Precision Medicine by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9781071609040
Publisher: Springer US

3.2 Pathology and Immunohistochemistry

Histopathology plays a very important role in the CUP diagnosis. If clinical evaluation (specific evaluation of signs/symptoms and CT scanning) cannot authenticate the primary site, the identification of origin depends on the pathologic evaluation [23]. The first step is to determine the type of cancer. 60% of cancers are identified as adenocarcinomas. 30–35% of cancers are poorly differentiated or undifferentiated carcinomas. Other types of cancers include 5% of squamous cell carcinomas and 2% of neuroendocrine cancers [3]. It is very important to identify the tumor lineage after determining the type of cancers. Immunohistochemical (IHC) is the standard pathological evaluation in CUP. IHC can lessen the diagnostic spectrum to identify the tissue of origin. 60% of CUPs are adenocarcinomas. IHC stain for PSA is quite sensitive and specific for prostate cancer [24]. CK5/6 has a nice performance in lung carcinomas that is negative for adenocarcinoma and positive for the squamous cell carcinomas. However, individual IHC stains cannot fully differentiate various adenocarcinomas. How to distinguish specific adenocarcinomas is the most frequent diagnostic issue. CK7 and CK20 are the most frequently used IHC staining. Urothelial carcinomas and gastrointestinal (GI) will be tested positive with CK20, while CK7 positive for lung, endometrial, breast, ovarian, or thyroid carcinomas [25, 26]. That provide a rough diagnosis (Table 1). After that a series of highly specific staining are performed (Table 2). We cannot use a great quantity of biomarkers to test because the CUP specimens are small. In addition, IHC staining has some limitations which include subjective interpretation of results from pathologists, diversity of techniques in performing the stains [5, 27].Table 1Pathology staining provides a rough diagnosis for cancers of an unknown primary site

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