Esthesioneuroblastoma differential diagnosis: Difference between revisions

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==Overview==
==Overview==
Esthesioneuroblastoma must be differentiated from olfactory neuroepithelioma, olfactory groove meningioma/haemangiopericytoma, sinonasal carcinoma, rhabdomyosarcoma, melanoma metastases, lymphoma, chordoma, juvenile nasopharyngeal angiofibroma, and pituitary macroadenoma.
Esthesioneuroblastoma must be differentiated from olfactory neuroepithelioma, olfactory groove meningioma/haemangiopericytoma, sinonasal carcinoma, rhabdomyosarcoma, melanoma metastases, lymphoma, chordoma, juvenile nasopharyngeal angiofibroma, and pituitary macroadenoma.
 
Esthesioneuroblastoma must be differentiated from other tumors with similar histological appearance, such as lymphoma, Ewing sarcoma, melanoma, olfactory/ other [rhabdomyosarcoma or Merkel cell carcinoma], neuroblastoma, and small cell carcinoma.
==Differential Diagnosis==
==Differential Diagnosis==
 
Distinguishing esthesioneuroblastomas from the other tumors is of paramount importance because the tumors respond differently to various treatment modalities.
Further confounding accurate diagnosis is the fact that ENB is histologically similar to other small, round blue cell tumors. The acronym LEMONS ( lymphoma, Ewing sarcoma, melanoma, olfactory/ other [ENBs, rhabdomyosarcoma or Markel cell carcinoma], neuroblastoma, and small cell carcinoma) defines the other tumors from which ENB should be differentiated. Distinguishing ENBs from the other tumors is of paramount importance because the tumors respond differently to various treatment modalities.
 
The following list describes the outcome of each of these diseases with various immunohistochemical tests.
The following list describes the outcome of each of these diseases with various immunohistochemical tests.
Esthesioneuroblastomas stain positive for S-100 protein and/or neuron-specific enolase, while the stain usually is negative for cytokeratin, desmin, vimentin, actin, glial fibrillary acidic protein, UMB 45, and the common leukocytic antigen. For difficult cases, electron microscopy can be useful. Common features are small, round neuroepithelial cells arranged in rosette or pseudorosette patterns, separated by fibrous elements. Rosettes consist of a central space ringed by columnar cells with radially oriented nuclei.
Lymphoma can be excluded when the majority of tumor cells are negative for CD45 (the remaining positive cells demonstrate no atypical immunophenotype).
Ewing sarcoma is positive for MIC2/CD99 gene products that result from an 11;22 translocation. [13]
Melanoma can be identified using a combination of immunohistochemical markers: MART-1/Melan-A, HMB-45, and S-100. S-100 is expressed in more than 95% of melanomas.
Rhabdomyosarcoma displays a loss of chromosome 11 and stains positive for desmin (expressed in 95%), muscle-specific actin, and myoglobin.
Markel cell carcinoma stains positively for low-molecular-weight cytokeratin 20 and NSE.
Neuroblastoma often stains positive for NSE, synaptophysin, Leu7, and neurofilament protein. Elevated serum catecholamines are also suggestive of neuroblastoma.
Small cell carcinomas stain positively for chromogranin, NSE, and synaptophysin (presynaptic nerve cell vesicles). Most small cell carcinomas are positive for TTF-1.
The differential diagnosis of esthesioneuroblastoma includes the following:
The differential diagnosis of esthesioneuroblastoma includes the following:
*Olfactory neuroepithelioma
*Olfactory neuroepithelioma
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*Juvenile nasopharyngeal angiofibroma
*Juvenile nasopharyngeal angiofibroma
*Pituitary macroadenoma
*Pituitary macroadenoma
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! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Disease}}
! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Immunohistochemical Tests}}
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:Esthesioneuroblastoma
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*Esthesioneuroblastomas stain positive for neuron-specific enolase and/or S-100 protein,
*While the stain usually is negative for desmin, cytokeratin, vimentin, actin, glial fibrillary acidic protein, UMB 45, and the common leukocytic antigen.
*For difficult cases, electron microscopy can be useful.
*Common features are small, round neuroepithelial cells arranged in rosette or pseudorosette patterns, separated by fibrous elements. Rosettes consist of a central space ringed by columnar cells with radially oriented nuclei.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Lymphoma
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*Lymphoma can be excluded when the majority of tumor cells are negative for CD45 (the remaining positive cells demonstrate no atypical immunophenotype).
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Ewing sarcoma
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*Ewing sarcoma is positive for MIC2/CD99 gene products that result from an 11;22 translocation
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Melanoma
| style="padding: 5px 5px; background: #F5F5F5;" |
*Melanoma can be identified using a combination of immunohistochemical markers: HMB-45, MART-1/Melan-A, and S-100.
*S-100 is expressed in more than 95% of melanomas.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Rhabdomyosarcoma
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*Rhabdomyosarcoma displays a loss of chromosome 11 and stains positive for desmin (expressed in 95%), muscle-specific actin, and myoglobin.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Merkel cell carcinoma
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*Markel cell carcinoma stains positively for low-molecular-weight cytokeratin 20 and NSE.
|-
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:Neuroblastoma
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*Neuroblastoma often stains positive for NSE, synaptophysin, Leu7, and neurofilament protein.
*Elevated serum catecholamines are also suggestive of neuroblastoma.
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Small cell carcinomas
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*Small cell carcinomas stain positively for chromogranin, NSE, and synaptophysin (presynaptic nerve cell vesicles). Most small cell carcinomas are positive for TTF-1.
|-
|}


