Template:Cytology, tumors, evaluation of suspected malignancies, immunohistochemistry, consultation and reporting
Contents
- 1 Cytology introduction
- 2 Tumors, introduction
- 3 Evaluation of suspected malignancies
- 4 Metastasis
- 5 Immunohistochemistry
- 6 Consultation
- 7 Reporting
Cytology introduction
Overall evaluation
In addition to a general evaluation, also evaluate the following in cytology samples, or any sample with scattered cells rather than coherent tissue:
- Consider looking for any additional concurrent samples from the same patient, especially excisions, as usually correlate.
- Adequacy of specimen. Cells may be too few or too obscured by other material to make a proper diagnosis.
- Background, mainly if it is clear or dirty
- Overall cellularity
- Artifacts
Smearing of cells across a glass plate may cause smearing artifacts, such as the nuclear smearing of this monocyte, shown as tail-like extension of nuclear material.
Tumors, introduction
Gross processing
Gross tumors according to organ and/or tumor type (as per above) whenever possible. In additional to general gross processing guidelines, the following instructions are usually acceptable:
- Identify surgical margins where tumor involvement may be necessary to identify or negate.
- Generally ink such margins.
- Section the specimen so as to get a gross overview of tumor extent.
- (Take a gross photograph of the tumor.)
- Describe the tumor, minimally by color and consistency (firm/rubbery versus semisolid), and possibly also including diffuse versus well-demarcated.
- Measure tumor dimensions and distances to relevant margins.
- Sampling of generally at least one slice per centimeter of tumor (which for larger tumors may be submitted as 2-3 sections per cassette).
Further information: Gross processing
By gross appearance
Evaluation
The most important aspects of a tumor is whether it is malignant or not, and staging.
Evaluation of suspected malignancies
For evaluation of suspected malignancies such as tumors, the most important aspect is whether it is benign or malignant. If malignant, then staging is necessary.[3] There are generally specific criteria for various forms of tumors, which should be used whenever applicable, but following are some generalizations.
A general approach is to start looking at a slide which seems to contain non-necrotic tumor, and if possible it should also show surrounding non-tumor tissue, so that the interface can be appreciated (and tumors are generally less necrotic at the periphery).
Benign or malignant
Benign[4] | Malignant[4] | |
---|---|---|
Gross examination |
|
Possibly:
|
Microscopy | Almost no irregularities of cellular structures | Nuclear atypia:
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Primary tumor versus metastasis

Indications of a metastasis rather than primary tumor are mainly:
- Tumors that are unlikely to arise at the location at hand.
- Tumors conforming to more likely metastasis pathways.
If a suspected malignancy is present, generally check the patient history for any history of cancer, especially for tumors in more common metastasis sites, which mainly include lung, bone, liver and/or brain. In case of such history, preferably look at the microscopy slides of the past cancer to help determining whether the current case is of the same origin, versus a primary at the current body location, versus a metastasis of yet another location. If there is no known history of cancer, still consider a metastasis of unknown primary origin, especially for suspected malignancies in lymph nodes, liver, lungs, bones, or skin.[6]
Further information: Metastasis
Histopathologic type
For specific diagnoses by organ system, see anatomic diagram on Patholines Main page. This resource will give the main steps towards reaching a diagnosis, but before making a tumor diagnosis, generally be sure that it fulfills the criteria of the condition according to The WHO Classification of tumors, and generally consult an experienced pathologist as well until you feel confident.
Visually, tumors and other suspected malignancies can usually be classified into one of the following groups:
Squamoid tumors, typically having abundant eosinophilic cytoplasm.[7]
- Histopathology of an ovarian fibroma.jpg
Spindle-cell tumors, with elongated cells and/or nuclei
Further pinpointing of a specific tumor type is often attained by thinking of one or more possible diagnoses, and looking up their differential diagnoses, followed by comparing their microscopic descriptions and multiple micrographs with the case at hand. When two or more diagnoses seem to fit with the case at hand, consider performing immunohistochemistry. Find relevant target proteins that are expected to stain substantially differently between the possible diagnoses. If it's not evident from initial sources, you may use Immunoquery.com which will generally suggest the most relevant target proteins to distinguish the suspected conditions at hand.
