Difference between revisions of "P16"

From Libre Pathology
Jump to navigation Jump to search
 
(7 intermediate revisions by 2 users not shown)
Line 17: Line 17:
[[Image:Endocervical adenocarcinoma in situ - p16 --- high mag.jpg|thumb|right|250px|[[Endocervical AIS]] showing the characteristic p16 staining.]]
[[Image:Endocervical adenocarcinoma in situ - p16 --- high mag.jpg|thumb|right|250px|[[Endocervical AIS]] showing the characteristic p16 staining.]]
'''p16''' is a commonly used [[immunostain]].  It can be considered a surrogate marker for [[HPV]] infection.
'''p16''' is a commonly used [[immunostain]].  It can be considered a surrogate marker for [[HPV]] infection.
p16, like most other "p" stains, is a nuclear stain.  
p16, like most other "p" stains, is a nuclear stain. The antibody target is a cell cycle protein, cyclin-dependent kinase inhibitor 2A, sometimes denoted p16<sup>INK4a</sup>.


==Pattern==
==Pattern==
Line 25: Line 25:
*Squamous lesions of the [[uterine cervix]] - see [[HSIL]].
*Squamous lesions of the [[uterine cervix]] - see [[HSIL]].
*Head and neck squamous cell carcinoma, specifically ''[[human papillomavirus-associated head and neck squamous cell carcinoma]]''.
*Head and neck squamous cell carcinoma, specifically ''[[human papillomavirus-associated head and neck squamous cell carcinoma]]''.
*Increased expression in well-differentiated liposarcoma.<ref>{{Cite journal  | last1 = Thway | first1 = K. | last2 = Flora | first2 = R. | last3 = Shah | first3 = C. | last4 = Olmos | first4 = D. | last5 = Fisher | first5 = C. | title = Diagnostic utility of p16, CDK4, and MDM2 as an immunohistochemical panel in distinguishing well-differentiated and dedifferentiated liposarcomas from other adipocytic tumors. | journal = Am J Surg Pathol | volume = 36 | issue = 3 | pages = 462-9 | month = Mar | year = 2012 | doi = 10.1097/PAS.0b013e3182417330 | PMID = 22301498 }}</ref>
*Limited use in melanocytic lesions.<ref>{{Cite journal  | last1 = Koh | first1 = SS. | last2 = Cassarino | first2 = DS. | title = Immunohistochemical Expression of p16 in Melanocytic Lesions: An Updated Review and Meta-analysis. | journal = Arch Pathol Lab Med | volume = 142 | issue = 7 | pages = 815-828 | month = Jul | year = 2018 | doi = 10.5858/arpa.2017-0435-RA | PMID = 29939777 }}</ref>


===Head and neck squamous cell carcinoma===
===Head and neck squamous cell carcinoma===
Line 46: Line 48:
*[[High-grade squamous intraepithelial lesion]] - full thickness, strong.
*[[High-grade squamous intraepithelial lesion]] - full thickness, strong.
**A subset of LSIL stains with p16; however, it is ''not'' full thickness - see ''[[HSIL]]'' article.
**A subset of LSIL stains with p16; however, it is ''not'' full thickness - see ''[[HSIL]]'' article.
*[[Small cell carcinoma of the lung]] - most cases (95 of 101 cases in one series<ref name=pmid29566943>{{cite journal |authors=Švajdler M, Mezencev R, Ondič O, Šašková B, Mukenšnábl P, Michal M |title=P16 is a useful supplemental diagnostic marker of pulmonary small cell carcinoma in small biopsies and cytology specimens |journal=Ann Diagn Pathol |volume=33 |issue= |pages=23–29 |date=April 2018 |pmid=29566943 |doi=10.1016/j.anndiagpath.2017.11.008 |url=}}</ref>).
Note:
*Positive staining (in the head and neck pathology context) is defined as (strong block) positive staining in >75% (or >50%) of lesional cells.<ref name=pmid28621317>{{cite journal |authors=Shelton J, Purgina BM, Cipriani NA, Dupont WD, Plummer D, Lewis JS |title=p16 immunohistochemistry in oropharyngeal squamous cell carcinoma: a comparison of antibody clones using patient outcomes and high-risk human papillomavirus RNA status |journal=Mod Pathol |volume=30 |issue=9 |pages=1194–1203 |date=September 2017 |pmid=28621317 |doi=10.1038/modpathol.2017.31 |url=}}</ref>
**Staining varies somewhat by the p16 clone used.


===Benign===
===Benign===

Latest revision as of 15:59, 25 November 2021

P16
Immunostain in short

HSIL showing the characteristic p16 staining. (WC/Nephron)
Similar stains HPV
Use HSIL versus LSIL, HPV associated SCC versus non-HPV associated SCC
Subspeciality gynecologic pathology, head and neck pathology
Normal staining pattern nuclear and cytoplasmic
Positive endometrial tubal metaplasia, cervical SCC, HPV-associated head and neck SCC, serous carcinoma of the endometrium
Endocervical AIS showing the characteristic p16 staining.

p16 is a commonly used immunostain. It can be considered a surrogate marker for HPV infection. p16, like most other "p" stains, is a nuclear stain. The antibody target is a cell cycle protein, cyclin-dependent kinase inhibitor 2A, sometimes denoted p16INK4a.

