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Chapter 29 - A Primer on Immunostains Flashcards

1
Q

CD31

A

Endothelial cells and megakaryocytes (cytoplasmic and membranous), also macrophages

To identify endothelial differentiation or angiosarcoma (most specific endothelial marker)

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2
Q

CD34

soft tissue

A

Endothelial cells, fibroblasts, and hematopoietic blasts (cytoplasmic and membranous)

To identify vascular sarcomas, Kaposi’s sarcoma, GIST, SFT, DFSP, epithelioid sarcoma, and some other soft tissue tumors. Synovial sarcoma is negative.

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3
Q

FVIII

blood vessels

A

Endothelial cells, megakaryocytes, platelets (cytoplasmic)

To identify endothelial differentiation

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4
Q

EMA

A

Epithelial, perineural, meningothelial cells (cytoplasmic or membranous)

To identify meningioma, perineuroma, chordoma, mesothelioma, sebaceous carcinoma and some sarcomas (synovial, epithelioid) and plasma cell neoplasms.

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5
Q

Name some entities that are EMA positive, keratin negative.

A

Meningioma, perineuroma, plasma cell myelomas.

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6
Q

GFAP

A

Glial cells (cytoplasmic)

To identify astrocytoma, GBM, ependymoma, and myoepithelial tumros of salivary gland. OGD and neuroblastoma are negative.

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7
Q

NSE (Neuron-specific enolase)

A

Neuroectodermal and neuroendocrine cells (cytoplasmic)

To identify neural differentiation but not very specific. Sensitive for neuroblastoma.

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8
Q

S-100

A

Glial cells, shwann cells, dendritic and langerhans cells, melanocytes, other mesenchymal cells (cytoplasmic and nuclear)

To identify schwannoma, gliomas, granular cell tumor, chordoma, ependymoma, MPNST, and melanocytic lesions. Breast can be positive.

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9
Q

Synaptophysin

A

Neuroendocrine cells (cytoplasmic)

To identify carcinoid, paraganglioma, pheochromocytoma, small cell, medullary carcinomas, neuroblastoma, islet cell tumors…

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10
Q

E-cadherin

A

Normal ductal and lobular cells (membranous)

Loss of staining identifies lobular carcinoma.

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11
Q

ER/PR

A

Estrogen receptor (nuclear) and progesterone receptor (nuclear)

For breast cancer prognosis (response to tamoxifen) and to identify metastatic breast cancer and some gynecologic tumors.

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12
Q

GCDFP

A

Apocrine metaplasia of breast and apocrine sweat glands (cytoplasmic)

To identify breast carcinoma and sweat/salivary gland carcinoma.

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13
Q

Her2Neu

A

Growth factor receptor, weakly expressed on normal epithelium (membranous and cytoplasmic)

To evaluate breast carcinomas (poor prognosis, response to trastuzumab)

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14
Q

Ki67

breast

A

Any proliferating cell (nuclear)

To gauge mitotic activity for prognosis

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15
Q

Alpha-actin

breast

A

Smooth muscle: myoepithelial cells, blood vessels, myofibroblasts (cytoplasmic)

To delineate myoepithelial layer and rule out invasive cancer

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16
Q

p63

breast

A

Tumor suppressor gene (nuclear)

Stains myoepithelial cells but not endothelial and fibroblasts (cleaner than actin/SMMHC). Also stains metaplastic carcinoma.

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17
Q

CK903

breast

A

Myoepithelial cells (cytoplasmic and membranous) and usual ductal hyperplasia

To differentiate usual ductal hyperplasia from DCIS. Also stains metaplastic carcinoma.

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18
Q

AE1/AE3

A

Wide panel of keratins, except 8+18 (cytoplasmic).

To identify carcinomas in general in conjunction with Cam5.2

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19
Q

Cam5.2

A

Low and intermediate-weight keratins 8, 18, and 19 (cytoplasmic)

To identify carcinomas in general in conjunction with AE1/AE3. Also identifies hepatocellular carcinoma, some adrenal cortical tumors, and some other carcinomas.

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20
Q

CK5/6

A

Two specific high-molecular-weight keratins (cytoplasmic)

To differentiate squamous cell carcinoma or mesothelioma from adenocarcinoma (negative).

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21
Q

CK7

A

A specific low-molecular-weight cytokeratin (cytoplasmic)

Positive in above-the-diaphragm carcinomas. Used in conjunction with CK20.

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22
Q

CK20

A

A specific low-molecular-weight cytokeratin (cytoplasmic)

Positive in below-the-diaphragm carcinomas and Merkel cell carcinoma. Used in conjunction with CK7.

