Nonspecific Reactivity of Polyclonal Napsin A Antibody in Mucinous Adenocarcinomas of Various Sites: A Word of Caution

Rekhtman, Natasha; Kazi, Sofia

doi:10.5858/arpa.2014-0452-le

Cited by 13 publications

(9 citation statements)

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“…The rate of KRAS mutation (2/8) is consistent with the rate of KRAS mutation found in adenocarcinomas in our institution. [ 31 ] Only 1/10 had EGFR mutation, which is also in keeping with the expected rate. [ 32 ] However interpretation of this data is limited by the small number of cases with molecular markers performed.…”

Section: Discussionsupporting

confidence: 71%

Early Stage Lung Cancer Detection in Systemic Sclerosis Does Not Portend Survival Benefit: A Cross Sectional Study

et al. 2015

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BackgroundSystemic Sclerosis (SSc) is a rare connective tissue disorder associated with an increased risk of malignancy including lung cancer.MethodsA single center review of all cases of lung cancer in patients with SSc was conducted. Clinical, radiographic, and detailed pathologic data was collected. Risk factors were compared with our center’s SSc Registry. Cancer characteristics were compared with the National Cancer Institute SEER Cancer Statistics (NCI SEER) data.Results17 cases were identified; the majority were females (82%) with the lung cancers diagnosed after the onset of SSc (88%). Tobacco use was identified in 65% of cases. Serologic testing showed 50% of cases were Scl-70 positive. Twelve cases had radiographic evidence of SSc lung involvement, however only 6 had restrictive physiology on pulmonary function testing. Thirteen cases had pulmonary nodules preceding lung cancer. Thirteen of the cancers were adenocarcinoma. Ten underwent molecular mutational profiling: 2/8 had KRAS mutation and 1/10 had EGFR mutation. More of the non-small cell lung cancers were diagnosed at localized disease (56%) than in the NCI SEER database. However, 5 years survival among the stage I cases was 25% versus an expected survival of 54%.ConclusionsThe high proportion of adenocarcinomas seen in our study is different from that reported in the literature. Lung cancers were diagnosed at an early stage, likely due to our center’s practice of radiographic screening for SSc associated lung involvement, however this did not confer a survival advantage. A high proportion of patients who developed lung cancer had interstitial lung disease.

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Section: Discussionsupporting

confidence: 71%

Early Stage Lung Cancer Detection in Systemic Sclerosis Does Not Portend Survival Benefit: A Cross Sectional Study

et al. 2015

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“…One study revealed napsin A expression in 92% of 13 nonpulmonary mucinous adenocarcinomas and 100% of 8 pulmonary mucinous adenocarcinomas by IHC with a polyclonal antibody versus in none of the 13 nonpulmonary and 38% of the eight pulmonary mucinous adenocarcinomas with napsin A expression when a monoclonal antibody was used. 157 Interestingly, other studies using a polyclonal antibody reported napsin A expression in none of 49 nonpulmonary mucinous adenocarcinomas 155,156 ; thus, the low specificity reported in the former study may be attributed to its particular IHC platform. 157,164 Further, nonspecific labeling with polyclonal napsin A in mucinous adenocarcinomas appears to have peculiar supranuclear localization, as opposed to the pan-cytoplasmic granular staining present with monoclonal napsin A, possibly owing to cross-reaction with panmucin antigen by the polyclonal antibody (see Fig.…”

Section: Salivary Gland-type Tumorsmentioning

confidence: 61%

“…Given that the differentiation of lung adenocarcinomas with mucinous features (pulmonary mucinous adenocarcinomas) from metastatic lesions is often challenging on a morphologic basis alone, multiple groups have studied the role of IHC in this context. In particular, distinguishing a metastasis from a pancreatic primary from invasive mucinous adenocarcinoma of the lung is far more challenging, given the similar immunoprofiles (focal caudal type homeobox 2 (CDX2) and cytokeratin 20 [ Table 8]) [140][141][142][143][144][145][146][147][148][149][150][151][152][153][154][155][156][157][158][159]161 ; furthermore, a lepidic growth pattern, which is characteristic of invasive mucinous adenocarcinoma (Fig. 12), is also often identified in pancreatic ductal adenocarcinoma metastatic to the lung (Fig.…”

Section: Salivary Gland-type Tumorsmentioning

confidence: 99%

“…14). 157,165 Most invasive mucinous adenocarcinomas and other pulmonary adenocarcinomas with mucinous features, in particular, those that lack TTF1 expression, react to hepatocyte nuclear factor 4a (HNF4a). 152,161 However, HNF4a is a differentiation transcription factor of the primary gut, including the hepatobiliary and GI tracts, which universally express this transcription factor.…”

