Immunohistochemistry- Not As Sensitive As Expected For Detecting Bone Marrow Micrometastases In Cases Of Epithelial Malignancies?

Authors

  • Akanksha Agarwal Department of Pathology, King George’s Medical University, Lucknow, UP,India
  • Rashmi Kushwaha Department of Pathology, King George’s Medical University, Lucknow, UP,India
  • Wahid Ali Department of Pathology, King George’s Medical University, Lucknow, UP,India
  • Vijay Kumar Department of Surgical Oncology, King George’s Medical University, Lucknow, UP,India
  • Ashutosh Kumar Department of pathology, King George’s Medical University, Lucknow, UP,India

Keywords:

Bone marrow metastases, immunohistochemistry, bone marrow examination, epithelial malignancies.

Abstract

Background: Bone marrow is the most common site of metastases of epithelial malignancies from breast, lung, colon, prostate, ovaries and endometrium. These have poor prognosis as early tumor cells dissemination to bone marrow leads to poor treatment response. Bone marrow involvement by tumor cells can be seen on microscopic bone marrow examination and confirmed by immunohistochemistry. In this prospective observational study, we plan to analyze the incidence of bone marrow dissemination in epithelial malignancies and estimate the utility of immunohistochemistry in detecting micro metastases and correlate it with other clinicopathological parameters.

Methods: clinical details and complete hematological workup was done in31 new cases of epithelial malignancies during our study period of one year. Bone marrow aspiration, bone marrow biopsy and clot section were done and analyzed morphologically and immunohistochemically using CK 7 and CK 20.

Result: out of a total of 31 cases of epithelial malignancies, 2 cases of prostate carcinoma showed positive metastatic cell cluster and 2 cases of breast carcinoma and 1 case of lung carcinoma showed dispersed atypical cells in bone marrow.

Conclusion: Immunohistochemistry did not show any observed benefit than routine microscopy in diagnosing the bone marrow metastases. Small sample size and lack of ancillary techniques like polymerase chain reaction(PCR) are drawback in the diagnosis of isolated tumor cells, micro metastases and confirmation of the results obtained on immunohistochemistry. Extensive studies are required to elucidate the pathogenetic pathway and clinical implications of bone marrow metastatic cells for the diagnosis, staging and treatment of epithelial malignancies.

DOI: 10.21276/APALM.1581

References

1. Dan L. Longo. Approach to the patient with cancer. Harrison’s principles of internal medicine, edition 18; vol 1, chapter 81: 646-54.

2. Galasko CSB. Skeletal matastases. Clin Orthop1986; September; 18-30.

3. Yusuke S, Elisabeth A Pederson, Russel S Taichman. Human prostate metastases target the hemopoeitic stem cell niche to establish foot holds in mouse bone marrow. J Clin Invest 2011; 121(4):1298-1312.

4. Sloane J.P., Ormedort M.G.,Imriet S.F., Coombest R.C.. The use of antisera to apithelial membrane antigen in detecting micrometastases in histological sections. Br J. Cancer; 1980(42):329.

5. Disibigo G, French SW . Metastatic patterns of cancers: results from a large autopsy study. Arch Pathol Lab Med 2008 Jun; 132(6) :931-9.

6. Coleman RE . Clinical features of metastatic bone disease and risk of skeletal morbidity. Clin. Cancer Re. 2006 Aug; 12 (20 Pt 2): 6243–9.

7. Saadettin K, Mustafa E, Murtan D, Sercan A, Hakan H, Suayib Y. Bone marrow metastases of solid tumours: clinicopathologic evaluation of 73 cases. Turkish J of Cancer 2007; 132(4): 81-6.

8. Wang MP, Zee S, Zarbo RJ, et al. Coordinate expression of cytokeratin 7 and 20 defines unique subsets of carcinomas. Appl Immunohistochem 1995;3:99-107.

9. Brown RS, Dogan A, Ell P J, Payne HA, Masters JR, Harland SJ. The comparative values of bone marrow aspirate and trephine for obtaining bone scan targeted metastases from hormone refractory prostate cancer. Prostate cancer prostatic dis 2002; 5(2):144-51

10. Gregory R Mundy. Mechanism of bone metastases. American cancer society 1997; 80 : 1546-56.

11. Greene FL, Page DL, Fleming ID et al. AJCC Cancer Staging Manual, Sixth Edition, New York, Springer-Verlag 2002.

12. Understanding the changes from 6th to 7th edition of AJCC Cancer Staging Manual 2009.

13. Mohanty SK, Dash S. Bone marrow metastases in solid tumors. Indian J pathol microbial 2003 Oct; 46(4):613-6.

14. RA Tasleem , N D Chowdhary, S M Kadri, Q A Chowdhary. Bone marrow metastases in solid tumors: clinical evaluation of 64 cases. Indian J Pathol Microbiol 2004 July; 47(3): 449-50.

15. Pauline A, Dimitra G. Bone marrow micro metastases in different solid tumours: pathogenesis and importance Surg Oncol 2008; 17(3): 153-64.

16. Singh M, MM Goel et al. Detection of bone marrow metastases in prostate cancer: Role of trephine biopsy and Immunohistochemistry. Clin Can Inv J. 2013;2(4):319-324.

17. BJ Bain. Bone marrow aspiration. J Clin Path. 2001; 54:657-663.

18. Bone marrow Pathology. BJ Bain, DM Clark, BS Wilkins.2010 edt.

19. S.H.Lee, W.N. Erber, A. Porwit, et al. ICSH guidelines for the standardization of bone marrow specimens and reports. Intl J Lab Hemat. 2008; 30:349-364.

20. KN Naresh, I Lampert, R Hasserjian, et al. Optimal processing of bone marrow trephine biopsy: the Hammersmith Protocol. J Clin Path. 2006; 59:903-11.

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Published

27-01-2018

How to Cite

1.
Agarwal A, Kushwaha R, Ali W, Kumar V, Kumar A. Immunohistochemistry- Not As Sensitive As Expected For Detecting Bone Marrow Micrometastases In Cases Of Epithelial Malignancies?. Ann of Pathol and Lab Med [Internet]. 2018 Jan. 27 [cited 2024 Oct. 30];5(1):A28-33. Available from: https://pacificejournals.com/journal/index.php/apalm/article/view/apalm1581

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