1. Eyas M. Hattab, M.D. Department of Pathology and Laboratory Medicine Scientific Committee of the ADIAP 25th Annual Congress and the 5th JSP International Conference

2.  71 yo M  History of partial thyroidectomy one year ago  Presents with arm weakness  MRI of the spine shows a mass lesion involving C6- T1 vertebral bodies and secondary pathologic fracture

5.  TTF-1  Thyroglobulin

6. TTF-1 Thyroglobulin

7.  Metastatic follicular thyroid carcinoma

8. Indianapolis Central Library

9.  59 yo M  History of “esophageal surgery” one month ago  Presents with cervical vertebral body “osteomyelitis”  Vertebral body biopsy performed

12.  Squamous cell carcinoma  CK 5/6  P63  ?p40

13. CK cocktailp63CK 5/6

14.  Metastatic squamous cell carcinoma, of esophageal origin

16.  48 yo F  History of breast carcinoma ten years ago  Presents with new onset headaches  Brain MRI shows a left frontal lobe mass

19.  H&E Dx: PD Carcinoma, likely breast  Recommended IHC workup:  CK7/20  GATA-3  GCDFP  Mammaglobin  ER/PR/Her2 (if requested or diagnostically relevant)

20.  CK7 + / CK20 -

21. CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

22. Estrogen ReceptorHer2/neuGATA-3

23.  Metastatic breast carcinoma

25.  63 yo F  Presents with headache  Brain MRI shows a left frontal peripherally enhancing mass with central necrosis located in the deep white matter  No known history!

28.  H&E Dx: carcinoma, likely renal cell  Recommended IHC workup:  CK7/CK20  Two of the following:  Vimentin  EMA  CD10  PAX8

29.  CK7 - / CK20 -

30. CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

31. VimentinEMA

32. CD10PAX8

33.  Metastatic renal cell carcinoma

34. Soldiers and Sailors Monument on the Circle

35.  65 yo M  Presents with sacroiliitis, retroperitoneal adenopathy, and abnormal bone marrow signal in T1 and T2  Clinical diagnosis: lymphoma  The bone marrow biopsy: initially worked up in hematopathology

38.  Keratin cocktail  CK7  CK20

39. Keratin cocktail

40.  CK 7 –  CK 20 –

41. CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

42. PSAPPSAP501S

43.  Metastatic prostatic adenocarcinoma

44. Bankers Life Fieldhouse

45.  51 yo F  Presented to an outside facility with headache  Imaging studies revealed a right occipital mass with rim enhancement

48.  Keratin cocktail  CK 7  CK 20  TTF-1  Napsin A  GATA 3

49. Keratin cocktail

50. CK7CK20

51. CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

52. TTF-1Napsin A

53. GATA 3

54.  Metastatic lung adenocarcinoma

56.  57 yo M  Presented with a spontaneous intraparenchymal hemorrhage in the right temporal lobe

59.  H&E Dx: adenocarcinoma, likely papillary thyroid  Recommended IHC workup:  CK7/20  TTF1  Napsin A  Thyroglobulin  Pax8

60.  CK7 +  CK 20 –

61. TTF-1Napsin A

62.  Thyroglobulin +  PAX8 +

63.  Metastatic papillary thyroid carcinoma

65.  56 yo F  Limited past medical history, presented to the county emergency room with heavy vaginal bleeding  Imaging studies revealed a large abdominal mass with extension into and pathologic fracture of the L3 vertebral body

68.  CK 7  CK 20

69. CK7CK20

70. CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

71. CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

72.  TTF1 –  Napsin A –

73. CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

74. CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

75.  GATA3 –  GCDFP-15 –

76. CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

77. CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

78. WT1

79. CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

80. CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

81.  BER-EP4 +  MOC-31 +

82. CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

83. CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

84. Estrogen receptor

85. CK 20 +CK 20 - CK 7 + Urothelial cell carcinoma Ovarian mucinous carcinoma Pancreatic adenocarcinoma Lung adenocarcinoma Breast carcinoma Ovarian serous carcinoma Endometrial adenocarcinoma Cervical squamous cell ca Mesothelioma CK7 - Colorectal carcinoma Merkel cell carcinoma Hepatocellular carcinoma Renal cell carcinoma Prostate adenocarcinoma Squamous cell carcinoma

86.  CDX2 +!

87.  Caveat: CDX2 may be aberrantly expressed in endometrial adenocarcinoma!

88.  Metastatic endometrial adenocarcinoma

90.  65 yo M  Presented with new onset seizures

94.  CK AE1/3  EMA  PR  CK7  CK20  p63

95.  Reactive Immunostains  Ki67  PR  AE1/AE3  P63  EMA  Negative Immunostains  Synaptophysin  GFAP  CDX2  CK5/6  CD45RB  S100 protein  CK20  CK7  CD34  Napsin A

96. CK AE1/3

97. EMA

98. Progesterone Receptor

99. CK 7CK 20

100. p63

101.  Metastatic lung squamous cell carcinoma???