Difference between revisions of "Immunohistochemical staining"
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===Hodgkin's lymphoma=== | ===Hodgkin's lymphoma=== | ||
Classic types: | Classic types: | ||
*CD30 Reed-Sternberg cells (RSCs) +ve ~98%<ref name=Ref_WMSP567>{{Ref WMSP|567}}</ref> | *CD30 Reed-Sternberg cells (RSCs) +ve ~98%.<ref name=Ref_WMSP567>{{Ref WMSP|567}}</ref> | ||
*CD15 Reed-Sternberg cells +ve ~80%, stains neutrophils. | *CD15 Reed-Sternberg cells +ve ~80%, stains neutrophils. | ||
Revision as of 17:20, 9 July 2010
Immunohistochemical staining is a godsend. It helps when ya can't quite figure it out from the histology or with conventional stains.
General (malignant) differential diagnosis
Malignancy | |||||||||||||||||||||||||||||||||||||||||||||||
Carcinoma | Sarcoma | Germ Cell Tumour | Neuroendocrine carcinoma | Lymphoma | Melanoma | ||||||||||||||||||||||||||||||||||||||||||
- Carcinoma.
- AE1/AE3 - pankeratin.
- Sarcoma.
- Vimentin.
- Many pathologists think this stain is totally useless.
- Vimentin.
- Germ cell tumours.
- PLAP (placental-like alkaline phosphatase) - not very sensitive.[1]
- Neuroendocrine carcinoma.
- Chromogranin.
- Synaptophysin.
- CD56.
- Melanoma.
- S-100, HMB-45, Melan A (MART-1).
- Lymphoma.
- CD45 (common leukocyte antigen).
Keratins
Classification:[2]
- Low molecular weight keratins (LMWK): 7, 8/18, 19, 20.
- High molecular weight keratins (HWMK): 4, 10, 13, 14, 17.
Uses:
- CK8 (CAM5.2)[3] - used to look for mets from breast cancer in axillary lymph nodes.
- HWMK - squamous cell carcinoma.
Organ specific
Thyroid
- TTF-1 (thyroid transcription factor-1).
- Very good for breast vs. lung.[4]
- Negative in squamous cell carcinoma of the lung (as with CK7 & CK20), though HMWK is usually positive.
- Very good for breast vs. lung.[4]
Breast markers
- GCDFP-15 (aka BRST2) -- specific, but NOT sensitive.
- ER (estrogen receptor) - in normal breast.
- PR (progesterone receptor) - in normal breast.
- HER2/neu - pathological, assoc. with worse prognosis.
- HER2/neu+ cancers Tx'ed with trastuzumab (Herceptin).
Prostate
- PSA - prostatic specific antigen.
- PSAP - prostatic specific acid phosphatase.
- p63 - stains nuclei of basal cell in normal prostate.
- 34betaE12 - stains basals cells in normal prostate.
- AMACR (racemase, P504S[5]) - present in adenocarcinoma (NOT in normal prostate).
- CAP cocktail - AKA CAP (AMACR p63 and 34βE12).
CRC markers
- CEA.
Small bowel
- CDX2.
- Villin.
Kidney
- RCC, EMA, CD10.
- CK7 -ve in clear cell RCC.
- AMACR +ve in papillary RCC.
- D2-40 +ve in ChRCC.
Xanthogranulomatous pyelonephritis
- CD68 (for macrophages).
Ovary
- CA125, CK7+, CK20-.
- WT1 -- 90% in serous +ve.
Serous markers
- WT-1, CA-125, D2-40.
Liver
- AFP (alpha-fetaprotein).
- Glypican-3.
- HCC stains with glypican 3, while liver with dysplastic changes and/or cirrhotic changes does not.[6]
- HepPar-1 (hepatocytes paraffin antibody 1) - labels hepatocellular mitochondria.[7]
HCC vs. cholangiocarcinoma:
- TTF-1: ~90-100% +ve (cytoplasmic) in HCC vs. ~10% in choleangiocarcinoma.[8]
Mesothelium
- Calretinin.
- WT-1.
- D2-40.
- CK5/6.
Typically negative:
- CEA.
- TTF-1.
Macrophages
- CD68.
- CD1a -- +ve in Langerhans histocytes.
Less common:
- HAM56.[9]
Pancreas
One organ vs. another
Cervix vs. uterus
- Cervix (typically): CEA +ve,[12] p16 +ve.
