[The utility of monoclonal antibodies in the diagnostic work-up of spinal metastases].

Abstract

The skeletal system is the third most frequent (after lungs and liver) seat of metastases, and metastatic tumours are the most common bone malignancies. The diagnostic work-up of spinal metastases begins with the identification of the primary neoplastic site. Histological analysis confirms the final diagnosis. The work-up of bony metastases poses considerable difficulty and requires the collaboration of a number of specialists. Historical paraffin-embedded tissue samples were subjected to a routine procedure for the preparation of histology specimens. All specimens were independently reassessed by two diagnosticians. The samples of metastatic tumours of 57 patients whose primary tumour sites had not been identified were subjected to an immunohistochemical analysis based on monoclonal antibodies and assays for antigens associated with tumours most often producing bony metastases, i.e.:: PSA, thyreoglobulin, villin, cytokeratin 7, cytokeratin 8, cytokeratin 17, cytokeratin 18, cytokeratin 19, cytokeratin 20, CD 38, oestrogen and progesterone and Vimentin, LCA, HMB-45 and S-100. The monoclonal antibodies and assays were shown to be useful aids for the identification of the histology and location of the primary tumour in patients in whom routine histological assessments had failed to determine the histological type of tumour. In many cases, effective immunohistochemical work-up can contribute to halting the progression of the tumour by enabling qualification for appropriate surgical and oncological treatment.