Gland-like tumors
Gland-like tumors are mainly evaluated for cellular atypia, architectural dysplasia and invasion, and thereby classified into the following main categories:
- Hyperplastic lesions, lacking significant atypia
- Adenomas, which can range from mild to high-grade dysplastic, yet are generally confined within their anatomic layers, that is, they are not invasive.
- Adenocarcinomas, with the main criterion being invasiveness. Evaluate specifically by location when possible. Some specific locations included in this resource:
Squamoid tumors
These are more or less looking like a squamous-cell carcinoma:
Differential diagnoses depend on location, such as:
- Squamous-cell carcinoma of the skin, with multiple differential diagnoses
- Squamous-cell carcinoma of the lung
- Urinary bladder: Urothelial versus squamous-cell carcinoma
- Cervix uteri: Cervical dysplasia
Spindle-cell tumors
For Spindle-cell tumors, the shape of the nuclei is a clue to the diagnosis, with the following tendency:
- Pointed on both ends: True fibroblastic tumors
- Pointed on one end and blunted on the other ("bullet-shaped"): Neural
- Blunted on both ends ("cigar-shaped"): Smooth muscle
- Triangular: Myofibroblastic
Evaluate specifically by location when possible
Further histopathologic subtyping and grading
Beyond determining overall malignancy diagnosis (such as adenocarcinoma), probable origin and staging, classification of tumors into a specific histopathologic type or grade is generally of relatively less value. In cases of clearly non-malignant tumors where it is difficult to determine the specific histopathologic type or grade, it is generally acceptable to conclude the evaluation and report it as such, unless the clinician specifically requests otherwise. For potentially malignant or high-risk tumors, typing and grading often still affects the management.
Undifferentiated tumor
An initial panel of cytokeratin (CK), S100, vimentin and LCA (CD45) can be used (see source article for subsequent work-up).[8]
Non-neoplastic
If a neoplasm has been ruled out for what clinically appeared like a tumor, seek a diagnosis that can be consistent with the clinical findings that caused the suspicion. If no explanation is found on the slides, generally take additional levels on the paraffin block, or more sections from any leftover tissue.
For example, for a breast biopsy of what appeared to look like a mass, and there is no neoplasia, look mainly for dense fibrosis or other fibrous changes, so that you can report it and thereby explain the finding, rather than merely writing "benign breast tissue".
Heterogeneity
After having characterized a suspected malignancy, still screen through it for any significant areas that are different and may need own mentioning, or even change the overall type or grade.
Additional levels or slices
Situations requiring additional material include mainly where tumor is expected but nevertheless not seen on existing slides. Such cases include:
- The gross report or other observation describes a tumor or polyp, but none is seen on microscopy.
- Re-excision does not identify tumor cells in a clearly non-radical primary excision or biopsy.
Also consider more material if the most aggressive pattern is seen in the last available section, in which case more sections are indicated (from the same paraffin block if additional tissue is not available).
Depending on availability and greatest suspicion, additional material is either acquired by taking addition step sections of remaining tissue in a paraffin block, or taking additional slices from the original specimen.
Staging
Staging is generally done by TNM classification. Specific TNM systems should be used whenever applicable, mainly the manual by the American Joint Committee on Cancer (AJCC) if you can access it. Further information: Secrets Otherwise, a general system may be used:[3]
T: size or direct extent of the primary tumor
N: degree of spread to regional lymph nodes
M: presence of distant metastasis Further information: Metastasis
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Put your main focus on features that will determine the final stage. For example, if you see a lymph node involved by cancer, the presence or absence of lymphatic invasion is no longer critical, but rather the presence or absence of additional involved nodes or distant metastasis.
