagnosis of a malignant tumour.
Cancers of unknown primary are dealt with in the cancer article. A general approach to undifferentiated tumours is given in the basics article under the heading modified general morphologic DDx of malignancy.
Special types
In-transit metastasis
Definition - the separate tumour nodule must be:[1]
- >2 cm from the primary tumour.
- Arises between the nearest (regional) lymph nodes and the primary tumour.
- The tumour presumably arises from a lymphatic that drains the tissue in which the primary tumour grew.
Notes:
- It is called "in-tranist", as it happens while the tumour is on the way to the regional lymph node.
- In-transit metastases are seen in malignant melanoma, merkel cell carcinoma.
- If a separate tumour nodule <= 2 cm from the primary tumour, it is known as satellitosis.
Specific sites
Internal organs
Lymph node
Other
Brain
Specific tumours
Melanoma
Osteosarcoma
IHC
- Dependent on (suspected) primary.
Not necessary to do stains/immunostains if all of the following are true:
- A primary is already established by pathology.
- The morphology of the lesion is compatible with the established primary.
- The clinical impression is a metastasis.
Sign out
This depends somewhat on the tumour. A synoptic is not done. Margin status should be commented on. A morphologic description is useful if a subsequent resection is done.
Bowel
SMALL BOWEL, RESECTION: - METASTATIC ADENOCARCINOMA, SEE COMMENT. - SURGICAL MARGINS NEGATIVE FOR MALIGNANCY. COMMENT: The tumour involves only the outer aspect of the bowel wall; the bowel mucosa is not involved. The tumour consists of glands with cuboidal tumour cells that have a moderate quantity of pale cytoplasm, and round nuclei. The tumour is moderately differentiated.
Spine
Pending
VERTEBRAL LESION, L1, BIOPSY: - ADENOCARCINOMA -- PENDING IHC.
LESION OF T7 VERTEBRA, CORE BIOPSY: - METASTATIC CARCINOMA, CONSISTENT WITH BREAST PRIMARY, SEE COMMENT. COMMENT: The morphology is compatible with a metastatic breast carcinoma. The tumour cells stain as follows: POSITIVE: CK7, ER, PR, MAMMOGLOBIN. NEGATIVE: CK20, TTF-1, CDX2, HER2, GCDFP. The immunostaining profile is compatible with a metastatic breast carcinoma. ER, PR and HER2 are interpreted as Class I IHC tests (results used by pathologists), as per the CAP classification.[1] 1. Am J Clin Pathol 133 (3):354-65.
Micro
Probable lung metastasis
The sections show atypical cohesive cuboidal-to-low columnar cells with moderate nuclear pleomorphism. The nuclei are round/ovoid and eccentrically placed in the cell. Nucleoli of moderate size are identified. Mitotic figures are present. The cytoplasm is lightly eosinophilic and vacuoles are seen focally.
See also
Reference
- ↑ URL: http://www.cancer.gov/dictionary?cdrid=634128. Accessed on: 28 March 2012.