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'''Metastases''' are usually an ominous finding. | [[Image:Metastatic adenocarcinoma - cerebellum - intermed mag.jpg|right|250px|thumb|A [[brain metastasis]]. [[H&E stain]].]] | ||
'''Metastases''' are tumours that have spread from elsewhere and are separate from the initial (primary) lesion; usually, they are an ominous finding. | |||
Metastases are not always obvious when encountered; thus, ''metastasis'' should be considered with every diagnosis of a [[cancer|malignant tumour]]. | |||
Seen from pathology, ''metastatic disease'' and ''direct extension of a tumour'' (on a biopsy) may be indistinguishable. Collectively, they may also be referred to as '''secondary tumours'''. | |||
'''''[[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]]'''''. | |||
[[Lymph node]] metastases are dealt with in the article ''[[lymph node metastases]]''. | |||
A handful of things have metastatic-like behaviour but are not malignant. Examples of benign things with metastatic-like behaviour are: benign metastasizing leiomyoma,<ref name=pmid15099894>{{Cite journal | last1 = Pitts | first1 = S. | last2 = Oberstein | first2 = EM. | last3 = Glassberg | first3 = MK. | title = Benign metastasizing leiomyoma and lymphangioleiomyomatosis: sex-specific diseases? | journal = Clin Chest Med | volume = 25 | issue = 2 | pages = 343-60 | month = Jun | year = 2004 | doi = 10.1016/j.ccm.2004.01.014 | PMID = 15099894 }}</ref> [[endometriosis]], [[endosalpingiosis]] and [[Nodal nevus|benign nevus cells (in lymph nodes)]].<ref>{{Cite journal | last1 = Cook | first1 = MG. | title = Benign melanocytic lesions mimicking melanomas. | journal = Pathology | volume = 36 | issue = 5 | pages = 414-8 | month = Oct | year = 2004 | doi = 10.1080/00313020412331283842 | PMID = 15370110 }}</ref> | |||
=Special types= | =Special types= | ||
==In-transit metastasis== | ==In-transit metastasis== | ||
{{Main|In-transit metastasis}} | |||
{{Main|Tumour deposits}} | |||
*It is called "in-transit", as it happens while the tumour is on the way to the regional lymph node. | |||
*If a separate tumour nodule is close to the primary tumour, it is known as ''[[satellitosis]]''. | |||
Note: | |||
* | *The definitions vary based on the primary site. | ||
*'' | **The general definition (see the ''[[in-transit metastasis]]'' article) applies to [[dermatopathology]]. | ||
**In the [[colon]] and [[rectum]], they are generally known as ''[[tumour deposits]]'', ''discoutinuous extramural extension'' and ''peritumoral deposits''.<ref name=pmid19136930>{{Cite journal | last1 = Puppa | first1 = G. | last2 = Ueno | first2 = H. | last3 = Kayahara | first3 = M. | last4 = Capelli | first4 = P. | last5 = Canzonieri | first5 = V. | last6 = Colombari | first6 = R. | last7 = Maisonneuve | first7 = P. | last8 = Pelosi | first8 = G. | title = Tumor deposits are encountered in advanced colorectal cancer and other adenocarcinomas: an expanded classification with implications for colorectal cancer staging system including a unifying concept of in-transit metastases. | journal = Mod Pathol | volume = 22 | issue = 3 | pages = 410-5 | month = Mar | year = 2009 | doi = 10.1038/modpathol.2008.198 | PMID = 19136930 }}</ref> | |||
=Specific sites= | =Specific sites= | ||
==Internal organs== | ===Internal organs=== | ||
{{Main|Liver metastasis}} | |||
{{Main|Lung metastasis}} | |||
{{Main|Kidney metastasis}} | |||
==Lymph node== | ===Lymph node=== | ||
{{Main|Lymph node metastasis}} | {{Main|Lymph node metastasis}} | ||
===Other=== | |||
{{Main|Peritoneal metastasis}} | |||
{{Main|Testicular metastasis}} | |||
{{Main|Ovarian metastasis}} | |||
{{Main|Urinary bladder metastasis}} | |||
===Brain=== | |||
{{Main|Brain metastasis}} | |||
=Specific tumours= | =Specific tumours= | ||
| Line 27: | Line 49: | ||
{{Main|Osteosarcoma}} | {{Main|Osteosarcoma}} | ||
*[[Giant cells]]. | *[[Giant cells]]. | ||
=IHC= | |||
*Dependent on (suspected) primary. | |||
Not necessary to do stains/[[immunostain]]s 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. | |||
#The suspected primary is ''not'' [[breast cancer|breast]]. | |||
#*ASCO/CAP guidelines state that ''ER and PR (in breast cancer recurrences) should always be re-tested''.<ref name=pmid20586616>{{Cite journal | last1 = Hammond | first1 = ME. | last2 = Hayes | first2 = DF. | last3 = Dowsett | first3 = M. | last4 = Allred | first4 = DC. | last5 = Hagerty | first5 = KL. | last6 = Badve | first6 = S. | last7 = Fitzgibbons | first7 = PL. | last8 = Francis | first8 = G. | last9 = Goldstein | first9 = NS. | title = American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer (unabridged version). | journal = Arch Pathol Lab Med | volume = 134 | issue = 7 | pages = e48-72 | month = Jul | year = 2010 | doi = 10.1043/1543-2165-134.7.e48 | PMID = 20586616 }}</ref> | |||
=Sign out= | =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. | 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== | |||
<pre> | <pre> | ||
SMALL BOWEL, RESECTION: | SMALL BOWEL, RESECTION: | ||
| Line 37: | Line 70: | ||
COMMENT: | COMMENT: | ||
The tumour | 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 | 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. | pale cytoplasm, and round nuclei. The tumour is moderately differentiated. | ||
</pre> | </pre> | ||
==Spine== | |||
===Pending=== | |||
<pre> | |||
VERTEBRAL LESION, L1, BIOPSY: | |||
- ADENOCARCINOMA -- PENDING IHC. | |||
</pre> | |||
<pre> | |||
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, MAMMAGLOBIN. | |||
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. | |||
</pre> | |||
====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= | =See also= | ||
*[[Cancer]]. | *[[Cancer]]. | ||
*[[Basics]]. | *[[Basics]]. | ||
*[[Pulmonary lymphangitic carcinomatosis]]. | |||
*[[Lytic metastases]]. | |||
=Reference= | =Reference= | ||
| Line 52: | Line 117: | ||
[[Category:Basics]] | [[Category:Basics]] | ||
[[Category:Cancer staging]] | |||