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23
Q

What carcinomas are CK7+/CK20+?

A

Urothelial carcinoma
Pancreatic carcinoma
Ovarian mucinous carcinoma

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24
Q

What carcinomas are CK7+/CK20-?

A 
Breast carcinoma
NSCLC
Ovarian serous carcinoma
Endometrial carcinoma
Epithelial mesothelioma
Thymoma
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25
Q

What carcinomas are CK7-/CK20+?

A

Colorectal carcinoma

Merkel cell carcinoma

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26
Q

What carcinomas are CK7-/CK20-?

A 
Hepatocellular carcinoma
CCRCC
Prostate carcinoma
Neuroendocrine small cell carcinoma
Squamou cell carcinoma
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27
Q

AFP

germ cell and testis

A

Fetal tissues (cytoplasmic)

To identify yolk sac tumor and HCC

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28
Q

c-KIT

A

Germ cells, mast cells, interstitial cells of Cajal (cytoplasmic or membranous)

To identify seminoma, mature teratoma, and GIST

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29
Q

b-hCG

A

Syncytiotrophoblasts (cytoplasmic)

To identify choriocarcinoma and germ cell tumors, some adenocarcinomas

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30
Q

HPL

A

Trophoblasts (cytoplasmic)

To identify germ cell tumors, moles, and choriocarcinoma.

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31
Q

Ki-1 (CD30)

A

Activate lymphocytes

To identify embryonal carcinoma, Hodgkin’s lymphoma, and ALCL

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32
Q

PLAP

A

Placenta (cytoplasmic)

To identify germ cell tumors, ITGCN. Does not stain spermatocytic seminoma.

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33
Q

CA-125

A

(no normal tissue stains)

To identify nonmucinous ovarian carcinomas

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34
Q

Inhibin

A

Granulosa cells, Sertoli cells, others (cytoplasmic)

To identify sex cord stromal tumors (Granulosa, Sertoli, Leydig) and moles, choriocarcinomas, fibrothecomas, and adrenal cortical tumors

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35
Q

Melcam (CD146)

A

Intermediate trophoblasts

To identify PSTT, choriocarcinoma

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36
Q

Mesothelin

A

Mesothelial cells (membranous)

To identify serous ovarian carcinoma, mesothelioma, and pancreatic carcinoma (targetable for immunotherapy?)

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37
Q

p16

A

Cells infected by HPV (nuclear)

To identify HSIL & HPV lesions of cervix and to differentiate endocervical (positive) and endometrial (negative) adenocarcinoma

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38
Q

p53

A

Tumor suppressor gene variant that should be absent in normal cells (nuclear)

To identify EIC and serous carcinoma of endometrium

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39
Q

ALK

A

Fusion protein only expressed by lymphomatous cells

Stains a subset of ALCL and DLBCL. HL is negative.

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40
Q

BCL-2

A

Inhibits apoptosis, normally turns off in germinal center (cytoplasmic & membranous)

To differentiate follicular lymphoma from reactive follicles. Also stains mantle cell lymphoma. Burkitt’s is negative.

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41
Q

BCL-6

A

Germinal center cells (cytoplasmic)

To identify lymphomas of follicular origin (FCC, Burkitt’s lymphoma)

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42
Q

CD1a

A

Thymocytes and Langerhans cells (membranous)

To identify Langerhans cell proliferations, T-LBL

43
Q

CDs 3, 4, 5, 7, 8

A

T-cells

To identify T-cell lymphomas/leukemias; CD4 also dimly positive in monocyte/histiocyte lesions

44
Q

CD10

heme

A

Precursor B + T cells, granulocytes (membranous)

To identify FCC, ALL, LBL, Burkitt’s lymphoma, and CML; MALTomas are negative.

45
Q

CD20

A

B cells (cytoplasmic & membranous)

Used as a pan-B-cell marker; stains B-cell lymphomas, but plasmacytomas are negative.

46
Q

CD15 (LeuM1)

heme

A

Granulocytes and macrophages (membranous and dot-like perinuclear)

To identify RS cells (HD), some large T-cell lymphomas and mycosis fungoides

47
Q

CD23

A

B-cells, IgE receptor (membranous)

To identify SLL/CLL; mantle cell lymphomas are negative

48
Q

CD30

A

Activated B + T cells, immunoblasts, other nonheme cells (cytoplasmic, membranous)

To identify RS cells, ALCL, large B- and T-cell lymphomas

49
Q

CD34

heme

A

Hematolymphoid blasts, fibroblasts, and endothelial cells (cytoplasmic and membranous)

To identify blasts in the marrow in acute leukemias; also many soft tissue tumors

50
Q

CD45 (CLA/LCA)