Pattern

  • Nuclear stain +/- cytoplasmic staining.

Use

Head and neck squamous cell carcinoma

p16 testing is useful in:

  1. Lymph node metastases with an unknown primary - positivity suggests an oropharyngeal primary.
  2. Oropharyngeal carcinomas.

Note:

  • Like elsewhere, i.e. other anatomical sites, p16 is an imperfect surrogate marker for the presence of HPV.[3]
  • Non-oropharyngeal sites (oral cavity, larynx, and hypopharynx) are not well-studied; however, it is known that p16 positivity is much less common in there.[3]

Images

Positive

Note:

  • Positive staining (in the head and neck pathology context) is defined as (strong block) positive staining in >75% (or >50%) of lesional cells.[7]
    • Staining varies somewhat by the p16 clone used.

Benign

  • p16 endometrial tubal metaplasia.[8]

Focal staining

Negative

References

  1. Thway, K.; Flora, R.; Shah, C.; Olmos, D.; Fisher, C. (Mar 2012). "Diagnostic utility of p16, CDK4, and MDM2 as an immunohistochemical panel in distinguishing well-differentiated and dedifferentiated liposarcomas from other adipocytic tumors.". Am J Surg Pathol 36 (3): 462-9. doi:10.1097/PAS.0b013e3182417330. PMID 22301498.
  2. Koh, SS.; Cassarino, DS. (Jul 2018). "Immunohistochemical Expression of p16 in Melanocytic Lesions: An Updated Review and Meta-analysis.". Arch Pathol Lab Med 142 (7): 815-828. doi:10.5858/arpa.2017-0435-RA. PMID 29939777.
  3. 3.0 3.1 Stephen, JK.; Divine, G.; Chen, KM.; Chitale, D.; Havard, S.; Worsham, MJ. (2013). "Significance of p16 in Site-specific HPV Positive and HPV Negative Head and Neck Squamous Cell Carcinoma.". Cancer Clin Oncol 2 (1): 51-61. doi:10.5539/cco.v2n1p51. PMID 23935769.
  4. Piaton, E.; Casalegno, JS.; Advenier, AS.; Decaussin-Petrucci, M.; Mege-Lechevallier, F.; Ruffion, A.; Mekki, Y. (Oct 2014). "p16(INK4a) overexpression is not linked to oncogenic human papillomaviruses in patients with high-grade urothelial cancer cells.". Cancer Cytopathol 122 (10): 760-9. doi:10.1002/cncy.21462. PMID 25069600.
  5. Chiesa-Vottero, AG.; Malpica, A.; Deavers, MT.; Broaddus, R.; Nuovo, GJ.; Silva, EG. (Jul 2007). "Immunohistochemical overexpression of p16 and p53 in uterine serous carcinoma and ovarian high-grade serous carcinoma.". Int J Gynecol Pathol 26 (3): 328-33. doi:10.1097/01.pgp.0000235065.31301.3e. PMID 17581420.
  6. Švajdler M, Mezencev R, Ondič O, Šašková B, Mukenšnábl P, Michal M (April 2018). "P16 is a useful supplemental diagnostic marker of pulmonary small cell carcinoma in small biopsies and cytology specimens". Ann Diagn Pathol 33: 23–29. doi:10.1016/j.anndiagpath.2017.11.008. PMID 29566943.
  7. Shelton J, Purgina BM, Cipriani NA, Dupont WD, Plummer D, Lewis JS (September 2017). "p16 immunohistochemistry in oropharyngeal squamous cell carcinoma: a comparison of antibody clones using patient outcomes and high-risk human papillomavirus RNA status". Mod Pathol 30 (9): 1194–1203. doi:10.1038/modpathol.2017.31. PMID 28621317.
  8. Horree, N.; Heintz, AP.; Sie-Go, DM.; van Diest, PJ. (2007). "p16 is consistently expressed in endometrial tubal metaplasia.". Cell Oncol 29 (1): 37-45. PMID 17429140.
  9. Stewart, CJ.; Bharat, C. (Feb 2016). "Clinicopathological and immunohistological features of polypoid endometriosis.". Histopathology 68 (3): 398-404. doi:10.1111/his.12755. PMID 26095917.
  10. O'Neill, CJ.; McCluggage, WG. (Jan 2006). "p16 expression in the female genital tract and its value in diagnosis.". Adv Anat Pathol 13 (1): 8-15. doi:10.1097/01.pap.0000201828.92719.f3. PMID 16462152.
  11. Pereira, TC.; Share, SM.; Magalhães, AV.; Silverman, JF. (Jan 2011). "Can we tell the site of origin of metastatic squamous cell carcinoma? An immunohistochemical tissue microarray study of 194 cases.". Appl Immunohistochem Mol Morphol 19 (1): 10-4. doi:10.1097/PAI.0b013e3181ecaf1c. PMID 20823766.
  12. Wang, CW.; Wu, TI.; Yu, CT.; Wu, YC.; Teng, YH.; Chin, SY.; Lai, CH.; Chen, TC. (May 2009). "Usefulness of p16 for differentiating primary pulmonary squamous cell carcinoma from cervical squamous cell carcinoma metastatic to the lung.". Am J Clin Pathol 131 (5): 715-22. doi:10.1309/AJCPTPBC6V5KUITM. PMID 19369633.

External links