PMC8632144_01
Pathological and 90-gene expression assay results of case 1. (A) The pathological diagnosis of the resected specimens was squamous cell carcinoma. Immunohistochemistry staining: P40 (-), Ki67 (90%+), TTF1 (-), CK7 (-), P16 (-). (B) The 90-gene expression assay showed that the similarity score of the right lung mass coming from the lung tissue is 89.6.
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A lung biopsy was performed by an outside provider under the guidance of CT, and the pathological findings ( Figure 1A ) were consistent with the previous conclusion of squamous cell carcinoma. Figure 1B ) indicated that the right lung mass was primary lung cancer. Finally, the patient was diagnosed with primary bronchial lung cancer, right lower lobe squamous cell carcinoma and underwent video-assisted thoracic surgery (VATS) radical resection of the right lower lobe cancer under general anesthesia on April 30, 2019 (pT2aN0M0, stage IB).
PMC8632144_02
Pathological and 90-gene expression assay results of case 2. (A) The pathological results showed diffuse proliferation of spindle cells, atypical epithelioid cells in a sheet-like distribution, and necrosis and bone formation were seen. Immunohistochemical staining confirmed CK, LCK, Hep (focally), Urop3 nucleus as positive. (B) The 90-gene expression assay indicated that there is a 74.6 similarity score of metastatic renal cancer on the right side of the bone.
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After examining the pathological section ( Figure 2A ), we considered it to be a poorly differentiated metastatic malignant tumor. To further identify the primary site, the 90-gene expression assay was performed on the biopsy tissue of the right iliac bone and the test results indicated that the right iliac bone had metastatic kidney cancer ( Figure 2B ).
PMC8632144_03
Pathological and 90-gene expression assay results of case 3. (A) The pathological diagnosis of the resected specimens was metastatic poorly differentiated carcinoma. Immunohistochemistry staining: CK-pan, Ki-67, P63, P40 were positive respectively. (B) The 90-gene expression assay indicated that the similarity score of bone biopsy tissue is head and neck tumor metastasis was 64.1.
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The histopathological findings ( Figure 3A ) demonstrated metastatic poorly differentiated carcinoma. To further clarify the primary tumor, the 90-gene expression assay was performed on the sacral biopsy tissue, and the test results indicated that the sacral biopsy tissue was head and neck tumor metastasis ( Figure 3B ).
PMC8632144_04
Pathological, 90-gene expression assay and cytology results of case 4. (A) The pathological diagnosis of the resected specimens was malignant tumors which tend to be metastatic poorly differentiated. Immunohistochemistry staining: CK (+++), CK7 (-), CK20 (-), Villin (-), TTF1 (-), SATB-2 (+), MelanA (+/-), NapsinA (-), P40 (-), CR (-), CK5/6 (-), CDX-2 (-), S-100 (-), Des (-), SOX-10 (-), HMB45 (-). (B) The 90-gene expression assay indicated that the similarity score of metastatic renal cancer and liver cancer on the left cervical lymph node was 58.9 and 17.4, respectively. (C) The cytology results showed cancer cells in the kidney puncture smear.
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The postoperative examination revealed a malignant tumor in the left neck, and poorly differentiated squamous cell carcinoma was considered ( Figure 4A ). To further clarify the source of the tumor, the 90-gene expression assay was performed, and the results suggested that the tumors on the left cervical lymph node maybe a metastasis from kidney tumors ( Figure 4B ). The cytological results showed cancer cells in the kidney puncture smear ( Figure 4C ), but no clear malignant tumor was found in the pathological section.