For the size, the greatest dimension of the tumor is most important. Second and third dimensions (preferably at right angles compared to each other) are optional. Use the largest measure for each dimension. For example if one slide shows a tumor measuring 2.0 x 1.0 cm, and another slide shows the same tumor measuring 1.5 x 1.5 cm, then the tumor can be reported as measuring 2.0 x 1.5 cm. The third dimension can be estimated from gross measurement, or, if the tumor is entirely submitted, adding together the presumed thickness of each slice where tumor is found microscopically.
Nx: lymph nodes cannot be assessed also applies when you only find lymph nodes that are not within the physiologic drainage path of the cancer, and they are benign.
Radicality

Determine if malignant cells are located close to, or even in, any surgical resection margins.
Lymphovascular invasion
Lymphovascular invasion should always be mentioned. When present at margins, it does not count as tumor extension.
Molecular workup
Send samples according to requirements and guidelines for each test. For molecular proliferation tests (other than immunohistochemistry) such as Ki67, avoid samples with previous biopsy site or inflammation (as these will cause a false high proliferation rate).
Reporting
For cancers, generally include a synoptic report, such as per College of American Pathologists (CAP) protocols at cap.org/protocols-and-guidelines. If there is no CAP synoptic available for the cancer type at hand, attempt to find one in the latest AJCC Cancer Staging Manual (see the Secrets article), but make sure to use pathologic staging (with a p preceding the T, N or M) rather than clinical staging.
If a surgery produces a specimen with cancer, as well as re-excisions from certain directions, you should preferably give the closest distance to margins in each specimen, as well as the closest distance overall in a synoptic, for example:
A. (Specimen with most of the cancer)
B. (Re-excision in the direction of the medial margin)
Synoptic report
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If possible, generally include features of any previous biopsies or smaller excisions in synoptic reports and staging. For example, if staging is based on tumor size, and the tumor size in a previous excisional biopsy corresponds to a higher stage than the size of residual tumor in a subsequent wider excision, then the report of the latter should give the higher stage, with a comment thereof, such as:
- pT__
- - Based on previous excisional biopsy (specimen ID: ______)
See also: General notes on reporting
Metastasis
Metastasis of unknown primary
Histopathologic type - see section below for descriptions[9] |
Relative incidence among metastases of unknown primary origin[9] |
Well and poorly differentiated adenocarcinomas | 50% |
Undifferentiated carcinoma | 30% |
Squamous cell carcinoma | 15% |
Undifferentiated neoplasms | 5% |
- Memorization-worthy:[note 1] Do not diagnose a renal cell carcinoma metastasis without radiologic evidence of a renal tumor. To be a plausible primary tumor for a renal cell carcinoma metastasis, a renal tumor should be visible radiologically. In cases of suspected renal cell carcinoma but no renal imaging is available, it is reasonable to ask the ordering doctor to allow you to wait with signing out the pathology report until renal radiology has been performed.
CK7 and CK20 in carcinomas of unknown primary site (CUPs)
CK7 and CK20 can give a broad indication of the primary site. Still use more specific immunohistochemistry stains instead or in addition where applicable.
CK20 | |||
---|---|---|---|
Positive | Negative | ||
CK7 | Positive |
|
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Negative |
|
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Immunohistochemistry
When learning pathology, the percentages by which immunohistochemistry (IHC) results are positive or negative for various diseases are generally easily looked up when needed, so what a pathologist needs to learn is mainly how to select the optimal immunohistochemistry panels in the first place for various presentations where the diagnosis is unknown.
Immunohistochemistry ordering
The main approaches to immunohistochemistry ordering are:
- If there is insufficient tissue left for immunohistochemistry after standard (usually H&E) staining, you can potentially ask a histotechnologist to destain a glass slide and subsequently perform IHC on that slide.
