BACKGROUND:Bevacizumab in combination with carboplatin and paclitaxel improves overall response and survival in patients with advanced or recurrent nonsmall cell lung carcinoma. However, this drug is not recommended in patients with squamous cell carcinoma or neoplasms with a dominant squamous component. Therefore, identification of squamous cell differentiation has therapeutic implications. In many instances, cytology is the diagnostic tool of choice; however, routine cytomorphology is limited in classification of nonsmall cell carcinomas into squamous and nonsquamous subtypes. The aim of this study was to identify the value of p63 immunocytochemical analysis in this distinction.METHODS:Review of cytology records identified 51 consecutive pulmonary specimens (16 fine needle aspiration samples, 15 washes, 12 brushes, and 8 lavages) with the diagnosis of nonsmall cell lung carcinoma (9 carcinomas with squamous differentiation and 42 carcinomas without squamous differentiation). Histologically, they all proved to be nonsmall cell carcinomas, 26 with squamous differentiation and 25 without squamous differentiation. p63 immunocytochemical stain was performed on archival alcohol‐fixed Papanicolaou‐stained cytology slides using standard immunocytochemical methods.RESULTS:Twenty‐three (88 %) of the 26 histologically proven squamous cell carcinomas were positive for p63 on cytologic smears. By using p63 immunocytochemistry, the authors detected 14 carcinomas with squamous differentiation not identified by cytomorphology. Smears from all histologically proven carcinomas with squamous differentiation were positive for p63. Sensitivity of cytology for the detection of nonsmall cell carcinoma of lung with squamous differentiation increased from 35% to 88% using p63 immunocytochemistry (P = .001; McNemar test). The squamous component in 4 carcinomas was detected only in cytologic and not in corresponding histologic samples when subsequent p63 immunostaining was performed.CONCLUSIONS:The authors concluded that p63 is a useful marker for the detection of nonsmall cell carcinomas of lung with squamous differentiation when used in cytologic pulmonary samples. p63 immunocytochemistry significantly increases the sensitivity for the identification of lung neoplasms with squamous differentiation from 35% to 88% (P = .001). Therefore, p63 immunocytochemistry may be used in pulmonary cytologic samples of nonsmall cell carcinomas to identify squamous differentiation and to improve therapeutic selection of patients with lung cancer. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.

Objective: Leiomyosarcomas are mesenchymal tumors that very rarely present as a primary adrenal malignancy. Methods: We present the complete clinical presentation, imaging, and anatomicopathologic features of a unique case of recurrent primary adrenal leiomyosarcoma (PAL) after initial surgery. This case is accompanied by an updated literature review. Results: A 63-year-old Hispanic female referred to our clinic 4 months after having right adrenalectomy. Eight months prior to this encounter, she started to notice bilateral lower extremity edema with skin changes. Computed tomography of the abdomen revealed a large 6.8 × 4.4 cm adrenal mass that appeared to be encroaching in the inferior vena cava with hypodense areas, irregular borders, and a necrotic center. A preoperative hormonal evaluation failed to reveal evidence of a functional adrenal tumor. Microscopic examination revealed spindle cell neoplasia. Immunohistochemistry of the surgical specimen revealed positive staining for desmin, smooth muscle actin, and focal myogenin (MYF-4). S-100 protein and inhibin were negative. The diagnosis of intermediate-grade leiomyosarcoma was confirmed. Two months after surgery, surveillance positron emission tomography scan revealed another right adrenal mass measuring 5.6 × 5 cm, with a standardized uptake value of 2.1. Conclusion: PAL is excessively rare. To our knowledge, this is only the second case of PAL with documented recurrence and the 19th case reported in the current medical literature. Surgical removal of the tumor is the first step in treatment. Adjuvant therapies are still not well standardized based on the low incidence of cases.

A limited immunohistochemical panel including pan-cytokeratin, synaptophysin, and p63 discriminates HGNEC/SmCC from high-grade UC.