You may think this is an esoteric topic but recently I had a patient sent to me who had a small nodule biopsied and after extensive tests reported as a metastatic adenocarcinoma to the skin by a locum histopathologist. The patient then had two weeks of mental torture being tested with every known scan to find the primary bfore the other pathologist came back and reviewed the slides and did other tests to change the diagnosis back to a poorly differentiated Scc. This test could have helped early on.
Podoplanin is a Highly Sensitive and Specific Marker to Distinguish Primary Skin Adnexal Carcinomas From Adenocarcinomas Metastatic to Skin.
Original Articles
American Journal of Surgical Pathology. 31(2):304-310, February 2007.
Liang, Haohai MD *; Wu, Hong MD, PhD +; Giorgadze, Tamar A. MD, PhD ++; Sariya, Dinesh MD +; Bellucci, Kirsten S.W. MD *; Veerappan, Ranjitha MD ++; Liegl, Bernadette MD [S]; Acs, Geza MD, PhD *; Elenitsas, Rosalie MD [//]; Shukla, Shruti MD ++; Youngberg, George A. MD [P]; Coogan, Philip S. MD ++; Pasha, Theresa *; Zhang, Paul J. MD *; Xu, Xiaowei MD, PhD *
Abstract:
Distinction of primary skin adnexal carcinomas from cutaneous metastasis of adenocarcinomas is challenging. In this study, we evaluated podoplanin immunoreactivity in a series of primary skin adnexal tumors and adenocarcinomas metastatic to skin using a D2-40 antibody. The initial test series were composed of a total of 93 cases including 32 primary skin adnexal carcinomas, 46 benign primary adnexal tumors, and 15 cutaneous metastatic adenocarcinomas. We found that variable D2-40 reactivity was seen in all of the primary cutaneous carcinomas including sebaceous carcinomas (10/10), squamous cell carcinomas (10/10), porocarcinomas (4/4), trichilemmal carcinomas (4/4), skin adnexal carcinomas not otherwise specified (4/4), and in the majority of benign skin adnexal tumors. In contrast, no podoplanin immunoreactivity was seen in any of the 15 (0/15) cutaneous metastases. To confirm the initial findings and to further explore the utility of podoplanin reactivity in the distinction of these tumors, we also examined a test set of 35 unknown cases, including 21 adenocarcinomas metastatic to skin and 14 primary adnexal tumors, in a blinded fashion. In this test set of cases, podoplanin was negative in 22 cases and positive in 13 cases. Of the 22 podoplanin negative cases, 20 were proven to be metastatic adenocarcinoma. Of the 13 D2-40 positive cases, 12 were proven to be primary adnexal tumors. Our results suggest that podoplanin can be a useful tool to distinguish primary skin adnexal carcinomas form adenocarcinomas metastatic to skin with high sensitivity (94.5%) and specificity (97.2%).
(C) 2007 Lippincott Williams & Wilkins, Inc.
2 comments:
I had read this article previously and it sounds like a useful test. In my experience, initial presentation with cutaneous metastases is uncommon. In my personal series of 1, a 75 year old male heavy drinker, with 2 browny pink nodules on his face, the pathologist reported them as adenocarcinoma secondaries probably from bowel and that was what it was. He was dead in 6 weeks although he denied prior bowel problems or weight loss.
Multiple lesions would make adenocarcinoma metastases more likely but reconsider the diagnosis with a solitary lesion.
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