- Look for a specified panel for the presentation at hand. For example, for an undifferentiated tumor with no clear lineage differentiation, an initial panel of cytokeratin (CK), S100, vimentin and LCA (CD45) can be used.[8]
- Coming up with the most relevant differential diagnoses for the case at hand, and find the immunohistochemistry stains that best distinguish them. Immunohistochemistry profiles for diseases and conditions, as well as their main differential diagnoses, is generally found at Pathology Outlines, or you can pay for a subscription to ImmunoQuery[note 2]:
Using Immunoquery
The main page of ImmunoQuery gives you the "Diagnoses" option, where you enter up to 3 differential diagnoses to generate the optimal immunohistochemistry panel to differentiate them (you may need to click ∨ Suggested Panel to show it if it is collapsed). It also displays an automatic message when the included antibodies/immunostains are not sufficient for a satisfactory panel, in which case you can:
- Make a specific search only including the two conditions where suggested immunostains were insufficient, if you had previously compared 3 diagnoses.
- Consider additional stains from the "Comprehensive panel" displayed below the suggested one.
- Switch the "Sensitivity" setting (seen at top) from 1 (which means that diffuse, focal as well as not specified staining count as positive) to 3 (which means that only diffuse staining counts as positive whereas both focal and absent staining count as negative, and references without any specified staining pattern are omitted from the analysis). This has less data to support the suggested stains (since many references do not specify whether positivity was diffuse or focal), but can sometimes state a better distinction between conditions. When including a stain based on its distinguishing features on a sensitivity setting of 3, you need to keep the practice of classifying only diffuse staining counts as positive, and focal to absent staining as negative.
Test question
The attending gives you a lung biopsy case to preview. You are first uncertain about the type of tumor, so you ask a fellow resident, who finds a diagnostic area of the tumor and tells you that this is a typical squamous cell carcinoma. You also look through the patient's history, and find that the patient has had a squamous cell carcinoma of the anus in the past, and you now want to find out whether the tumor originated in the lung, or if it is a metastasis from the anus, or possibly the skin. You therefore do an ImmunoQuery lookup, with the following results:
Insufficient antibodies for a satisfactory panel to differentiate Lung squamous cell carcinoma and Anus squamous cell carcinoma
You go talk with the attending, who agrees that EpCAM, GATA3 and p16 should be in the panel, but just as ImmunoQuery also tells, the attending thinks that the panel is not satisfactory to differentiate lung SCC from anus SCC, and wants you to add one more stain to improve the panel. You go back to ImmunoQuery and increase the Sensitivity from 1 to 3 (which means that only diffuse staining counts as positive whereas both focal and absent staining count as negative, and references without any specified staining pattern are omitted from the analysis), and get the following results:
You also perform a repeated search by only entering Lung and Anus SCC, and you get the following results:
Top results:
You switch sensitivity from 1 to 3 for this result as well, showing:
No antibodies to differentiate Lung squamous cell carcinoma and Anus squamous cell carcinoma
Top result:
You go talk with a technician at the histology lab, and your hospital offers all the stains in the alternatives, at similar costs, so you don't have to think about expenses and logistics of sending the case out to external labs. In addition to EpCAM, GATA3 and p16, what is the best alternative, given the information you retrieved above, to differentiate lung versus anus squamous cell carcinoma?
GRPR is the top result when specifically comparing lung versus anus squamous cell carcinoma, both at sensitivity settings 1 and 3, with no major difference between them, and thus anus origin is favored in case of either diffuse or focal cytoplasmic staining. DLK showed as N/A for anus SCC. |
Chromogen color
Request a red rather than brown chromogen in heavily pigmented lesions, such as in some melanomas.
Evaluation
First be familiar with which cells on the slide are being evaluated, such as first looking at a slide with standard staining (usually H&E) to avoid counting background cells.
Interpretation
The main methods for interpreting immunohistochemistry results are:
- Looking up each differential diagnosis at for example Pathology Outlines and comparing their expected staining to see which entity is most likely.
- Paying for a subscription to ImmunoQuery,[note 2] where you can enter immunohistochemistry results and generate a list of most likely conditions with that profile.
