Bronchogenic adenocarcinoma and pulmonary embolism
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Liver core biopsies: metastatic carcinoma consistent with poorly differentiated adenocarcinoma.
Sections show extensive infiltration of the liver lobules by nests of malignant cells. While some nuclei have powdery chromatin, many have prominent nucleoli. Atypia is moderate to severe. No glandular architecture is noted. On immunohistochemistry, the tumor is strongly positive for low molecular weight keratin and cytokeratin 7. It is negative for the lung marker TTF-1, neuroendocrine markers CD 56, chromogranin and synaptophysin, squamous cell markers p63, cytokeratin 5 and high molecular weight keratin, and for PSA and the liver marker Hep-R1. This case has been discussed at Intradepartmental Rounds and the consensus opinion is that it is a poorly differentiated adenocarcinoma. The site of origin can not accurately be determined: the absence of TTF-1 staining does not rule out a lung primary, but other CK 7 positive/CK 20 negative sites such as stomach, esophagus, pancreas and bile duct could be considered clinically.
NB No abdominal primary identified.