- ... and ER -ve, PR -ve, vimentin -ve.
- Uterus (typically): vimentin +ve, ER +ve, PR +ve.[13]
- ... and CEA -ve, p16 -ve.
Additional Ref.:[14]
Liver vs. bile duct
Intrahepatic cholangiocarcinoma (ICC) vs. hepatocellular carcinoma (HCC):[15]
- ICC: CK19 (92.5%), MUC-1 (73.8%) +ve.
- HCC: HepPar-1 (85.6%), CD34 (87.8%) +ve.
Lymphomas
Lymphocytes
- CD45 (AKA common leukocyte antigen).
B-cells
- CD20.
- CD19 (flow only).
Follicular lymphoma:
- CD10+, bcl-6+.
CLL:
- CD5+, CD23+.
Mantle cell lymphoma:
- Cyclin D1+.
T-cells
- CD3 - general T-cell marker (marks both CD4 +ve and CD8 +ve cells).
- CD4.
- CD8.
Hodgkin's lymphoma
Classic types:
- CD30 Reed-Sternberg cells (RSCs) +ve ~98%.[16]
- CD15 Reed-Sternberg cells +ve ~80%, stains neutrophils.
Germ cell tumours
Seminoma
- D2-40.[1]
Embryonal carcinoma
- CD30+ - cytoplasm, cell membrane, Golgi.
- NOT positive in seminoma.
Yolk sac tumour (endodermal sinus tumour)
- AFP (alpha fetoprotein)
Choriocarcinoma
- beta-hCG.
Mnemonic
The germ cell tumour (GCT) IHC mnemonic ABCD:
- AFP = yolk sac tumour.
- Beta-hCG = choriocarcinoma.
- CD30 = embryonal carcinoma.
- D2-40 = seminoma.
Sarcomas
MFH panel (MSH):
- CD34 - GISTs, solitary fibrous tumour/hemangiopericytoma, DFSP, angiosarcoma.
- S-100 - neural differentiation, melanoma.
- Desmin - smooth muscle.
- MIB1 - proliferation marker (target is Ki-67 protein).
- CD99 - blue small cell tumours, membranous staining EWS.
- Bcl-2.
- PGP 9.5.
- SMMS - smooth muscle.
- Caldesmon - muscle.
- PDGFR - GIST.
Muscle markers
- Desmin - all three types.
- Caldesmon - smooth muscle.
- Smooth muscle myosin - smooth muscle.
- MyoD1 - skeletal muscle.
Proliferation markers
- MIB1 - an antibody against the protein Ki-67 (a protein expressed in proliferating cells).
Note: MIB1 should not be confused with mindbomb homolog 1 (MIB-1), a gene that regulates apoptosis.[17]
Carcinomas
CK7 and CK20
CK7+ CK20-
- Ovary (but not mucinous).
- Breast.
- Endometrial.
- Lung (adenocarcinoma).
- Mesothelium.
- Salivary.
- Thyroid (all).
Mnemonic: OBE + lung x2 + H&N x2
CK7- CK20+
- Colorectal adenocarcinoma.
- Merkel cell tumour.
CK7+ CK20+
- Pancreatic adenocarcinoma.
- Ovary, mucinous subtype.
- Occasionally gastric adeno, cholangiocarcinoma.
- Transistional cell carcinoma or urothelial cell carcinoma (UCC).
- Esophagus (adenocarcinoma).
Mnemonic: POOTE.
CK7- CK20-
- Neuroendocrine lung (small cell carcinoma).
- Adrenocortical carcinoma (ACC).
- Squamous cell carcinoma (all sites of the body).
- Hepatocellular carcinoma (HCC).
- Thymoma.
- Urogenital tumours - germ cell tumours.
- Renal cell carcinoma (clear cell type).
- Prostate adenocarcinoma.
Mnemonic: NASH TURP.
Vimentin & cytokeratin
A few tumours are positive for both vimentin and cytokeratins.
- Renal cell carcinoma.
- Endometrial carcinoma.[12]
- Synovial sarcoma.[18]
- Gastric adenocarcinoma rarely.[19]
- Rhaboid tumour (rare tumour).[20]
References
- ↑ 1.0 1.1 Iczkowski KA, Butler SL, Shanks JH, et al (February 2008). "Trials of new germ cell immunohistochemical stains in 93 extragonadal and metastatic germ cell tumors". Hum. Pathol. 39 (2): 275-81. doi:10.1016/j.humpath.2007.07.002. PMID 18045648.
