In a retrospective review of 245 poorly differentiated non–small cell lung cancers, TTF-1 and napsin A were both specific (87% vs 100%), but TTF was more sensitive than napsin A (80 vs 64%) for lung adenocarcinoma.24 In this case report, the patient had tumor that was TTF-1 and napsin A positive, yet negative for intestinal (CK20 and CDX2) and neural (chromogranin, synaptophysin, and CD56) biomarkers, supporting metastatic adenocarcinoma with an immunoprofile favoring pulmonary origin. Here, NCAM1 is linked to neoplasm.