Metastatic Tumors

Most metastatic tumors are adenocarcinomas with both histologic and cytologic features dependent on their site of origin. The more common primary sites include breast, lung, prostate, kidney, and thyroid (Figs. 25 and 26). Less likely candidates in the adult include small cell carcinoma of the lung, transitional cell carcinoma, and gynecologic carcinomas. A variety of epithelial immunohistochemical markers are now available which can help identify the site of origin for many of these tumors. This is particularly helpful if the tumor is poorly differentiated, thus limiting classification by histologic examination alone. In the pediatric population, the possibility of a metastatic neuroblastoma or rhabdomyosarcoma needs to be considered and

FIGURE 25 Metastatic follicular thyroid carcinoma. Metastatic well-differentiated follicular thyroid carcinoma is easily identified within this needle core biopsy of a vertebral mass (hematoxylin and eosin, original magnification x 10).
FIGURE 26 Metastatic renal cell carcinoma, clear cell type. This needle core biopsy demonstrates metastatic renal cell carcinoma. The clear cytoplasm of the tumor cells is typical of this neoplasm (hematoxylin and eosin, original magnification x 10).

added to the differential list of small round blue cell tumors (27). A detailed clinical history is beneficial not only for diagnosis but also invaluable when selecting a panel of relevant immu-nohistochemical stains when working up a particular case.

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