AboutNeha Dahiya MD Expertise I can help patients understand their lab report results, help them with queries regarding what pretest preparation is required. How often a follow up test needs to be done. What does a particular tissue biopsy report mean in everyday English. I can explain the biopsy or cytology procedure. I can deal with Histopathology / cytology / clinical pathology and clinical chemistry queries. Helping in this manner will be my contribution to the community.
Experience I am a pathologist and director of clinical laboratory services. I have been a practicing pathologist for last 9 years in a 350 bed multi specialty hospital laboratory.
Organizations Indian association of pathologists and microbiologists.
MIAC - Member International Academy of Cytology
International association of Pathologists - indian division
Indian association of Cytology
Question My father was just diagnosed with pancreatic adenocarcinoma with lung metastasis, and I am concerned that the cancer origin is wrong. He presented a few weeks ago with severe jaundice without pain. CT scan noted a enlarged bile duct, and some lung masses. A endoscopic procedure confirmed a bile-duct stricture, and a brushing biopsy was taken. It came back normal. A second endoscopic procedure was done to explore the pancreas via ultrasound, and they found a very small lesion, so small they couldn't biopsy it. In the lung there is one mass that is larger than the others, with irregular edges. The other nodules are small and regular shape. They did a fine needle biopsy of the larger mass, and determined immediately that the cells were abnormal. The lab report reads: "Malignant cells were positive for CK7, and rare cells showed cytoplasmic positivity with TTF-1. However, no nuclear staining was noted. Malignant cells were negative for CK20." I read in another forum that TTF-1 positivity indicated Lung cancer, but I haven't been able to find any info on cytoplasmic vs. nucleic positivity. I just don't understand how the pancreas can be the origin when there doesn't seem to be a substantial mass/lesion. Please shed some light on the subject. My parents are the type that will go along with whatever the doctor says without seeking a second opinion. I know that even the BEST doctors sometimes make mistakes, and I want to feel confident in this diagnosis before we decide on treatment. Thank you in advance for your time.
Answer Hello Heather:
CK7 positive and CK 20 negative cells favor lung cancer.
TTF 1 helps differentiate between primary lung cancer and cancer metastatic to lung.
you mention that the report indicates rare cells show TTF1 positivity. This could be non specific....there should be much more cells positive to indicate lung cancer.
There can be a primary cancer even if it is a minute lesion. However I am not sure if the report specifically mentioned pancreas as the primary. you may discuss this with the pathologist who reviewed the slides.
