Pathology of nodal and bone marrow metastasis

Question 1

Most likely primary site of a metastasis in the inguinal node?

Answer 1

Melanoma of the lower limb

Question 2

Most likely primary site of a metastasis in the supraclavicular nodes?

Answer 2

1. Upper GIT carcinoma

2. Bronchogenic carcinoma

Question 3

Most likely primary site of a metastasis in the cervical nodes?

Answer 3

1. Head or Neck carcinoma
2. Nasopharyngeal carcinoma
3. Oropharyngeal carcinoma

Question 4

Most likely primary site of a metastasis in the axillary nodes?

Answer 4

Breast carcinoma

Question 5

What does keratin in a node suggest?

Answer 5

Metastatic Squamous cell carcinoma

Question 6

What does Mucin in a node suggest?

Answer 6

Metastatic Adenocarcinoma

Question 7

What do Tubules in a node suggest?

Answer 7

Metastatic Adenocarcinoma

Question 8

What does a cytokeratin tumour marker suggest?

Answer 8

Metastatic carcinoma

Question 9

What does CD45 tumour marker suggest?

Answer 9

Lymphoma

Question 10

What does Vimentin tumour marker suggest?

Answer 10

Metastatic Sarcoma or Mesothelioma

Question 11

What does S100P and HMB45 tumour markers suggest?

Answer 11

Metastatic melanoma

Question 12

What does the presence of glands suggest?

Answer 12

Metastatic adenocarcinoma

Question 13

General principles to recognise a metastasis?

Answer 13

1. Often focal
2. Reticulin stain can highlight grouping of cells
3. Stromal reactions may happen but are variable

Question 14

Helpful stains to recognise metastasis?

Answer 14

1. Reticulin
2. PAS
3. Alcian blue