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Washington University Experience | NEOPLASMS (METASTASES) | Microscopic | 64B Metastasis, lung & Marked Rxn (Case 64) B1 CD68 1

64B Immunostaining for CD68 identifies the extent of histiocyte/macrophage infiltration. ---- Not shown: SMA highlights thickened disrupted vessel walls. The neoplastic cells were immunoreactive for TTF-1 and negative for thyroglobulin. ---- Comment: The findings are those of a metastatic carcinoma and the immunoprofile (reactivity for CK7 and TTF-1) is most consistent with a lung primary. Given the history of psychosis and prominent lymphatic involvement by imaging in the absence of a definitive lung mass, an immunostain for thyroglobulin was performed to evaluate for the possibility of a thyroid primary. Thyroglobulin was negative and an undetected lung tumor was favored. The patient was lost to followup.

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