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Book - Molavi > Chapter 29 - A Primer on Immunostains > Flashcards

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
What carcinomas are CK7-/CK20+?
Colorectal carcinoma | Merkel cell carcinoma
26
What carcinomas are CK7-/CK20-?
``` Hepatocellular carcinoma CCRCC Prostate carcinoma Neuroendocrine small cell carcinoma Squamou cell carcinoma ```
27
AFP | germ cell and testis
Fetal tissues (cytoplasmic) To identify yolk sac tumor and HCC
28
c-KIT
Germ cells, mast cells, interstitial cells of Cajal (cytoplasmic or membranous) To identify seminoma, mature teratoma, and GIST
29
b-hCG
Syncytiotrophoblasts (cytoplasmic) To identify choriocarcinoma and germ cell tumors, some adenocarcinomas
30
HPL
Trophoblasts (cytoplasmic) To identify germ cell tumors, moles, and choriocarcinoma.
31
Ki-1 (CD30)
Activate lymphocytes To identify embryonal carcinoma, Hodgkin's lymphoma, and ALCL
32
PLAP
Placenta (cytoplasmic) To identify germ cell tumors, ITGCN. Does not stain spermatocytic seminoma.
33
CA-125
(no normal tissue stains) To identify nonmucinous ovarian carcinomas
34
Inhibin
Granulosa cells, Sertoli cells, others (cytoplasmic) To identify sex cord stromal tumors (Granulosa, Sertoli, Leydig) and moles, choriocarcinomas, fibrothecomas, and adrenal cortical tumors
35
Melcam (CD146)
Intermediate trophoblasts To identify PSTT, choriocarcinoma
36
Mesothelin
Mesothelial cells (membranous) To identify serous ovarian carcinoma, mesothelioma, and pancreatic carcinoma (targetable for immunotherapy?)
37
p16
Cells infected by HPV (nuclear) To identify HSIL & HPV lesions of cervix and to differentiate endocervical (positive) and endometrial (negative) adenocarcinoma
38
p53
Tumor suppressor gene variant that should be absent in normal cells (nuclear) To identify EIC and serous carcinoma of endometrium
39
ALK
Fusion protein only expressed by lymphomatous cells Stains a subset of ALCL and DLBCL. HL is negative.
40
BCL-2
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.
41
BCL-6
Germinal center cells (cytoplasmic) To identify lymphomas of follicular origin (FCC, Burkitt's lymphoma)
42
CD1a
Thymocytes and Langerhans cells (membranous) To identify Langerhans cell proliferations, T-LBL
43
CDs 3, 4, 5, 7, 8
T-cells To identify T-cell lymphomas/leukemias; CD4 also dimly positive in monocyte/histiocyte lesions
44
CD10 | heme
Precursor B + T cells, granulocytes (membranous) To identify FCC, ALL, LBL, Burkitt's lymphoma, and CML; MALTomas are negative.
45
CD20
B cells (cytoplasmic & membranous) Used as a pan-B-cell marker; stains B-cell lymphomas, but plasmacytomas are negative.
46
CD15 (LeuM1) | heme
Granulocytes and macrophages (membranous and dot-like perinuclear) To identify RS cells (HD), some large T-cell lymphomas and mycosis fungoides
47
CD23
B-cells, IgE receptor (membranous) To identify SLL/CLL; mantle cell lymphomas are negative
48
CD30
Activated B + T cells, immunoblasts, other nonheme cells (cytoplasmic, membranous) To identify RS cells, ALCL, large B- and T-cell lymphomas
49
CD34 | heme
Hematolymphoid blasts, fibroblasts, and endothelial cells (cytoplasmic and membranous) To identify blasts in the marrow in acute leukemias; also many soft tissue tumors
50
CD45 (CLA/LCA)
Lymphocytes, granulocytes, and histiocytes, but not plasma cells (cytoplasmic, membranous) To identify poorly differentiated neoplasms as of hematopoietic origin
51
CD56
NK cells (membranous) To idenitify natural killer/T-cell lymphomas
52
CD68
Histiocytes/macrophages/monocytes, granulocytes, others (cytoplasmic, membranous) To identify histiocytic origin; also stains soft tissue tumors
53
CD79a
B-cells and plasma cells (membranous) To identify B-cell neoplasms negative for other B-cell markers...
