Special Stains and Immunohistochemistry

Kavita Singhal



        

Topic Topic Topic Topic Topic Topic Topic Topic Topic Topic

1 - Mesotheliomas 2 - CD34 3 - Cytokeratins 4 - Spindle cell tumours of skin 5 - Bone marrow trephine 6 - Urology 7 - Special stains 8 - Various IHC markers 9 - Lymphomas 10 - Various IHC markers

Topic 1



 a. b. c. d. e.

1. A 69 year old male with history of asbestos exposure presents with pleural effusion: The CT scan shows diffuse left sided pleural thickening. The pleural cytology shows clusters of atypical cells with an epithelioid morphology which are immunohistochemically AE1/3 and CK7 positive, but negative for BerEP4, CEA, TTF-1, CK20, CD34 and desmin.

The likely diagnosis is: Pulmonary adenocarcinoma.

Malignant mesothelioma.

Small cell carcinoma.

Malignant solitary fibrous tumour.

Epithelioid leiomyosarcoma.

B



Histological common sub-types: ◦ Epithelioid ◦ Sarcomatoid  desmoplastic

◦ Biphasic 

Differential diagnosis ◦ Epithelioid - adenocarcinoma ◦ Biphasic- carcinosarcoma, synovial sarcoma (translocation t(X:18)) ◦ Sarcomatoid - spindle cell carcinoma, solitary fibrous tumour ◦ Desmoplastic - fibrous pleuritis

◦ Mesothelial markers - Calretinin, CK5/6, WT-1, thrombomodulin ◦ Recent mesothelial markers- D2-40, podoplanin, hcaldesmon ◦ Adeno Ca’s - CEA, BerEp4, MOC-31+ ◦ Mesotheliomas - CEA, BerEp4, MOC-31-, EMA strong membranous +, p53+ ◦ Reactive mesothelial proliferation – desmin+, E-cadherinand weak membranous staining with EMA (p53-) ◦ Cytokeratins – MNF-116/AE1/AE3/EMA stain both epithelial and mesothelial cells- cannot differentiate ◦ Sarcomatoid and desmoplastic mesotheliomas are often negative for mesothelial markers ◦ TTF-1- + in pul adenoca and small cell ca ◦ CK5/6 + in squamous cell carcinomas

Topic 2

2. CD34 is positive in which of the following tumours: a. b. c. d. e.

Dermatofibrosarcoma protuberans.

Solitary fibrous tumour.

Gastrointestinal stromal tumour.

Spindle cell lipoma.

All of the above.

E







A dermal low-grade sarcoma which exhibits a prominent storiform pattern and infiltrates the upper subcutis complex alternating translocation t(17;22)(q22;q13) D/D : Dermatofibroma- CD34-, XIIIa+





 

Seen in pleural and extrapleural locations Patternless proliferation of spindle cells, ‘keloid’ like hyalinisation, haemangioperictyomatous blood vessels Positive for CD34,bcl-2 and CD99 (triad) Fusion of NGFI-A–binding protein 2 (NAB2) and STAT6 located at chromosomal region 12q13.



Spindle cell /epithelioid cell tumour



Common in the stomach and small intestine





Perinuclear vacoulation and skeinoid fibres (PAS+ and blue on Masson’s trichrome) Typically positive for CD117(cytoplasmic and granular with membrane +ity) and DOG-1.

Often also positive for CD34, bcl-2 and SMA

www.pubcan.org

   

Mutations in c-Kit (85%) or PDGFRa gene Mutually exclusive pathways DOG-1 can be +ve in c-kit –ve GISTs DOG1is –ve in (CD117) KIT-positive tumors, such as metastatic melanoma, seminoma, Ewing sarcoma, and extramedullary myeloid tumor.

