bule cells tumor in the hospital diagnoisng thhe tumor

cases of small round blue cell tumors

1. Department of clinical pathology and lab medicine

2. Blue Cells, Big Problems: Diagnosing the Small Round Tumor Gang! Department of clinical pathology and lab medicine

3. What is Small round blue cell tumors???? Small round blue cell tumors (SRBCTs) represent a diverse and challenging group of tumors . They have overlapping histological features, making them difficult to diagnose with just routine microscopy . Accurate diagnosis is critical for prognosis, treatment planning, and patient outcomes.

4. Goal of the Presentation : To share insights into the diagnostic challenges posed by SRBCTs . To showcase how we tackle these difficulties using a multidisciplinary approach involving histopathology, IHC, and molecular testing .

5. "Ever wondered why pathologists need a magnifying glass and a molecular test for a definitive diagnosis?"

6. These tumors look alike but behave differently. Let's find out who’s who!"

7. What are Small Round Blue Cell Tumors? A group of neoplasms that share a characteristic appearance under the microscope—small, round, and densely packed blue cells . Key Characteristics : High nuclear-to-cytoplasmic ratio (small cells with large nuclei ). Prominent nucleoli (giving the blue color under H&E ). Scant cytoplasm . Tumors often grow in sheets, cords , or rosettes .

8. Tumors Included in SRBCTs : Ewing Sarcoma Neuroblastoma Lymphoblastic Lymphoma Rhabdomyosarcoma Medulloblastoma Small Cell Lung Cancer (SCLC)

9. Why Are SRBCTs a Diagnostic Challenge? Tumors look morphologically similar under the microscope, making them hard to differentiate based on H&E staining alone . Histopathology shows similar features across different types of SRBCTs, complicating diagnosis . Not all hospitals have immediate access to genetic testing, which delays diagnosis . Incorrect diagnosis leads to inappropriate treatment plans.

10. Example of Overlap : Ewing Sarcoma vs. Lymphoblastic Lymphoma : Both show small blue cells, but their clinical implications and treatments differ significantly . Neuroblastoma vs. Rhabdomyosarcoma : Small round blue cells, but different origins ( neuroectodermal vs. mesenchymal ).

11. When everything looks like blue cells, how do we identify the real culprit ?"

12. How Do We Tackle These Diagnostic Difficulties? Multidisciplinary Approach : Histopathology : Initial morphological analysis. IHC (Immunohistochemistry) : Crucial for differentiation between SRBCTs. Molecular Testing : Provides definitive diagnostic confirmation (e.g., genetic translocations, amplifications).

13. The Power of IHC : "IHC is like a fingerprint for tumors—it helps us identify the origin and nature of these blue cells."

14. The Role of IHC in Diagnosing SRBCTs What is IHC ? Immunohistochemistry (IHC) uses specific antibodies to detect particular proteins on the surface or within cells, helping to pinpoint tumor origin and cell type . Why IHC is Essential ? Key Differentiating Marker : We use IHC markers to distinguish between tumors with similar histology.

15. Approach to diagnosis: Clinical, radiological, and biochemical parameters are important .

16. Based on age: <3 years: Neuroblastoma Wilm’s tumor Retinoblastoma Rhabdomyosarcoma > 3years: Ewing's sarcoma Rhabdomyosarcoma Lymphoma Wilm’s tumor Desmoplastic SRCT Hepatoblastoma Synovial sarcoma

17. Based on site: Bone <3 years : Metastatic neuroblastoma Leukemia/Lymphoma Bone >3 years: Ewing's sarcoma Osteosarcoma Chondrosarcoma Lymphoma/ leukemia Rhabdomyosarcoma Ewing's sarcoma Extremely soft tissue

18. Malignant round cell tumor in Adult: Lymphoma Small cell neuroendocrine carcinoma Alveolar Rhabdomyosarcoma Melanoma

19. Organ specific tumor: Adrenal gland: Neuroblastoma Liver: Hepatoblastoma Eye: Retinoblastoma Kidney: Wilms tumor Bladder: Rhabdomyosarcoma Peritoneal mass: Desmoplastic Small Round Cell Tumor

20. Biochemical parameters: Alpha fetoprotein- Hepatoblastoma Vanillylmandelic acid (VMA) - Neuroblastoma

21. Pattern-based approach Diffuse round cell pattern: Ewing’s sarcoma/Primitive neuroectodermal tumor Embryonal Rhabdomyosarcoma Small cell carcinoma Lymphoma/Leukemia

22. B: Septate or lobulated round cell pattern: Ewing's sarcoma Alveolar Rhabdomyosarcoma

23. C: Alveolar/ pseudo alveolar round cell tumor Alveolar rhabdomyosarcoma Primitive neuroectodermal tumor

24. D: Round cell tumor with rosette: Homer wright rosettes: Neuroblastoma Flexner’s winterstein rosettes: Neuroblastoma/PNET Neuroblastoma

25. Round cell tumor with hemangiopericytoma vascular pattern: Poorly differentiated synovial sarcoma Mesenchymal chondrosarcoma

26. On the basis of origin: Neurogenic origin: Ewing’s sarcoma PNET Neuroblastoma Rhabdosarcoma Medulloblastoma Small cell carcinoma Mesenchymal origin: Myogenic differentiation: Rhabdomyosarcoma Osteoid differentiation: Small cell osteosarcoma Chondroid differentiation: Mesenchymal chondrosarcoma Adipose tissue-like differentiation: Myxoid/ round cell liposarcoma

27. Hematolymphoid origin: Lymphoma Malignant soft tissue tumors of uncertain type: Desmoplastic small round cell tumor Poorly differentiated synovial sarcoma.

28. Key Takeaways SRBCTs are diverse but share a similar histopathological appearance . With the right tools—microscopy, IHC, and molecular tests—you can reveal their true identities . IHC is an invaluable tool for tumor differentiation , providing critical diagnostic information . Molecular testing (e.g., FISH, PCR) confirms the diagnosis and informs prognosis . A multidisciplinary approach is essential to ensure accurate diagnosis and optimal treatment.

29. While blue cells might seem simple, diagnosing them requires the combined efforts of pathologists, radiologists, and clinicians. With IHC and molecular testing, we can crack the mystery.

30. Thank you!!!