Preferably, immunohistochemistry results will be very specific or sensitive for a suspected condition, thereby confirming it if positive, or excluding it if negative, respectively. Even when that is not the case, immunohistochemistry can at least alter the likelihoods of different differential diagnoses. In practice, clinicians or pathologists do not state exact or even approximate numbers of likelihoods of differential diagnoses (Further information: Reporting see the Reporting chapter for phrasing uncertainty), since reality is too complex for that, but to demonstrate the general principle of how immunohistochemistry results can be calculated, the following formula can be used:
- Gross likelihood of a disease/condition = (Pre-test probability) x (Probability that the condition shows the immunohistochemistry results at hand).
The pre-test probability is a product of for example the incidence of the condition in the patient's epidemiologic type such as age and sex, as well as the probability that the condition would have caused the clinical course, including signs and symptoms, as well as the microscopic impression. For example, if you want to differentiate a pleomorphic liposarcoma from a pleomorphic rhabdomyosarcoma in soft tissue, you may find in ImmunoQuery that the following stains are most efficient in distinguishing the two, with the following percentages of being positive:
Soft tissue pleomorphic liposarcoma | Soft tissue pleomorphic rhabdomyosarcoma | |
Desmin | 17% | 95% |
Actin HHF-35 | 0% | 71% |
Let's say for example that your pre-test probability was about 30% for pleomorphic liposarcoma and 70% for pleomorphic rhabdomyosarcoma, that desmin stains positive, and actin HHF-35 stains negative in this case. Assuming that 0% positive rate means that 100% stain negative, the probability that pleomorphic liposarcoma shows these immunohistochemistry results at hand is:
- 17% x 100% = 17%
The gross likelihood of pleomorphic liposarcoma therefore becomes:
- 30% x 17% = 5.1%
In the same way, the corresponding gross likelihood of pleomorphic rhabdomyosarcoma is calculated as:
- 70% x 95% x (100% - 71%) = 19%
As a result in this case, immunohistochemistry resulted in pleomorphic rhabdomyosarcoma going from about twice as likely compared to pleomorphic liposarcoma to about 4 times as likely. Although results like these do not make major differences individually, detailed calculations of results from a large panel of immunohistochemistry stains can have a major impact when taken together, even if each stain has relatively low sensitivity and specificity.[note 3]
Consultation
Reporting
Following are general notes on reporting in pathology.
- Save your digital work frequently, and also before you leave a computer, even if you think you'll be back shortly. If you have many small specimens to write up in the same report, you may want to save every 2 to 3 specimens. It doesn't matter how much time and effort you spend on something if you're just going to let it disappear in the next glitch.
- Double-check your report, especially if you copy-pasted and adapted a previous report rather than using a template with blank fields or making your report from scratch.
Components
Selection and trimming
From the stage of selection and trimming, a histopathology report should preferably include:
- Case:
- Patient identification and/or sample number
- Type of tissue sample as described on container
Microscopic evaluation
- Specimen chronology, often A, B, C, etc., at least where there are multiple specimens from the same case. With multiple specimens, preferably write out the chronology for all of them first, so that you don't miss reporting any of them later.
- Specimen type and/or surgery type, such as "appendix, appendectomy", for clarification. This is not necessary at all departments. For the procedure, use the same term as the operating report whenever possible.
- Microscopic description. This is not always necessary, but should be included if the diagnosis is uncertain. One systematic approach is to describe findings from largest to smallest ones. For example, a description of a tumor can start with the demarcation of the tumor, followed by texture, cell shapes, nucleus shapes and chromatin appearance.
- Diagnosis or most probable diagnoses.
- If the diagnosis does not clearly account for all conditions that were requested, suspected or asked to be ruled out by the referring clinician (such as stated on the requisition form), you need to classify the specimen as "positive for" versus "negative for" for each such condition, or give a reason for why an evaluation thereof could not be made.
- In case of malignancy or suspected malignancy:
- Depth or most distant invasion of malignant findings.[12] Depending on location, it may need to exclude important pathways, such as vascular, neural and/or through capsules or other layers.
- Whether the resection is radical or not.
