Metastatic proximal epithelioid sarcoma in pleural effusion: Cytopathologic findings and differential diagnosis

Guan, Hui; Haque, Farah; Ali, Syed Z.

doi:10.1002/dc.21818

Cited by 4 publications

(3 citation statements)

References 16 publications

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“…Although the differential diagnosis for AE1=AE3-positive and WT1-negative cells consists mostly of nonovarian carcinomas, other keratin-positive neoplasms such as epithelioid sarcoma have been reported in pleural fluids. 29 Accordingly, tumor cells with this profile (pattern A) ( Figs. 2 and 6) should be evaluated within the context of clinical history and morphologic features, with the addi-tional workup targeted toward identifying a primary site of carcinoma, such as TTF-1 for lung adenocarcinoma and GATA3 for breast or bladder carcinoma.…”

Section: Discussionmentioning

confidence: 99%

“…However, metastases to the pleura from numerous other sites, including prostate, upper gastrointestinal tract, colorectal, and pancreatic primary tumors are encountered. Although the differential diagnosis for AE1/AE3‐positive and WT1–negative cells consists mostly of nonovarian carcinomas, other keratin‐positive neoplasms such as epithelioid sarcoma have been reported in pleural fluids . Accordingly, tumor cells with this profile (pattern A) (Figs.…”

Section: Discussionmentioning

confidence: 99%

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Wilms tumor 1/cytokeratin dual‐color immunostaining reveals distinctive staining patterns in metastatic melanoma, metastatic carcinoma, and mesothelial cells in pleural fluids: An effective first‐line test for the workup of malignant effusions

Conner

Cibas

Hornick

et al. 2014

Cancer Cytopathology

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BACKGROUND:The workup of a malignant effusion usually requires immunostaining with a panel of markers. Although nuclear Wilms tumor 1 (WT1) expression is widely used to detect tumors of ovarian and mesothelial origin, it is less well known that WT1 is also expressed in the cytoplasm of melanomas and mesenchymal tumors. Because to the authors' knowledge the diagnostic utility of cytoplasmic WT1 expression has not been explored to date, the usefulness of a WT1=AE1=AE3 dual-color immunostain in the workup of malignant effusions was evaluated. METHODS: A total of 86 pleural effusions, including 17 metastatic melanomas, 31 metastatic adenocarcinomas, 10 malignant mesotheliomas, 10 lymphoproliferative disorders, 5 metastatic sarcomas, and 13 benign specimens, were immunostained using a peroxidase-based brown chromogen for WT1 and an alkaline phosphatase-based red chromogen for AE1=AE3 on cell block sections. RESULTS:The majority of malignant effusions stained in 1 of 4 distinctive patterns: 1) all lung and breast adenocarcinomas demonstrated cytoplasmic AE1=AE3 expression without nuclear or cytoplasmic WT1 expression; 2) serous carcinomas of M€ ullerian origin, mesotheliomas, and benign mesothelial cells were positive for cytoplasmic AE1=AE3 as well as nuclear WT1; 3) melanomas, sarcomas, and a subset of plasma cell neoplasms were positive for cytoplasmic expression of WT1 but negative for AE1=AE3; and 4) large B-cell lymphomas and a subset of plasma cell neoplasms were negative for both markers. CONCLUSIONS: A WT1=AE1=AE3 dual-color immunostain can reliably identify malignancy in pleural effusions and group malignant cells into discrete subsets, thereby narrowing the differential diagnosis. This simple double stain can be a cost-effective, first-line test in the workup of patients with malignant effusions. Cancer (Cancer Cytopathol) 2014;122:586-95.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Wilms tumor 1/cytokeratin dual‐color immunostaining reveals distinctive staining patterns in metastatic melanoma, metastatic carcinoma, and mesothelial cells in pleural fluids: An effective first‐line test for the workup of malignant effusions

Conner

Cibas

Hornick

et al. 2014

Cancer Cytopathology

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“…[9][10][11][12] Hence, the diagnosis can be challenging since it can mimic other malignancies with epithelioid morphology. 13,14,15 While the presence of erythrocytes in the intracytoplasmic vacuole of tumor cells could be a clue, given that it is not specific for EHE, immunohistochemical stains such as FLI-1, ERG, CD31 and CD34 are often helpful in establishing the vascular nature of the tumor. That said, none of these markers are entirely specific.…”

Section: Introductionmentioning

confidence: 99%

Cytologic features and immunohistochemical findings of epithelioid hemangioendothelioma (EHE) in effusion: A case series

Thangaiah

Hanley²,

Nomani

et al. 2020

Diagnostic Cytopathology

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Background Epithelioid hemangioendothelioma (EHE) is a rare malignant vascular tumor characterized by WWTR1‐CAMTA1, t (1:3) (p36;q25) translocation in 90% of cases. Without prior EHE history, it can mimic other malignant effusions. Recently, CAMTA1 was published as an excellent immunohistochemical surrogate marker for molecular testing for WWTR1‐CAMTA1 fusion in surgical specimens. Methods A 6‐year retrospective search using our computer system was performed for cases diagnosed as EHE on effusion cytology and surgical specimens. The clinical presentation, cytologic findings and immunohistochemical stain results, including CAMTA1 were reviewed. Results Four pleural and one peritoneal effusions were identified. The median age was 52 years with a female to male ratio of 3:2. Most patients presented with pulmonary symptoms. The cytologic features were non‐specific easily mimicking other malignancies; especially in the absence of known prior malignancy. This was exemplified by one of our cases which was initially misdiagnosed as adenocarcinoma. Intracytoplasmic erythrocytes were present only on the cell blocks but not on cytology. The cytology cell blocks from patients with prior EHE confirmed on surgical biopsies stained positive for vascular markers (CD31, ERG) and CAMTA1. Conclusion The features of EHE in effusion are non‐specific and a diagnostic pitfall in cytology. In the absence of prior EHE diagnosis, inclusion of this entity in the differential diagnoses and application of immunohistochemical stain panels will be prudent in avoiding a misdiagnosis. However, in cases with prior EHE diagnosis, CAMTA1 could serve as diagnostic marker; especially on limited cytology material. Additional studies will be helpful in supporting our results.

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Sarcoma redux: Past, present, and future

Dodd

Bedrossian

2012

Diagnostic Cytopathology

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Metastatic proximal epithelioid sarcoma in pleural effusion: Cytopathologic findings and differential diagnosis

Cited by 4 publications

References 16 publications

Wilms tumor 1/cytokeratin dual‐color immunostaining reveals distinctive staining patterns in metastatic melanoma, metastatic carcinoma, and mesothelial cells in pleural fluids: An effective first‐line test for the workup of malignant effusions

Wilms tumor 1/cytokeratin dual‐color immunostaining reveals distinctive staining patterns in metastatic melanoma, metastatic carcinoma, and mesothelial cells in pleural fluids: An effective first‐line test for the workup of malignant effusions

Cytologic features and immunohistochemical findings of epithelioid hemangioendothelioma (EHE) in effusion: A case series

Sarcoma redux: Past, present, and future

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