A

Lymphocytes, granulocytes, and histiocytes, but not plasma cells (cytoplasmic, membranous)

To identify poorly differentiated neoplasms as of hematopoietic origin

51
Q

CD56

A

NK cells (membranous)

To idenitify natural killer/T-cell lymphomas

52
Q

CD68

A

Histiocytes/macrophages/monocytes, granulocytes, others (cytoplasmic, membranous)

To identify histiocytic origin; also stains soft tissue tumors

53
Q

CD79a

A

B-cells and plasma cells (membranous)

To identify B-cell neoplasms negative for other B-cell markers…

54
Q

CD138

A

Plasma cells (membranous), epithelial cells

To identify plasma cell neoplasms

55
Q

Cyclin D1

A

Nuclear stain in mantle cell lymphoma

To identify mantle cell lymphoma

56
Q

EBV EBER

A

EBV RNA in infected B-cells (nuclear)

To identify EBV-related tumors, including nasopharyngeal carcinoma, post-transplant/AIDS lymphomas, and mononucleosis.

57
Q

FVIII (vWF)

heme

A

Megakaryocytes, platelets, and endothelial cells (cytoplasmic)

To identify megakaryocytic leukemias

58
Q

Hemoglobin

A

Hemoglobin in erythroid cells (cytoplasmic)

To identify erythroid leukemias

59
Q

Kappa/Lambda

A

Light chains of immunoglobulins in plasma cells and B-cells (cytoplasmic)

Restricted staining indicates monoclonal B/plasma cell population

60
Q

Ki67

heme

A

Any proliferating cell (nuclear)

To gauge mitotic activity and identify Burkitt’s lymphoma (100% positivity)

61
Q

MPO

A

Enzyme granules in myeloid-lineage cells (cytoplasmic)

To identify AML and myeloid sarcoma (chloroma)

62
Q

TdT

A

Immature lymphocytes (nuclear)

To identify LBL and ALL

63
Q

RCC (gp200/RTA)

A

Proximal renal tubules (cytoplasmic)

To identify renal cell carcinoma

64
Q

TFE3

A

Transcription factor (nuclear)

To identify Xp11-translocation RCC and alveolar soft part sarcoma

65
Q

TFE3B

A

Transcription factor (nuclear)

To identify t(6;11) renal cell carcinoma

66
Q

Thrombomodulin

A

Endothelial (cytoplasmic) and mesothelial (membranous) cells

To identify TCC, mesothelioma, some vascular tumors

67
Q

WT-1

A

Tumor suppressor gene in developing nephrons; nephrogenic rests and adult glomerular podocytes (nuclear)

To identify Wilm’s tumor; also mesothelioma, desmoplastic small round cell tumor

68
Q

A1-antitrypsin

A

Histiocytes and reticulum cells (cytoplasmic)

To highlight globules of A1-antitrypsin disease; not specific to a tumor

69
Q

b-Catenin

A

APC-binding protein present in most cells (nuclear is significant and abnormal)

To identify colon cancer, abdominal fibromatosis, and solid pseudopapillary tumor of pancreas

70
Q

CD10

A

Liver canaliculi, brush border of small bowel, other tissues

A canlicular pattern in HCC

71
Q

pCEA

A

Fetal tissues and adenocarcinomas (cytoplasmic)

A canalicular pattern in HCC (not seen with mCEA); also stains lung, colon, pancreatic carcinoma

72
Q

DPC-4 clone B8

A

Most normal tissues (cytoplasmic)

To identify pancreatic carcinoma (55% lose staining)

73
Q

EGFR

A

Hepatocytes, perineurium in peripheral nerves, squamous epithelium

Prediction of response to anti-EGFR antibodies in advanced colon cancer

74
Q

HepPar1 (OCH1E5)

A

Mitochondria in normal hepatocytes (granular cytoplasmic)

To identify HCC

75
Q

BerEP4

A

Epithelial cells (membranous)

To differentiate mesothelioma from carcinoma

76
Q

mCEA and pCEA

A

Fetal tissues and mucin-secreting glandular tissues (cytoplasmic)

To differentiate mesothelioma from adenocarcinoma

77
Q

Calretinin

A

Various neural and epithelial cells (cytoplasmic and nuclear)

To differentiate epithelial mesothelioma (positive) from carcinoma (negative)

78
Q

LeuM1 (CD15)

lungs

A

Hematopoietic cells and some carcinomas (membranous and cytoplasmic)

To differentiate mesothelioma (negative) from adenocarcinoma

79
Q

TTF-1

A

Transcription factor in lung and thyroid (nuclear)

To differentiate nonsquamous carcinoma of lung origin from nonpulmonary, and to identify thyroid carcinomas.