- ↑ http://www.nordiqc.org/Epitopes/Cytokeratins/cytokeratins.htm
- ↑ Murata T, Nakashima Y, Takeuchi M, Sueishi K, Inomata H (September 1993). "The diagnostic use of low molecular weight keratin expression in sebaceous carcinoma". Pathol. Res. Pract. 189 (8): 888–93. PMID 7508102.
- ↑ Jagirdar J (March 2008). "Application of immunohistochemistry to the diagnosis of primary and metastatic carcinoma to the lung". Arch. Pathol. Lab. Med. 132 (3): 384–96. PMID 18318581. http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=0003-9985&volume=132&page=384.
- ↑ http://www.antibodies-online.com/antibody/125649/P504S+alphaMethylacylCoA+Racemace+AMACR+Human/
- ↑ Anatelli F, Chuang ST, Yang XJ, Wang HL. (2008). "Value of glypican 3 immunostaining in the diagnosis of hepatocellular carcinoma on needle biopsy". Am J Clin Pathol. 130 (2): 219-23?. doi:10.1309/WMB5PX57Y4P8QCTY. PMID 18628090.
- ↑ The diagnostic value of hepatocyte paraffin antibody 1 in differentiating hepatocellular neoplasms from nonhepatic tumors: a review. Lamps LW, Folpe AL. Adv Anat Pathol. 2003 Jan;10(1):39-43. Review. PMID 12502967.
- ↑ Lei JY, Bourne PA, diSant'Agnese PA, Huang J (April 2006). "Cytoplasmic staining of TTF-1 in the differential diagnosis of hepatocellular carcinoma vs cholangiocarcinoma and metastatic carcinoma of the liver". Am. J. Clin. Pathol. 125 (4): 519–25. doi:10.1309/59TN-EFAL-UL5W-J94M. PMID 16627262.
- ↑ Pernick NL, DaSilva M, Gangi MD, Crissman J, Adsay V (November 1999). ""Histiocytic markers" in melanoma". Mod. Pathol. 12 (11): 1072–7. PMID 10574605.
- ↑ Goldstein NS, Bassi D (May 2001). "Cytokeratins 7, 17, and 20 reactivity in pancreatic and ampulla of vater adenocarcinomas. Percentage of positivity and distribution is affected by the cut-point threshold". Am. J. Clin. Pathol. 115 (5): 695–702. doi:10.1309/1NCM-46QX-3B5T-7XHR. PMID 11345833.
- ↑ Geller SA, Dhall D, Alsabeh R (March 2008). "Application of immunohistochemistry to liver and gastrointestinal neoplasms: liver, stomach, colon, and pancreas". Arch. Pathol. Lab. Med. 132 (3): 490–9. PMID 18318589.
- ↑ 12.0 12.1 Alkushi A, Irving J, Hsu F, et al. (March 2003). "Immunoprofile of cervical and endometrial adenocarcinomas using a tissue microarray". Virchows Arch. 442 (3): 271-7. doi:10.1007/s00428-002-0752-4. PMID 12647218.
- ↑ URL: http://www.nature.com/modpathol/journal/v19/n8/full/3800620a.html
- ↑ LAE 15 Jan 2009.
- ↑ [Evaluation of immunohistochemical markers for differential diagnosis of hepatocellular carcinoma from intrahepatic cholangiocarcinoma] Dong H, Cong WL, Zhu ZZ, Wang B, Xian ZH, Yu H. Zhonghua Zhong Liu Za Zhi. 2008 Sep;30(9):702-5. Chinese. PMID 19173916.
- ↑ Humphrey, Peter A; Dehner, Louis P; Pfeifer, John D (2008). The Washington Manual of Surgical Pathology (1st ed.). Lippincott Williams & Wilkins. pp. 567. ISBN 978-0781765275.
- ↑ http://www.genenames.org/data/hgnc_data.php?hgnc_id=21086
- ↑ Llombart-Bosch A, Lopez-Guerrero JA, Peydro-Olaya A (2002). "Synovial sarcoma (SS): new perspectives supported by modern technology". Arkh. Patol. 64 (3): 39–47. PMID 15338724.
- ↑ http://cat.inist.fr/?aModele=afficheN&cpsidt=2504165
- ↑ http://www.nature.com/modpathol/journal/v14/n9/full/3880401a.html
External links
- Stanford Surgical Pathology IHC guide - standford.edu.