Depth
Factors supporting a relatively more comprehensive report, particularly in the inclusion of negated findings:
- Lack of explanation from existing evidence. For example, an inflamed appendix that fits the medical history does not need detailed mention of harmless incidental findings.
- Prospective review: If your report is likely to undergo double-reading by another pathologist before sign-out, it should either be more detailed, because the doctor who will do the double-reading then gets an idea of your thought process, including what you have looked for versus what may still need to be evaluated. If you know who will do the prospective review for a report of yours, you may alternatively convey your thought process by other means such as directly talking to that person.
- Highly suspected locations, such as given from the referral.
- Difficulty in obtaining the specimen, such as a CT-guided biopsy versus a skin shave.
- Defensive precautions, which appears to be more common among doctors in the Unites States compared to for example Europe.[13][14]
Multiple instances of the same type of pathology (such as lung nodules) can often simply be reported as such, at least with a particular mention of the largest or the most severe example thereof.
Uncertainty
|
probably likely |
suggesting |
suspicious for |
possibly |
(benign condition) cannot be excluded |
not likely |
(malignant condition) cannot be excluded |
|
When something looks very much like a specific entity but you are not sure, preferably use "-like" (or when feasible, "-oid" such as squamoid for squamous-like cells).
When the clinical picture strongly favors a certain condition, and the pathology favors it as well, findings are generally described as "consistent with". Sometimes, "bordering on" can be described when the picture almost fits specified criteria of a specific diagnosis.
It is alright to consider the diagnosis of a pathology report to be a combination of the clinical picture and what can be seen on the specimen. For example, if the microscopy picture is uncertain, you may to a certain degree tend towards the diagnosis that best fits the clinical picture. However, mention differential diagnoses if they are still significantly possible, and would confer a different treatment or another substantially different consequence.
For both findings and diagnoses, is preferable to write "negative for..." rather than "no..." to emphasize the possibility of false negative findings.
Synoptic reports
For cancers, generally include a synoptic report, such as per College of American Pathologists (CAP) protocols at cap.org/protocols-and-guidelines. However, synoptic reports are generally not needed for tumor metastases.
Sizes
Whenever possible, give numerical quantities of sizes, rather than descriptions that are subjective (such as "small" or "large") or variable (such as "apple-sized").
Tailoring
The information contained in the reporting sections in this resource assume that the clinician has requested the exam for the topic at hand, but should still be tailored to any particular questions or requests by the clinician. Any relevant findings beyond the issues or questions raised by the clinician should also be mentioned.
As there are generally local practices about how to write reports, it is recommended to have either a personal or practice-specific repository of report templates that you can copy-paste for various cases. When doing so, however, use marks or empty spaces for relevant findings that are frequently changed in the template. Such marks should be conspicuous, so that the report clearly looks unfinished if you haven't tailored it to the case at hand (such as "...measuring _____."). Thereby, you avoid omissions or even wrongly entered information from templates.
The most important findings are preferably moved to near the top of the report if feasible.
Example of report format:
A. Organ, side/site, procedure:
|
Wording
If a certain grammatical rule has a risk of making the report less clear to the reader, ignore that rule in that situation.
Restrict acronyms/abbreviations to those who are certainly well known among all doctors, such as "cm".[note 4]
Generally describe what can be seen rather than processes (such as preferring "an abundance of" rather than "proliferation of").
If using a dictation device, avoid "no", and instead use "negative for" (and "positive for" in opposite cases), since there's a risk of "no" not being transcribed and thereby creating the opposite meaning.
Avoid "evidence of" unless you feel comfortable with the legal implications of its meaning in the report.
Whenever there is text needing formatting (text size, font type and/or UPPER vs lower case), it is generally most efficient to do it all at once after all the text is written.
Skin excisions
In skin cancers, use "peripheral" or "radial" margins (whereas "lateral" margin should be reserved for the margin opposite to the medial margin).[15]
Notes
- ↑ Further information on what is memorization-worthy or not: Learning pathology
- ↑ 2.0 2.1 The author has no financial or other conflict of interest in the mentioning of ImmunoQuery.