==References==
==References==

Revision as of 15:02, 26 January 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

Esthesioneuroblastoma must be differentiated from olfactory neuroepithelioma, olfactory groove meningioma/haemangiopericytoma, sinonasal carcinoma, rhabdomyosarcoma, melanoma metastases, lymphoma, chordoma, juvenile nasopharyngeal angiofibroma, and pituitary macroadenoma. Esthesioneuroblastoma must be differentiated from other tumors with similar histological appearance, such as lymphoma, Ewing sarcoma, melanoma, olfactory/ other [rhabdomyosarcoma or Merkel cell carcinoma], neuroblastoma, and small cell carcinoma.

Differential Diagnosis

Distinguishing esthesioneuroblastomas from the other tumors is of paramount importance because the tumors respond differently to various treatment modalities. The following list describes the outcome of each of these diseases with various immunohistochemical tests. The differential diagnosis of esthesioneuroblastoma includes the following:

  • Olfactory neuroepithelioma
  • Olfactory groove meningioma/haemangiopericytoma
  • Sinonasal carcinoma (including SCC, minor salivary gland adenocarcinoma)
  • Rhabdomyosarcoma
  • Melanoma metastases
  • Lymphoma
  • Chordoma
  • Juvenile nasopharyngeal angiofibroma
  • Pituitary macroadenoma
Disease Immunohistochemical Tests
Esthesioneuroblastoma
  • Esthesioneuroblastomas stain positive for neuron-specific enolase and/or S-100 protein,
  • While the stain usually is negative for desmin, cytokeratin, vimentin, actin, glial fibrillary acidic protein, UMB 45, and the common leukocytic antigen.
  • For difficult cases, electron microscopy can be useful.
  • Common features are small, round neuroepithelial cells arranged in rosette or pseudorosette patterns, separated by fibrous elements. Rosettes consist of a central space ringed by columnar cells with radially oriented nuclei.
Lymphoma
  • Lymphoma can be excluded when the majority of tumor cells are negative for CD45 (the remaining positive cells demonstrate no atypical immunophenotype).
Ewing sarcoma
  • Ewing sarcoma is positive for MIC2/CD99 gene products that result from an 11;22 translocation
Melanoma
  • Melanoma can be identified using a combination of immunohistochemical markers: HMB-45, MART-1/Melan-A, and S-100.
  • S-100 is expressed in more than 95% of melanomas.
Rhabdomyosarcoma
  • Rhabdomyosarcoma displays a loss of chromosome 11 and stains positive for desmin (expressed in 95%), muscle-specific actin, and myoglobin.
Merkel cell carcinoma
  • Markel cell carcinoma stains positively for low-molecular-weight cytokeratin 20 and NSE.
Neuroblastoma
  • Neuroblastoma often stains positive for NSE, synaptophysin, Leu7, and neurofilament protein.
  • Elevated serum catecholamines are also suggestive of neuroblastoma.
Small cell carcinomas
  • Small cell carcinomas stain positively for chromogranin, NSE, and synaptophysin (presynaptic nerve cell vesicles). Most small cell carcinomas are positive for TTF-1.




References

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