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<p>BRAF V600E (VE1) immunohistochemistry (IHC) is widely used as a mutation-specific assay, but its characteristic apical ciliary staining in benign respiratory epithelium is less well recognized and may help distinguish benign from malignant epithelium in small pulmonary biopsies where morphology is limited by suboptimal sampling. An elderly woman with a history of lung adenocarcinoma presented with a new right upper lobe mass. Fine needle aspiration and biopsy showed detached epithelial strips with mild nuclear enlargement, hyperchromasia, and stunted apical snouts, admixed with cartilage and crushed lymphoid tissue, raising a differential of reactive atypia versus malignancy. VE1 IHC demonstrated two distinct patterns: apical ciliary staining in some epithelial groups consistent with benign ciliated epithelium, and diffuse cytoplasmic positivity in separate epithelial strips. Subsequent next-generation sequencing confirmed a <i>BRAF</i> V600E mutation in the latter. This case highlights the dual diagnostic utility of VE1 IHC in differentiating benign ciliated epithelium from malignant cells.</p>

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Diagnostic role of BRAF VE1 immunohistochemistry to distinguish benign ciliated epithelium from malignant epithelium in small pulmonary biopsies

  • 期刊论文

  • 发表日期：

    2026年4月24日

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  • Deepali Jain,
  • Udit Naik,
  • Tim D Oury,
  • Chen Zhang

摘要

BRAF V600E (VE1) immunohistochemistry (IHC) is widely used as a mutation-specific assay, but its characteristic apical ciliary staining in benign respiratory epithelium is less well recognized and may help distinguish benign from malignant epithelium in small pulmonary biopsies where morphology is limited by suboptimal sampling. An elderly woman with a history of lung adenocarcinoma presented with a new right upper lobe mass. Fine needle aspiration and biopsy showed detached epithelial strips with mild nuclear enlargement, hyperchromasia, and stunted apical snouts, admixed with cartilage and crushed lymphoid tissue, raising a differential of reactive atypia versus malignancy. VE1 IHC demonstrated two distinct patterns: apical ciliary staining in some epithelial groups consistent with benign ciliated epithelium, and diffuse cytoplasmic positivity in separate epithelial strips. Subsequent next-generation sequencing confirmed a BRAF V600E mutation in the latter. This case highlights the dual diagnostic utility of VE1 IHC in differentiating benign ciliated epithelium from malignant cells.