 

NF1 Carney’s triad ◦ (pulmonary chondroma, extra-adrenal paraganglioma, GIST)



Mutations in SDH pathways

Spindle Cell Lipoma







Typically seen on the shoulder/back of elderly males Bland spindle cells interspersed with ‘ropey’ collagen bundles and adipocytes Also positive for bcl-2

Other lesions which are CD34 positive:  Vascular tumours – hemangioendothelioma, angiosarcoma, Kaposi’s sarcoma.

Vascular tumours - Fli-1(93% sensitive and 100% specific), CD31, CD34 and Factor VIII 

Acute leukaemias (CD34 stains the blasts)



Epithelioid sarcoma – EMA/CK+, CD34+

Topic 3

3. The commonest phenotype of primary ovarian mucinous cystadenocarcinoma is:

a. b. c. d.

CK7 CK7 CK7 CK7

positive/CK20 negative. negative/CK20 positive. negative/CK20 negative. positive/CK20 positive

D

Combination of CK7 and CK20 is commonly used for determination of primary site of a carcinoma: 







CK7+/CK20-: breast, lung, upper GI, pancreatobiliary, ovarian (except mucinous), salivary gland, endometrium, thyroid, cervix SCCs CK7-/CK20+: colorectal, appendix and Merkel cell Ca CK7+/CK20+: upper GI, pancreato-biliary, ovarian (mucinous), TCC, endocervical adenoca CK7-/CK20-: prostate, HCC, RCC (except papillary RCC which is CK7 positive), GCT (OCT3/4, SALL-4) and adrenocortical ca



 

  

  



TTF-1 - lung (adenocarcinoma/small cell Ca) thyroid (Pax8+), occ. in ovarian ca PSA, PSAP, PSMA and P501S (Prostein) - prostate GCDFP-15, ER, mammaglobin, GATA-3 – breast (Pax8-) CDX2 - GI tract – GEJ onwards WT-1 - ovarian/peritoneal serous Ca CA125 – ovarian serous and endometrioid Pax8 – all ovarian ca (87-100%) mucinous (8%) Hepar 1 - liver (HCC) Pax2, Pax8, Renal cell carcinoma antigen, CD10 – Kidney tumours Melan A, calretinin, inhibin, SF-1 - adrenal



   

 

SF-1(steroidgenic factor 1), inhibin, calretinin, CD99, WT-1 – ovarian sex cord/stromal tumours CD10 - endometrial stromal sarcoma SMA, desmin, h-caldesmon - smooth muscle p53, ER - endometrial serous carcinoma p57 - absent in complete moles/+in partial moles p16 – CGIN, endocervical adenoca CK7, MUC-1, Cam5.2, DPAS - vulval Paget’s disease

Topic 4

An 80 year old man undergoes a skin excision biopsy for an ill-defined nodule on the face measuring 2cm in diameter: Histologically the epidermis is atrophic but otherwise normal. The sun-damaged dermis shows a pleomorphic spindle cell lesion with many mitotic figures, which does not extend into the subcutaneous tissue.

Immunohistochemically, the tumour cells are negative for AE1/AE3, MNF116, S100, smooth muscle actin and desmin. The

most likely diagnosis is:

a.Spindle

cell carcinoma. b.Synovial sarcoma c.Cutaneous leiomyosarcoma. d.Atypical fibroxanthoma e.Malignant melanoma.

D







 

Occurs on the sun-damaged skin of elderly (commonly head and neck region) Dermal nodule which may extend into the upper subcutis. Composed of pleomorphic, bizarre cells with many mitoses D/D- spindle cell SCC, melanoma, leiomyosarcoma CD10 and NKIC3 positive Benign behaviour, may show local recurrence

Topic 5

A 60 year-old male with pancytopenia undergoes a bone marrow trephine biopsy: This shows infiltration by sheets of immature blastlike cells. Immunohistochemically, these cells are negative for CD3,

CD20 and CD138 but positive for CD117, CD34 and myeloperoxidase.