Section: Salivary Gland-type Tumorsmentioning

confidence: 99%

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Best Practices Recommendations for Diagnostic Immunohistochemistry in Lung Cancer

Yatabe

Đačić

Borczuk

et al. 2019

Journal of Thoracic Oncology

Self Cite

242

221

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Since the 2015 WHO classification was introduced into clinical practice, immunohistochemistry (IHC) has figured prominently in lung cancer diagnosis. In addition to distinction of small cell versus non-small cell carcinoma, patients' treatment of choice is directly linked to histologic subtypes of non-small cell carcinoma, which pertains to IHC results, particularly for poorly differentiated tumors. The use of IHC has improved diagnostic accuracy in the classification of lung carcinoma, but the interpretation of IHC results remains challenging in some instances. Also, pathologists must be aware of many interpretation pitfalls, and the use of IHC should be efficient to spare the tissue for molecular testing. The International Association for the Study of Lung Cancer Pathology Committee received questions on practical application and interpretation of IHC in lung cancer diagnosis. After discussions in several International Association for the Study of Lung Cancer Pathology Committee meetings, the issues and caveats were summarized in terms of 11 key questions covering common and important diagnostic situations in a daily clinical practice with some relevant challenging queries. The questions cover topics such as the best IHC markers for distinguishing NSCLC subtypes, differences in thyroid transcription factor 1 clones, and the utility of IHC in diagnosing uncommon subtypes of lung cancer and distinguishing primary from metastatic tumors. This article provides answers and explanations for the key questions about the use of IHC in diagnosis of lung carcinoma, representing viewpoints of experts in thoracic pathology that should assist the community in the appropriate use of IHC in diagnostic pathology.

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“…Rekhtman N (2015) 15 found that polyclonal NapsA had at least focal labeling in nearly all (24 of 25) tested tumors, regardless of the site of origin. In contrast, m-NapsA antibody was completely negative in all extrapulmonary carcinomas.…”

Section: Egfr Mutationsmentioning

confidence: 99%

Comparative Characteristics of Napsin A, TTF 1 and EGFR Mutation Expression in Mucinous Lung Cell Carcinomas

et al. 2017

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Background: Invasive mucinous lung adenocarcinomas are rare and account for 2%-10% of all lung adenocarcinoma cases. It is believed that Napsin A exhibits a weaker expression in mucinous adenocarcinomas compared with TTF1, but such correlation is still poorly researched. Aim: The aim of the study was to determine the frequency of mucinous to nonmucinous adenocarcinomas and compare specifi city and sensitivity of monoclonal Napsin A with TTF1 in mucinous adenocarcinomas and defi ne the frequency of EGFR mutations. Materials and methods: Eighty-four resected lung carcinomas were prospectively evaluated. All biopsies were analysed with p63, TTF1, monoclonal Napsin A, CK7, CK20 and CDX2 and were studied with real-time PCR technology. Results: In resected material we detected 49/84 (58.3%) adenocarcinomas and selected 21 mucinous adenocarcinomas out of 46 non-mucinous adenocarcinomas (45.6%). The most common pattern of mucinous adenocarcinomas is papillary -24% and colloidal -24%, followed by acinar -19.2% and lepidic -19.2%. mNapsin A was positive in 18/21 (85.7%) mucinous adenocarcinomas v/s 17/21 TTF1 positive (80.9%). EGFR mutations were detected in 3/21 cases with mucinous adenocarcinomas (14.3%): mucinous papillary, mucinous acinar and "salivary gland-like". Conclusion: Our study demonstrates a high proportion of primary mucinous lung adenocarcinomas to primary non-mucinous adenocarcinomas. Sensitivity and specifi city of mNapsin A and TTF1 did not show signifi cant diff erence in pulmonary mucinous and non-mucinous adenocarcinomas, as mNapsin A gave greater sensitivity to mucinous adenocarcinomas. Our results indicate the same mutation frequency of EGFR in mucinous adenocarcinomas as mutation frequency detected in non-mucinous adenocarcinomas in the Bulgarian region.

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Nonspecific Reactivity of Polyclonal Napsin A Antibody in Mucinous Adenocarcinomas of Various Sites: A Word of Caution

Cited by 13 publications

References 5 publications

Early Stage Lung Cancer Detection in Systemic Sclerosis Does Not Portend Survival Benefit: A Cross Sectional Study

Early Stage Lung Cancer Detection in Systemic Sclerosis Does Not Portend Survival Benefit: A Cross Sectional Study

Best Practices Recommendations for Diagnostic Immunohistochemistry in Lung Cancer

Comparative Characteristics of Napsin A, TTF 1 and EGFR Mutation Expression in Mucinous Lung Cell Carcinomas

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