Priti Trivedi

Abstract

Introduction: Worldwide, lung carcinoma is the most common cancer in terms of number of cases and deaths. Lung carcinomas are broadly divided into small cell carcinoma and non-small cell lung carcinoma (NSCLC). In recent years availability of targeted therapies necessitated subtyping the NSCLC to improve the survival and quality of life. NSCLC can be subtyped by routine Haematoxylin and Eosin (H&E) stained section slides alone, poorly differentiated tumors are difficult to segregate morphologically, especially in guided biopsies, necessitating ancillary techniques like immunohistochemistry (IHC). Materials and Methods: A prospective study of two years duration (2017 and 2018) during which 100 cases of NSCLC on guided biopsies were first reported on Haematoxylin and Eosin sections and later subjected for IHC using relevant markers like CK5/6, CK7, TTF-1, Napsin-A, P63, P40, Synaptophysin and Chromogranin. Results: Out of 100 cases, after IHC, 49 were diagnosed as adenocarcinoma and 51 as squamous cell carcinoma. In adenocarcinoma positivity for CK7, TTF-1, and Napsin-A was 95%, 60% and 45% respectively. In squamous cell carcinoma positivity for CK5/6, P63 and P40 was 76%, 82% and 88% respectively. Conclusion: P40 and TTF-1 are more specific markers in our study to differentiate squamous cell carcinoma and adenocarcinoma. Keywords: Adenocarcinoma, Squamous cell carcinoma, Napsin-A, TTF-1, CK7, P40, P63, CK5/6.

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Abstract

Alveolar soft part sarcoma (ASPS) is a very rare malignant, highly aggressive and profusely vascular soft tissue sarcoma of controversial histological origin accounting for less than 1% of the soft tissue sarcoma cases worldwide. Though it has an indolent clinical course, however, because of its propensity to recur and frequently metastasize, it usually has a fatal outcome. The knowledge of its microscopic features and TFE3 staining facilitate earlier diagnosis. Surgical resection helps in increasing the disease-free period, but the role of adjuvant chemotherapy and radiotherapy is disputed. After resection, it should be frequently monitored because of its malignant potential and dismal prognosis. We present a case report of twenty-year-old male patient whose entire clinical presentation was that of a primary brain malignancy with no symptoms anywhere else in the body but was diagnosed to be a case of alveolar soft part sarcoma of para lumbar region with brain and lung metastasis. To the best of our knowledge, it is an extremely uncommon presentation with only fourteen cases have been reported so far. Keywords: Alveolar soft part sarcoma, brain metastasis, TFE3 nuclear positivity.

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