Pathology report back from Mt. Sinai in NYC

Silver Gelatin Print: From the Collection: Photographer Unknown.

My patho report is back... Much of the same markers were confrmed, but new stains were performed.

OLD INFO: Still positive for AE1/ AE3, Synaptophysin, & CAM5.2. Negative for TTF-1, Chromogranin, and CD31, CD34. KI67 = 2.3%. Well to moderately differentiated, depending on the lab.

NEW INFO: CDX2 is focally positive and MIB is less than 1% (Similar to KI67). No Mitoses or Necrosis (Typical Carcinoid). Serotonin is negative.

Some info on CDX-2... which is supposed to be an important marker. TTF-1 being positive might indicate a tumor in the lung. (my TTF-1 is negative). Note that my tumor is "Focally Positive" for CDX2...

"...Other potential uses of this marker include the workup of metastatic tumors at other sites. The marker may aid in the differential diagnosis of well-differentiated neuroendocrine tumors first detected in the liver. Extensive positive Cdx2 staining predicts a metastasis from a gastrointestinal carcinoid of midgut or hindgut origin. Negative or focal Cdx2 staining predicts a source from the lung, stomach, biliary tract, or pancreas. As has been reported in abstract form by another group (13), our results suggest that Cdx2 immunohistochemistry is also useful in distinguishing primary lung adenocarcinomas from gastrointestinal metastases..." Read Full Article.

Dr. Warner told me that if CDX2 is positive, the primary would almost certainly be in the gut. However, all tests to date have yielded no primary tumor in that region, or any other. So, it is possible that it is just not visible via available imaging. That is, it's really small, almost granular? However, there seems to be a distinction between CDX2 being Positive and Negative / Focally Positive. So, I've been doing my homework in preperation for my meeting with Warner. More to follow...

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