title: Selective immunohistochemical markers to distinguish between metastatic high-grade urothelial carcinoma and primary poorly differentiated invasive squamous cell carcinoma of the lung.
abstract: BACKGROUND
  Distinction between primary lung carcinomas and metastases from other sites, especially the urinary tract, is a common diagnostic dilemma. As urothelial carcinomas can demonstrate a broad range of morphology and frequently demonstrate squamous differentiation, discerning metastatic urothelial carcinoma to the lung from primary pulmonary squamous cell carcinoma can be challenging.
  
  
  OBJECTIVE
  To investigate immunostains that may aid in the distinction of urothelial carcinoma metastatic to the lung.
  
  
  METHODS
  Staining patterns of 14 markers in primary urothelial carcinoma of the bladder and primary squamous cell carcinoma of the lung were examined to establish a diagnostic panel. These antibodies were subsequently tested on tumors taken from 30 patients with a paired urinary tract and metastatic lung lesion.
  
  
  RESULTS
  The best markers to distinguish poorly differentiated metastatic urothelial carcinoma from primary pulmonary squamous cell carcinoma were CK7, CK20, GATA-3, CK14, desmoglein-3, and uroplakin III, with the utility of the latter dependent upon the quantity of tissue available for analysis. The observed percentage positive staining in nonmetastatic urothelial carcinoma versus primary pulmonary squamous cell carcinoma with these antibodies was as follows: CK7 (100% versus 33%), CK20 (54% versus 7%), GATA-3 (78% versus 23%), CK14 (32% versus 77%), desmoglein-3 (11% versus 87%), and uroplakin III (14% versus 0%). Similar expression patterns were observed among the paired cases.
  
  
  CONCLUSIONS
  When interpreted in correlation with clinical history and histomorphology, a panel of immunostains including CK7, CK20, GATA-3, CK14, desmoglein-3, and uroplakin III may be a useful adjunct in the distinction of metastatic urothelial carcinoma to the lung.
authors.affiliation: Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Ave, Desk L25, Cleveland, OH 44195, USA.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Gruver
authors.forename: Mahul B
authors.initials: MB
authors.lastname: Amin
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Luthringer
authors.forename: Danielle
authors.initials: D
authors.lastname: Westfall
authors.forename: Komal
authors.initials: K
authors.lastname: Arora
authors.forename: Carol F
authors.initials: CF
authors.lastname: Farver
authors.forename: Adeboye O
authors.initials: AO
authors.lastname: Osunkoya
authors.forename: Jesse K
authors.initials: JK
authors.lastname: McKenney
authors.forename: Donna E
authors.initials: DE
authors.lastname: Hansel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000378:metabolism*; D002454:Cell Differentiation; D051184:Desmoglein 3 / Q000378:metabolism; D003937:Diagnosis, Differential; D005260:Female; D050990:GATA3 Transcription Factor / Q000378:metabolism; D006801:Humans; D007150:Immunohistochemistry; D053547:Keratin-14 / Q000378:metabolism; D053554:Keratin-20 / Q000378:metabolism; D053552:Keratin-7 / Q000378:metabolism; D008175:Lung Neoplasms / Q000175:diagnosis / Q000378:metabolism* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000378:metabolism; D060171:Uroplakin III / Q000378:metabolism
chemical_list: D014408:Biomarkers, Tumor; C071894:DSG3 protein, human; D051184:Desmoglein 3; D050990:GATA3 Transcription Factor; C494749:GATA3 protein, human; D053547:Keratin-14; D053554:Keratin-20; D053552:Keratin-7; C554660:UPK3A protein, human; D060171:Uroplakin III