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The Ten Commandments of Vimentin:
1. It’s useless.
It’s stains carcinomas, melanomas, lymphomas. Pretty much everything. Ok, not everything, but close. https://twitter.com/drsmbean/status/1246097470175789064
The Ten Commandments of Vimentin:
1. It’s useless.
It’s stains carcinomas, melanomas, lymphomas. Pretty much everything. Ok, not everything, but close. https://twitter.com/drsmbean/status/1246097470175789064
The Ten Commandments of Vimentin:
2. Just because something is positive for vimentin doesn’t mean it’s a sarcoma.
Check out this masterpiece by @JMGardnerMD
2. Just because something is positive for vimentin doesn’t mean it’s a sarcoma.
Check out this masterpiece by @JMGardnerMD
3. Just because something is positive for vimentin doesn’t mean it’s mesenchymal.
Check out this sarcomatoid lung carcinoma
https://twitter.com/smlungpathguy/status/1273997334934888451?s=21 https://twitter.com/smlungpathguy/status/1273997334934888451
Check out this sarcomatoid lung carcinoma
https://twitter.com/smlungpathguy/status/1273997334934888451?s=21 https://twitter.com/smlungpathguy/status/1273997334934888451
4. Vimentin is not required for the diagnosis of any sarcoma.
As a thought experiment, take any sarcoma where vimentin was used, take it away, and ask yourself “would this diagnosis still be valid without vimentin?”.
Hint: the answer is yes.
https://twitter.com/texpathol/status/1235920633965481986?s=21 https://twitter.com/texpathol/status/1235920633965481986
As a thought experiment, take any sarcoma where vimentin was used, take it away, and ask yourself “would this diagnosis still be valid without vimentin?”.
Hint: the answer is yes.
https://twitter.com/texpathol/status/1235920633965481986?s=21 https://twitter.com/texpathol/status/1235920633965481986
5. A malignant spindle cell neoplasm in the lung (or any organ where carcinomas are common) is FAR more likely to be sarcomatoid carcinoma than sarcoma.
PS: this example has malignant glands so it’s easy but others are pure spindle cell tumors.
https://twitter.com/smlungpathguy/status/983511970333773824?s=21 https://twitter.com/smlungpathguy/status/983511970333773824
PS: this example
has malignant glands so it’s easy but others are pure spindle cell tumors. https://twitter.com/smlungpathguy/status/983511970333773824?s=21 https://twitter.com/smlungpathguy/status/983511970333773824
6. Rare uses of vimentin in other settings may exist, but the vast majority of vimentin stains are done (wrongly) as a marker for sarcoma.
Check out a non-sarcoma use suggested by GU guru (and my neighbor and colleague) @Williamson_SR
https://twitter.com/williamson_sr/status/1274294508637818881?s=21 https://twitter.com/williamson_sr/status/1274294508637818881
Check out a non-sarcoma use suggested by GU guru (and my neighbor and colleague) @Williamson_SR
https://twitter.com/williamson_sr/status/1274294508637818881?s=21 https://twitter.com/williamson_sr/status/1274294508637818881
7. No one gets a vimentin stain to check if the tissue is immunoreactive. Honestly. C’mon. Seriously?
8. IHC that might help in spindle cell tumors of lung: pankeratin, another pankeratin, TTF-1, p40, STAT-6, ALK (esp D5F3). FISH helps sometimes. Not vimentin. Never vimentin.
#ihcpath #vimentin
https://twitter.com/smlungpathguy/status/800257514881372161?s=21 https://twitter.com/smlungpathguy/status/800257514881372161
#ihcpath #vimentin
https://twitter.com/smlungpathguy/status/800257514881372161?s=21 https://twitter.com/smlungpathguy/status/800257514881372161
9. Even more helpful than IHC: history of sarcoma, imaging, H&E morphology. If all fails, consult a soft tissue pathologist. No vimentin. Nunca. Never. Kabhi nahi.
https://twitter.com/smlungpathguy/status/998746373502767105?s=21 https://twitter.com/smlungpathguy/status/998746373502767105
https://twitter.com/smlungpathguy/status/998746373502767105?s=21 https://twitter.com/smlungpathguy/status/998746373502767105
10. So the next time you think about ordering vimentin to “rule out sarcoma”, ask yourself: Whymentin?
I will close with this excellent paper by @IHC_guy and @LizMontgomeryMD and Jason Hornick.
https://doi.org/10.1016/j.anndiagpath.2019.151419
end of thread
I will close with this excellent paper by @IHC_guy and @LizMontgomeryMD and Jason Hornick.
https://doi.org/10.1016/j.anndiagpath.2019.151419
end of thread