The most likely diagnosis is: a.Hodgkin lymphoma. b.Acute myeloid leukaemia c.Diffuse large B-cell lymphoma. d.Plasma cell myeloma. e.Metastatic gastrointestinal stromal tumour.

B



Normal bone marrow: ◦ myeloperoxidase - myeloid cells ◦ glycophorin A - erythroid cells ◦ CD61- megakaryocytes



Atypical cells in bone marrow ◦ ◦ ◦ ◦ ◦ ◦

CD3, CD5, CD43 – T cell lymphoma CD20, CD79, PAX5 – B cell lymphomas Tdt – B/T cell ALLs CD34, CD117 - myeloblasts (AML) CD138, CD38 - plasma cell myeloma AE1/3, MNF116, cam5.2 - carcinoma mets

     

GISTs Acute myeloid leukaemia Seminoma Melanomas Mast cell neoplasms Chromophobe renal cell carcinoma

Topic 6

A 32 year old male undergoes an orchidectomy: This shows a tumour composed of pleomorphic epithelioid cells forming solid papillary and glandular patterns with areas of necrosis and many mitoses. The tumour cells are diffusely positive for AE1/3 and CD30 and show patchy positivity with placental alkaline phosphatase. They are negative for EMA and Human chorionic gonadotropin.

The most likely diagnosis is: a.Embryonal

carcinoma.

b.Seminoma.

c.Choriocarcinoma. d.Yolk

sac tumour. e.Hodgkin’s lymphoma.

A

Testicular Germ Cell Tumours Overview Tumour/Marke Oct r 3/4

PLAP

CD30 C-kit

AFP

HCG

Classical Seminoma

+

+

-

+

-

-

Spermatocytic Seminoma

-

-

-

-

-

-

Embryonal Ca

+

+

+

-

+/-

-

YST

-

-

-

-

+

-

Chorioca

-

-

-

-

-

+

Renal Eosinophilic Tumours Tumour/marker C-kit

CK7

Oncocytoma

+ve

Scattered +ve cells

Chromophobe RCC

+ve

Diffuse, strong +ve

Eosinophilic Papillary RCC

-ve

+ve

Other

Hale’s colloidal iron

  



Testicular tumours - PLAP, CD30, hCG, AE1/3, AFP, CD117 Prostate - 34BE12, p63, CK5/6, Racemase Bladder - CK20 (carcinoma in-situ), GATA-3, uroplakin, thrombomodulin, p63 and 34BE12 Renal tumours ◦ CD10, vimentin - clear cell RCC ◦ Racemase, CD10, CD15 - papillary RCC CK7 – 1>2; CK20 and E-cadherin – 2>1 ◦ CK7, CD117 - chromophobe RCC ◦ 34BE12 & Racemase – Mucinous tubular and spindle cell ca ◦ WT-1, CD57 – Metanephric adenoma

  

   

Embryonal carcinoma Classical Hodgkin’s lymphoma Anaplastic large cell lymphoma

CD30, EMA, CD138 triad: Anaplastic Large Cell Lymphoma Anaplastic myeloma Primary effusion lymphoma

Topic 7

A: B: C: D: E:

PAS with diastase.

Alcian blue Perl’s Prussian blue.

Warthin Starry.

Toluidine blue.

F: Masson Trichrome G: ZN stain H: Reticulin.

I: Congo red.

J: Von Kossa.

K: Elastic Van Gieson.

In each of the following situations, select the special stain most likely to help make a definitive diagnosis: 1. A 70 year old female suffering from rheumatoid arthritis for the past 20 years undergoes a renal biopsy for deranged renal function test: Extensive eosinophilic, homogenous appearing deposits are noted in the mesangium and capillary loops of the glomeruli.

.I

A: B: C: D: E:

PAS with diastase.

Alcian blue Perl’s Prussian blue.

Warthin Starry Toluidine blue.

F: Masson Trichrome G: ZN stain H: Reticulin.

I: Congo red.

J: Von Kossa.