80
Q

WT-1

A

Tumor suppressor gene in mesothelium and developing nephrons, nephrogenic rests and adult podocytes (nuclear)

To differentiate epithelial mesothelioma from carcinomas, and to identify desmoplastic small round cell tumor and Wilms’ tumor

81
Q

HMB45

A

Immature melanocytes (cytoplasmic)

To identify epithelioid melanoma, metastatic melanoma, angiomyolipoma, clear cell sarcoma, perivascular epithelioid cell tumors, and others

82
Q

MART-1/Melan-A (N2-7C10 clone)

A

Melanocytes (cytoplasmic)

To identify melanoma (mainly epithelioid), more sensitive than HMB45. Recognizes same protein as Melan-A antibody

83
Q

Melan-A (A103 clone)

A

Melanocytes (cytoplasmic)

To identify melanoma (mainly epithelioid), more sensitive than HMB45; also angiomyolipoma. Unlike MART-1, labels steroid cell tumors

84
Q

MitF

A

Melanocytes (nuclear)

To identify melanoma and melanocytic tumors, also angiomyolipoma

85
Q

S-100 protein

A

Melanocytes, glial cells, dendritic and Langerhans cells, other mesenchymal cells (nuclear and cytoplasmic)

To identify nevi and melanoma (most sensitive), cellular schwannoma, granular cell tumor, glial neoplasms. Not useful in lymph nodes.

86
Q

Chromogranin

A

Neurosecretory granules (cytoplasmic and granular) in endocrine tissues and neurons

To differentiate pheochromocytoma from adrenal cortical carcinoma (negative), or to identify neuroendocrine tumors

87
Q

Inhibin

A

Adrenal cortical cells (cytoplasmic)

To identify adrenal cortical tumors, stromal sex cord tumors, and fibrothecomas

88
Q

Synaptophysin

A

Neuroendocrine cells (cytoplasmic), neuromuscular junction, Merkel cells

To identify neuroendocrine tumors

89
Q

(various neuroendocrine hormones like gastrin, insulin)

A

(cells that produce the respective hormone)

To identify products of neuroendocrine tumors, such as islet cell tumors and others

90
Q

CK903

prostate

A

High-molecular-weight keratin (cytoplasmic and membranous) in basal cells

To identify prostatic basal cells (lost in cancer) and urothelial carcinomas (positive)

91
Q

p63

prostate

A

Prostatic gland basal cells (nuclear)

To identify basal cells (lost in cancer)

92
Q

PSA

A

Prostatic epithelium (cytoplasmic), salivary gland

To identify metastatic or ambiguous prostate cancer. Seminal vesicle is negative.

93
Q

PSAP (PAP)

A

Prostatic epithelium (cytoplasmic)

To identify metastatic or ambiguous prostate cancer and uroCA; also stains rectal carcinoids

94
Q

Racemase (p504s)

A

Prostatic carcinoma

To confirm prostate carcinoma; also stains nephrogenic adenoma of bladder

95
Q

Alpha-actin

soft tissue

A

Smooth muscle actin (cytoplasmic)

To identify smooth muscle differentiation, leiomyoma/leiomyosarcoma. Rhabdomyosarcoma is usually negative.

96
Q

Actin (HHF-35)

A

Smooth, skeletal, and cardiac muscle, myoepithelial cells (cytoplasmic)

To identify muscle differentiation

97
Q

CD99 (O13)

A

A variety of mesenchymal cells (membranous)

To identify PNET/Ewing’s, lymphocytes in thymoma, plus other sarcomas and hematologic tumors. Neuroblastoma is negative.

98
Q

Desmin

A

Intermediate filaments in smooth, striated, and cardiac muscle (cytoplasmic)

To identify muscle differentiation

99
Q

FXIIIa and CD68

A

Fibrohistiocytic cells (cytoplasmic)

To identify fibrohistiocytic tumors, such as MFH and dermatofibroma (FXIIIa), giant cell tumor of tendon sheath

100
Q

Myogenin

A

Regenerating, but not normal, skeletal muscle (cytoplasmic)

To identify rhabdomyosarcoma

101
Q

Vimentin

A

Most mesenchymal cells (cytoplasmic), including fibroblasts, endothelium, smooth muscle

As an internal control for immunoreactivity and antigen preservation (the “pan-keratin” of soft tissue)

102
Q

Calcitonin

A

C-cells of the thyroid (cytoplasm and extracellular)

To identify medullary carcinoma of thyroid

103
Q

Thyroglobulin

A

Thyroid follicles (cytoplasmic)

To identify metastatic thyroid carcinoma

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