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What I Talk When I Talk About Cutaneous Neoplasias?: Topic 6
What I Talk When I Talk About Cutaneous Neoplasias?: Topic 6
cutaneous neoplasias? 4.
5.
Is it epithelial, lymphohistiocytic or mesenchymal?
Have I enough material to make a safe diagnosis?
6. Which histochemical techniques can help me?
7. Which immunohistochemical techniques can help me?
María Teresa Fernández Figueras
8. Which molecular techniques can help me?
Hospital Universitari General de Catalunya. Grupo Quironsalud
9. Are they pathognomonic features to distinguish a malignant tumor?
Universitat Internacional de Catalunya
10. Are they unequivocal techniques to distinguish a malignant tumor?
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04/08/2020
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0.08mm 0.13mm
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Fibrin thrombus
Smooth muscle
Tumor cells
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2
04/08/2020
Fibrin thrombus
Smooth muscle
Tumor cells
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Basic terminology in tumoral pathology Questions and reflections to make in front of any biopsy
Typical mitosis 1. Tumoral or non-tumoral?
Atypical mitosis
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04/08/2020
Questions and reflections to make in front of any biopsy Questions and reflections to make in front of any biopsy
1. Tumoral or non-tumoral? 1. Tumoral or non-tumoral?
2. Is it benign or malignant? 2. Is it benign or malignant?
3. Is it epithelial, mesenchymal, melanocytic or lymphohistiocytic?
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Questions and reflections to make in front of any biopsy Questions and reflections to make in front of any biopsy
1. Tumoral or non-tumoral? 1. Tumoral or non-tumoral?
2. Is it benign or malignant? 2. Is it benign or malignant?
3. Is it epithelial, mesenchymal, melanocytic or lymphohistiocytic? 3. Is it epithelial, mesenchymal, melanocytic or lymphohistiocytic?
4. Primary or secondary/metastatic? 4. Primary or secondary/metastatic?
5. Have I enough material to make a safe diagnosis?
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Questions and reflections to make in front of any biopsy Questions and reflections to make in front of any biopsy
1. Tumoral or non-tumoral? 1. Tumoral or non-tumoral?
2. Is it benign or malignant? 2. Is it benign or malignant?
3. Is it epithelial, mesenchymal, melanocytic or lymphohistiocytic? 3. Is it epithelial, mesenchymal, melanocytic or lymphohistiocytic?
4. Primary or secondary/metastatic? 4. Primary or secondary/metastatic?
5. Have I enough material to make a safe diagnosis? 5. Have I enough material to make a safe diagnosis?
6. Which histochemical techniques can help me? 6. Which histochemical techniques can help me?
7. Which immunohistochemical techniques can help me? 7. Which immunohistochemical techniques can help me?
8. Which molecular techniques can help me? 8. Which molecular techniques can help me?
9. Are they pathognomonic features to distinguish a malignant tumor?
10. Are they unequivocal techniques to distinguish a malignant tumor?
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4
04/08/2020
3cm
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1. Tumoral or non-tumoral: typical tumor features 1. Tumoral or non-tumoral: typical tumor features
Tumors: cohesive or interconnected areas of cellular proliferation Tumoral growth: pagetoid
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04/08/2020
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5. Have I enough material to make a safe diagnosis? 6. Which histochemical techniques can help me?
PAS (red) + mucosecretion and basal membranes Kamino body
Keratoacanthoma in a tattoo
Microcystic adnexal carcinoma
with perineural involvement
1½ month
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7. Which immunohistochemical techniques can help me? 7. Which immunohistochemical techniques can help me?
• Epithelial: keratins, p63, p40, CEA,EMA Epithelial
Keratins (AE1/AE3, 34βE12, …) p63, p40
• Mesenchymal: Vimentin
Muscle: actin, desmin, caldesmon, caponin
Neural: s100 protein, neurofilaments, Sox10
Fibrohistiocytic: CD34, factor XIIIa
Vascular: CD34, CD31, D2-40, ERG
• Melanocitary: s100, Melan A/Mart1, HMB45, Sox10
• Neuroendocrine: synaptophisin, chromogranin, CD56
• Histiocytic: CD68, CD163, s100, CD1a, Langherin
• Lymphoid: LCA (CD45), B (CD20, CD79a) and T (CD3, CD4, CD8)
• Viral infections: HHV8, MCPyV, p16
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7
04/08/2020
7. Which immunohistochemical techniques can help me? 8. Which molecular techniques can help me?
Proliferative fraction
Ki67
• ISH (In situ hybridization): EBER for Epstein Barr virus detection,
kappa and lambda monotypic populations of plasma cells
• PCR (Polymerase chain reaction): clonality of lymphocytic
populations, HPV detection
• FISH (Fluorescent in situ hybridization): melanomas, sarcomas
• CGH (comparative genomic hybridization): melanoma
• Sequentiation: Detection of targetable oncogenic mutations
• NGS (next generation sequencing): Melanomas and sarcomas
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9. Are they pathognomonic features to distinguish a malignant tumor? 10. Are they unequivocal techniques to distinguish a malignant tumor?
Some
Not a single feature! (although there are false positives and negatives)
(Not even lymph node involvement)
FISH for MDM2 in well-differentiated liposarcomas
Only the combination of several histopathological features in FISH for MYC in well-differentiated angiosarcomas
correlation with the clinical presentation
CGH in melanoma
and others
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