K: Elastic Van Gieson.

In each of the following situations, select the special stain most likely to help make a definitive diagnosis:

2. A 25 year old female with multiple small yellow brown papules over the trunk and arms with a clinical suspicion of urticaria pigmentosa undergoes a skin biopsy.

Histologically, nodular aggregates and sheets of mast cells and eosinophils are seen in the dermis.

.E

A: B: C: D: E:

PAS with diastase.

Alcian blue.

Perl’s Prussian blue.

Warthin Starry Toluidine blue.

F: Masson Trichrome G: ZN stain H: Reticulin.

I: Congo red.

J: Von Kossa.

K: Elastic Van Gieson.

In each of the following situations, select the special stain most likely to help make a definitive diagnosis:

3. A 47 year old man undergoes a liver biopsy for mildly deranged liver function tests: The hepatocytes show prominent, brown coarse and granular cytoplasmic pigment, but no other significant abnormality.

.C

A: B: C: D: E:

PAS with diastase.

Alcian blue Perl’s Prussian blue.

Warthin Starry Toluidine blue.

F: Masson Trichrome G: ZN stain H: Reticulin.

I: Congo red.

J: Von Kossa.

K: Elastic Van Gieson.

In each of the following situations, select the special stain most likely to help make a definitive diagnosis: 4. A 67 year old immuno-compromised male presents with multiple oesophageal ulcers: A biopsy shows extensive necrosis and inflammation, but no evidence of malignancy. A few possible hyphae are noted within the necrotic debris.

.A

A: B: C: D: E:

PAS with diastase.

Alcian blue Perl’s Prussian blue.

Warthin-Starry Toluidine blue.

F: Masson Trichrome G: ZN stain H: Reticulin.

I: Congo red.

J: Von Kossa.

K: Elastic Van Gieson.

In each of the following situations, select the special stain most likely to help make a definitive diagnosis: 5. A 56 year old female with headaches undergoes a temporal artery biopsy: It shows patchy transmural inflammation.

.K

A: PAS with diastase - Fungi (also Grocott’s); alpha-1 AT globules B: Alcian blue- Mucins (intestinal metaplasia in upper gi bx, non small cell carcinomas of lung) C: Perl’s Prussian blue - Iron, haemosiderin D: Warthin-Starry - spirochaetes, Cat-scratch disease E: Toluidine blue - Mast cells F: Masson Trichrome - Collagen stain (collagenous colitis, liver fibrosis) G: ZN stain/modified ZN - Acid fast bacilli H: Reticulin - Reticlin fibres (Bone marrow fibrosis, liver architecture) I: Congo red - Amyloid J: Von Kossa - Calcium K: Elastic Van Gieson - Elastic fibres

◦ Orcein - Liver (copper associated protein, Hepatitis B surface antigen); Elastic stain ◦ Silver methenamine- Basement membrane (renal biopsies) ◦ Gram stain – bacteria ◦ Chloracetate esterase - Myeloid cells,mast cells ◦ Cresyl violet - Helicobacter (also modified Giemsa) ◦ Mucicarmine - cryptococcus

Topic 8

A: B: C: D: E: F:

Oestrogen receptor.

Thyroglobulin.

Calcitonin.

Prostase specific antigen.

Inhibin.

CK7.

G: CD56 (NCAM).

H: Melan-A. I: CA125.

J: p63.

K: WT-1

In each of the following situations, select the special stain most likely to make a definitive diagnosis:

1. A 60 year old male undergoes a bronchial biopsy: It shows infiltration by cells with scanty cytoplasm, nuclear molding, granular chromatin, inconspicuous nucleoli and many mitoses.

.G

  

 

Synaptophysin, CD56 - sensitive; less specific Chromogranin - more specific Not all are necessarily positive in every tumour Other markers (NSE, PGP9.5) CD56 also positive in myleomas, NK cell lymphomas

A: B: C: D: E: F:

Oestrogen receptor.

