1.Obstructive jaundice in small cell lung carcinoma
Ali Mokhtar Pour ; Noraidah Masir ; D.Phil ; Isa Mohd Rose
The Malaysian Journal of Pathology 2015;37(2):149-152
Small cell lung carcinoma (SCLC) commonly metastasizes to distant organs. However, metastasis to the
pancreas is not a common event. Moreover, obstructive jaundice as a first clinical presentation of SCLC
is extremely unusual. This case reports a 51-year-old male with SCLC, manifesting with obstructive
jaundice as the initial clinical presentation. Endoscopic retrograde cholangiopancreatograghy (ERCP)
and abdominal computed tomography (CT) scan showed a mass at the head of the pancreas. The patient
underwent pancreatoduodenectomy (Whipple procedure). Histopathology revealed a chromogranin-
A-positive poorly-differentiated neuroendocrine carcinoma of the pancreas. No imaging study of
the lung was performed before surgery. A few months later, a follow-up CT revealed unilateral lung
nodules with ipsilateral hilar nodes. A lung biopsy was done and histopathology reported a TTF-
1-positive, chromogranin A-positive, small cell carcinoma of the lung. On review, the pancreatic
tumour was also TTF-1-positive. He was then treated with combination chemotherapy (cisplatin,
etoposide). These findings highlight that presentation of a mass at the head of pancreas could be a
manifestation of a metastatic tumour from elsewhere such as the lung, and thorough investigations
should be performed before metastases can be ruled out.
2.Glypican-3 is useful but not superior to Hep Par 1 in differentiating hepatocellular carcinoma from other liver tumours
Ali Mokhtar Pour ; Noraidah Masir ; Isa Mohd Rose
The Malaysian Journal of Pathology 2016;38(3):229-233
To assess the diagnostic utility of glypican-3 (GPC-3) in comparison to Hep Par 1 in the diagnosis of
liver tumours, a cross-sectional study involving 66 resected liver tumours were tested for the protein
expression of these markers by immunohistochemistry using monoclonal antibodies. Of the 66 cases,
26 (39.4%) were hepatocellular carcinoma (HCC), 4 (6.1%) were intrahepatic cholangiocarcinoma
and 36 (54.5%) were metastatic tumours. Hep Par 1 and GPC-3 expressions in HCC were 24/26
(92.3%) and 19/26 (73.1%) respectively. In contrast, of non-HCC cases, only 2/40 cases (5.0%)
expressed Hep Par 1, including a metastatic colorectal adenocarcinoma and a metastatic gastric
adenocarcinoma. GPC-3 was expressed in 3/40 cases (7.5%), i.e. a metastatic adenocarcinoma of
unknown origin, a metastatic gastric adenocarcinoma and an intrahepatic cholangiocarcinoma. The
sensitivity and specificity for Hep Par 1 were 92.3% and 95% respectively while that of GPC-3 was
73.1% and 92.5% respectively. GPC-3 is a useful marker in the diagnosis of HCC. However it is
not superior to Hep Par 1 in its sensitivity and specificity. We recommend that it is utilized together
with Hep Par 1 as a panel in the diagnosis of HCC.