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Scripta Scientifica Medica

The great imitator - EMA positive glioblastoma multiforme

George St. Stoyanov, Deyan Dzhenkov, Peter Ghenev

Abstract

INTRODUCTION: Glioblastoma multiforme (GBM) has always been a diagnostic challenge for pathologists. As a rare oncological entry with astrocytic differentiation, it can manifest itself in a variety of histomorphological forms, mimic other tumors and it often has varying immunohistochemical (IHC) profiles, further challenging the process of its verification.

MATERIALS AND METHODS: Four pathologically verified cases of GBM, registered at the St. Marina University Hospital, Varna, Bulgaria were retrieved from the central pathological archive. The cases were tested and reviewed based on their hematoxylin and eosin (H&E) profiles and IHC reactions with GFAP used as a glial differentiation marker, Vimentin - as a positive IHC control and EMA, an epithelial marker, non-reactive in healthy brain tissue.

RESULTS: As expected all GBM cases had the histomorphological hallmarks of the tumor on the H&E stain. They were diagnostically positive for GFAP and had a strong positive IHC reaction with Vimentin. Three out of the four cases also revealed a varying in intensity reaction with EMA, with one case having a weak reaction in individual cells that could not be considered diagnostic and the other two cases having a diffuse positive reaction in most of the tumor cells.

CONCLUSION: In the age of immunohistochemistry, GBM continues to expand the set of IHC markers that react with it, although several of them such as Cytokeratin AE1/AE3 and EMA, as demonstrated in this study, should be non-reacting as they react with proteins normally present only in epithelial cells and absent in healthy brain tissue. This can often be misleading and, in certain cases, lead to histopathological misdiagnosis.


Keywords

GBM, IHC, EMA, CNS tumor, pathology, antibody mimicry

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DOI: http://dx.doi.org/10.14748/ssm.v49i1.2056

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About The Authors

George St. Stoyanov
Medical University of Varna
Bulgaria

Department of General and Clinical Pathology, Forensic Medicine and Deontology

Deyan Dzhenkov
Medical University of Varna

Department of General and Clinical Pathology, Forensic Medicine and Deontology

Peter Ghenev
Medical University of Varna

Department of General and Clinical Pathology, Forensic Medicine and Deontology

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