- ↑ More detailed explanations about likelihood calculations on differential diagnoses in general can be read at:
-Häggström, Mikael (2014). "An epidemiology-based and a likelihood ratio-based method of differential diagnosis ". WikiJournal of Medicine (Wikiversity Journal of Medicine) 1 (1). doi: . ISSN 2002-4436. - ↑ Acronyms/abbreviations increase reading speed only if the reader is familiar with the abbreviated terms:
Main page
References
- ↑ Okayama K, Ishii Y, Fujii M, Oda M, Okodo M (2022). "Causation of cornflake artifacts: Possible association of poor dehydration with drying before mounting in Papanicolaou stain. ". Diagn Cytopathol. doi: . PMID 35712848. Archived from the original. .
- ↑ Gary Gill. RE: Cornflaking. Histosearch. Retrieved on 2022-09-01.
- ↑ 3.0 3.1 . Cancer staging. National Cancer Institute. Retrieved on 4 January 2013.
- ↑ 4.0 4.1 . General oncology. Amboss. Retrieved on 2020-01-29.
- ↑ List of included entries and references is found on main image page in Commons: Wikimedia Commons: Metastasis sites for common cancers.svg
- ↑ Lymph nodes, liver, lungs, bones, or skin are the main sites of cancer of unknown primary origin (CUP):
{{cite web|url=https://www.mskcc.org/cancer-care/types/cancer-unknown-primary-origin%7Ctitle=Cancer of Unknown Primary Origin|website=Memorial Sloan Kettering Cancer Center|accessdate=20222-10-14 - ↑ Choi JH, Ro JY (2020). "Epithelioid Cutaneous Mesenchymal Neoplasms: A Practical Diagnostic Approach. ". Diagnostics (Basel) 10 (4). doi: . PMID 32316685. PMC: 7236000. Archived from the original. .
- ↑ 8.0 8.1 Lin F, Liu H (2014). "Immunohistochemistry in undifferentiated neoplasm/tumor of uncertain origin. ". Arch Pathol Lab Med 138 (12): 1583-610. doi: . PMID 25427040. Archived from the original. .
- ↑ 9.0 9.1 9.2 Collado Martín R, García Palomo A, de la Cruz Merino L, Borrega García P, Barón Duarte FJ, Spanish Society for Medical Oncology (2014). "Clinical guideline SEOM: cancer of unknown primary site. ". Clin Transl Oncol 16 (12): 1091-7. doi: . PMID 25392080. PMC: 4239766. Archived from the original. .
- ↑ Selves J, Long-Mira E, Mathieu MC, Rochaix P, Ilié M (2018). "Immunohistochemistry for Diagnosis of Metastatic Carcinomas of Unknown Primary Site. ". Cancers (Basel) 10 (4). doi: . PMID 29621151. PMC: 5923363. Archived from the original. .
- ↑ Elliot Weisenberg, M.D.. Esophagus - Carcinoma - Adenocarcinoma. Pathology Outlines. Last author update: 1 June 2013. Last staff update: 31 October 2022
- ↑ 12.0 12.1 12.2 12.3 . An Example of a Melanoma Pathology Report. Melanoma Foundation. Retrieved on 2019-09-24.
- ↑ Studdert D. M.; Mello M. M.; Sage W. M.; DesRoches C. M.; Peugh J.; Zapert K.; Brennan T. A. (2005). "Defensive medicine among high-risk specialist physicians in a volatile malpractice environment ". JAMA 293 (21): 2609–2617. doi: . PMID 15928282.
- ↑ Steurer J.; Held U.; Schmidt M.; Gigerenzer G.; Tag B.; Bachmann L. M. (2009). "Legal concerns trigger PSA testing ". Journal of Evaluation in Clinical Practice 15 (2): 390–392. doi: . PMID 19335502.
- ↑ David Slater, Paul Barrett. Standards and datasets for reporting cancers - Dataset for histopathological reporting of primary cutaneous basal cell carcinoma. The Royal College of Pathologists. February 2019
Image sources