Thyroglobulin.

Calcitonin.

Prostase specific antigen.

Inhibin.

CK7.

G: CD56 (NCAM).

H: Melan-A. I: CA125.

J: p63.

K: WT-1

In each of the following situations, select the special stain most likely to make a definitive diagnosis: 2. A 74 year old male has a six quadrant prostate core biopsy for a high PSA: One of these cores shows a cluster of small, round glands with a back to back architecture and prominent nucleoli.

.J





34BE12, CK5/6 (High molecular weight CKs) p63 Help in the detection of small foci of prostatic carcinoma and in the exclusion of benign mimics of cancer (AAH, partial atrophy, basal cell hyperplasia, seminal vesicles)



p63, ck5/6, SMA, SMM



DCIS or invasive?



Other applications of IHC in breast pathology

A: B: C: D: E: F:

Oestrogen receptor.

Thyroglobulin.

Calcitonin.

Prostase specific antigen.

Inhibin.

CK7.

G: CD56 (NCAM).

H: Melan-A. I: CA125.

J: p63.

K: WT-1

In each of the following situations, select the special stain most likely to make a definitive diagnosis: 3. A 52 year old woman who has MEN 2a syndrome undergoes thyroidectomy. This shows an infiltrative 3cm large tumour on slicing. Histologically, it is composed of nests of epithelioid and spindle shaped cells with fairly uniform nuclei, separated by fibrous stroma containing foci of amyloid deposition.

.C



Composed of sheets and nests of spindle or epithelioid cells, stroma contains amyloid Association with MEN syndromes Positive for calcitonin, CEA, chromogranin



Other markers in thyroid tumours:





◦ Thyroglobulin, TTF-1 - thyroid follicular cell tumours ◦ CK19, HBME-1, galectin - papillary carcinoma; not specific enough to rely on

A: B: C: D: E: F:

Oestrogen receptor.

Thyroglobulin.

Calcitonin.

Prostase specific antigen.

Inhibin.

CK7.

G: CD56 (NCAM).

H: Melan-A. I: CA125.

J: p63.

K: WT-1

In each of the following situations, select the special stain most likely to make a definitive diagnosis: 4. A 72 year old female undergoes hysterectomy for an enlarged right ovarian mass: It shows a poorly differentiated adenocarcinoma with a focal papillary architecture, marked nuclear pleomorphism, prominent nucleoli and psammoma bodies.

.K

A: B: C: D: E: F:

Oestrogen receptor.

Thyroglobulin.

Calcitonin.

Prostase specific antigen.

Inhibin.

CK7.

G: CD56 (NCAM).

H: Melan-A. I: CA125.

J: p63.

K: WT-1

In each of the following situations, select the special stain most likely to make a definitive diagnosis: 5. A 68 year old male undergoes an axillary lymph node biopsy for lymphadenopathy: Histology shows replacement by malignant epithelioid and spindle shaped cells with large eosinophilic nucleoli.

He has history of excision of a dark skin nodule on the arm six months before.

.H





S100, microphthalmia transcription factor (MITF): Sensitive, less specific HMB-45, Melan A: Less sensitive , more specific (Stain lower proportion of spindle cell melanomas)

Topic 9

A: B: C: D: E: F:

Follicular lymphoma.

Anaplastic large cell lymphoma.

Classical Hodgkin’s lymphoma.

Marginal zone lymphoma.

CLL/SLL. Peripheral T-cell lymphoma

G: T-lymphoblastic lymphoma.

H: Burkitt’s lymphoma I: Angioimmunoblastic T-cell lymphoma.

J: Mantle cell lymphoma.

K: Nodular lymphocyte predominant Hodgkin’s lymphoma.

Choose the above category of lymphoma which best fits the immunoprofile given below: 1. CD5 positive/CD10 negative/CD23 positive/Cyclin D1 negative/CD20 positive.

.E

CD20

CD3

CD5

CD10

A: B: C: D: E: F:

Follicular lymphoma.

Anaplastic large cell lymphoma.

Classical Hodgkin’s lymphoma.

Marginal zone lymphoma.

CLL/SLL. Peripheral T-cell lymphoma

G: T-lymphoblastic lymphoma.

H: Burkitt’s lymphoma I: Angioimmunoblastic T-cell lymphoma.

J: Mantle cell lymphoma.

K: Nodular lymphocyte predominant Hodgkin’s lymphoma.

Choose the above category of lymphoma which best fits the immunoprofile given below: 2. CD5 positive/CD10 negative/CD23 negative/Cyclin D1 positive/CD20 positive.

.J

A: B: C: D: E: F:

Follicular lymphoma.

Anaplastic large cell lymphoma.

Classical Hodgkin’s lymphoma.

Marginal zone lymphoma.

CLL/SLL. Peripheral T-cell lymphoma

G: T-lymphoblastic lymphoma.

H: Burkitt’s lymphoma I: Angioimmunoblastic T-cell lymphoma.

J: Mantle cell lymphoma.

K: Nodular lymphocyte predominant Hodgkin’s lymphoma.

Choose the above category of lymphoma which best fits the immunoprofile given below: 3. CD5 negative/CD10 positive/Bcl-6 positive/Bcl-2 positive/CD20 positive.

.A

A: B: C: D: E: F:

Follicular lymphoma.

Anaplastic large cell lymphoma.

Classical Hodgkin’s lymphoma.

Marginal zone lymphoma.

CLL/SLL. Peripheral T-cell lymphoma

G: T-lymphoblastic lymphoma.

H: Burkitt’s lymphoma I: Angioimmunoblastic T-cell lymphoma.

J: Mantle cell lymphoma.

K: Nodular lymphocyte predominant Hodgkin’s lymphoma.

Choose the above category of lymphoma which best fits the immunoprofile given below: 4. CD10 positive/Bcl-6 positive/Bcl-2 negative/Ki67 100%/CD20 positive/c-myc positive.

.H

A: B: C: D: E: F:

Follicular lymphoma.

Anaplastic large cell lymphoma.

Classical Hodgkin’s lymphoma.

Marginal zone lymphoma.

CLL/SLL. Peripheral T-cell lymphoma

G: T-lymphoblastic lymphoma.

H: Burkitt’s lymphoma I: Angioimmunoblastic T-cell lymphoma.

J: Mantle cell lymphoma.

K: Nodular lymphocyte predominant Hodgkin’s lymphoma.

Choose the above category of lymphoma which best fits the immunoprofile given below: 5. CD3 positive/CD20 negative/EMA negative/CD30 positive/Alk-1 positive

.B











  

Small B-cell neoplasms (CLL/SLL, follicular lymphoma, mantle cell, marginal zone)- CD5, CD10, CD23, bcl-6, cyclin D1, cd43, bcl-2 DLBCL vs Burkitt’s - bcl-2, CD10, bcl-6, Ki-67, C-MYC gene testing Precursor B/T cell lymphomas – TdT Anaplastic large cell lymphoma - CD3 (often negative), CD30, ALK-1 Peripheral T cell lymphoma –NOS – CD2, CD3, CD4, CD5, CD7, CD8 NK cell lymphomas – CD56, CD57, TIA-1, granzyme, perforin Hodgkin’s lymphoma - CD30, CD15, CD20 Nodular lymphocyte predominant Hodgkin lymphoma – CD20, CD79, PAX5, OCT2, BOB1

Topic 10

     





A: B: C: D: E: F:

HMB45. p53.

CK20.

TTF-1.

Desmin.

CD10.

G: CD117.

H: Vimentin.

I: Alpha Inhibin.

J: CD34.

K: CD1a.

L: Myeloperoxidase.

In each of the following lesions, select the antibody from the above list, which is most likely to make the diagnosis: 1. Renal angiomyolipoma.

.A









Most common in the kidney but also occurs in the liver, lungs and other sites Association with tuberous sclerosis

Arises from perivascular epithelioid cells (family of tumours called PEComas) Composed of thick-walled blood vessels, smooth muscle cells and adipocytes

     





A: B: C: D: E: F:

HMB45. p53.

CK20.

TTF-1.

Desmin.

CD10.

G: CD117.

H: Vimentin.

I: Alpha Inhibin.

J: CD34.

K: CD1a.

L: Myeloperoxidase.

In each of the following lesions, select the antibody from the above list, which is most likely to make the diagnosis: 2. Endometrial stromal sarcoma.

.F

     





A: B: C: D: E: F:

HMB45. p53.

CK20.

TTF-1.

Desmin.

CD10.

G: CD117.

H: Vimentin.

I: Alpha Inhibin.

J: CD34.

K: CD1a.

L: Myeloperoxidase.

In each of the following lesions, select the antibody from the above list, which is most likely to make the diagnosis: 3. Langerhan’s cell histiocytosis.

.K









A neoplasm of Langherhans cells (a type of dendritic cell which contains Birbeck granules demonstrated by EM) Occurs in young males and commonly affects bones, skin, lymph nodes and lungs Comprises cells with elongated grooved nuclei and interspersed eosinophils Typically positive for CD1a, Langerin and S100

  

   

Langherhans cell histiocytosis Melanomas Peripheral nerve sheath tumours (neurofibroma, Schwannoma, MPNST) Granular cell tumours Cartlilagenous, adipocytic tumours Myoepithelial tumours Paragangliomas (sustentacular cells)

     





A: B: C: D: E: F:

HMB45. p53.

CK20.

TTF-1.

Desmin.

CD10.

G: CD117.

H: Vimentin.

I: Alpha Inhibin.

J: CD34.

K: CD1a.

L: Myeloperoxidase.

In each of the following lesions, select the antibody from the above list, which is most likely to make the diagnosis: 4. Merkel cell carcinoma.

.C







Commonly occurs on the sun-damaged skin of the head and neck or extremities of the elderly Morphology resembles small cell carcinoma D/D - metastatic pulmonary small cell Ca: TTF-1, CK7 and CK20

     





A: B: C: D: E: F:

HMB45. p53.

CK20.

TTF-1.

Desmin.

CD10.

G: CD117.

H: Vimentin.

I: Alpha Inhibin.

J: CD34.

K: CD1a.

L: Myeloperoxidase.

In each of the following lesions, select the antibody from the above list, which is most likely to make the diagnosis: 5. Pulmonary adenocarcinoma.

.D

Small Round Blue Cell Tumours. Arch Pathol Lab Med- Vol 132, March 2008.

CK

CD45

S100

CD99

Desmin

Myogenin/M yoD1

CD56

WT1

Ewing Sarc/ PNET

+/-

-

-

+

-

-

+/-

-

Rhabdomyosar c

-

-

-

-

+

+

+/-

-

DSRBCT

+

-

-

+/-

+

-

+/-

+

Synovial Sarc

+/-

-

+/-

+

-

-

+/-

-

Wilm’s

+/-

-

-

+/-

+

-

+

+

Neuroblastoma

+/-

-

-

-

-

-

+

-

Small cell ca

+

-

-

-

-

-

+

-

Melanoma

-

-

+

+/-

-

-

+/-

-

  

Sternberg’s diagnostic pathology Ackerman’s surgical pathology Immunohistochemistry Vade Mecum ◦ www.e-immunohistochemistry.info







Fletcher’s Diagnostic Histopathology of Tumours, 3rd edition D Nonaka. Immunohistochemical differentiation of metastatic tumours.

Diagnostic histopathology 2010; Volume 16:12:581-592 Diagnostic criteria handbook in histopathology – Paul Tadrous