54
CD138
Plasma cells (membranous), epithelial cells To identify plasma cell neoplasms
55
Cyclin D1
Nuclear stain in mantle cell lymphoma To identify mantle cell lymphoma
56
EBV EBER
EBV RNA in infected B-cells (nuclear) To identify EBV-related tumors, including nasopharyngeal carcinoma, post-transplant/AIDS lymphomas, and mononucleosis.
57
FVIII (vWF) | heme
Megakaryocytes, platelets, and endothelial cells (cytoplasmic) To identify megakaryocytic leukemias
58
Hemoglobin
Hemoglobin in erythroid cells (cytoplasmic) To identify erythroid leukemias
59
Kappa/Lambda
Light chains of immunoglobulins in plasma cells and B-cells (cytoplasmic) Restricted staining indicates monoclonal B/plasma cell population
60
Ki67 | heme
Any proliferating cell (nuclear) To gauge mitotic activity and identify Burkitt's lymphoma (100% positivity)
61
MPO
Enzyme granules in myeloid-lineage cells (cytoplasmic) To identify AML and myeloid sarcoma (chloroma)
62
TdT
Immature lymphocytes (nuclear) To identify LBL and ALL
63
RCC (gp200/RTA)
Proximal renal tubules (cytoplasmic) To identify renal cell carcinoma
64
TFE3
Transcription factor (nuclear) To identify Xp11-translocation RCC and alveolar soft part sarcoma
65
TFE3B
Transcription factor (nuclear) To identify t(6;11) renal cell carcinoma
66
Thrombomodulin
Endothelial (cytoplasmic) and mesothelial (membranous) cells To identify TCC, mesothelioma, some vascular tumors
67
WT-1
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
A1-antitrypsin
Histiocytes and reticulum cells (cytoplasmic) To highlight globules of A1-antitrypsin disease; not specific to a tumor
69
b-Catenin
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
CD10
Liver canaliculi, brush border of small bowel, other tissues A canlicular pattern in HCC
71
pCEA
Fetal tissues and adenocarcinomas (cytoplasmic) A canalicular pattern in HCC (not seen with mCEA); also stains lung, colon, pancreatic carcinoma
72
DPC-4 clone B8
Most normal tissues (cytoplasmic) To identify pancreatic carcinoma (55% lose staining)
73
EGFR
Hepatocytes, perineurium in peripheral nerves, squamous epithelium Prediction of response to anti-EGFR antibodies in advanced colon cancer
74
HepPar1 (OCH1E5)
Mitochondria in normal hepatocytes (granular cytoplasmic) To identify HCC
75
BerEP4
Epithelial cells (membranous) To differentiate mesothelioma from carcinoma
76
mCEA and pCEA
Fetal tissues and mucin-secreting glandular tissues (cytoplasmic) To differentiate mesothelioma from adenocarcinoma
77
Calretinin
Various neural and epithelial cells (cytoplasmic and nuclear) To differentiate epithelial mesothelioma (positive) from carcinoma (negative)
78
LeuM1 (CD15) | lungs
Hematopoietic cells and some carcinomas (membranous and cytoplasmic) To differentiate mesothelioma (negative) from adenocarcinoma
79
TTF-1
Transcription factor in lung and thyroid (nuclear) To differentiate nonsquamous carcinoma of lung origin from nonpulmonary, and to identify thyroid carcinomas.
80
WT-1
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
HMB45
Immature melanocytes (cytoplasmic) To identify epithelioid melanoma, metastatic melanoma, angiomyolipoma, clear cell sarcoma, perivascular epithelioid cell tumors, and others
82
MART-1/Melan-A (N2-7C10 clone)
Melanocytes (cytoplasmic) To identify melanoma (mainly epithelioid), more sensitive than HMB45. Recognizes same protein as Melan-A antibody
83
Melan-A (A103 clone)
Melanocytes (cytoplasmic) To identify melanoma (mainly epithelioid), more sensitive than HMB45; also angiomyolipoma. Unlike MART-1, labels steroid cell tumors
84
MitF
Melanocytes (nuclear) To identify melanoma and melanocytic tumors, also angiomyolipoma
85
S-100 protein
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
Chromogranin
Neurosecretory granules (cytoplasmic and granular) in endocrine tissues and neurons To differentiate pheochromocytoma from adrenal cortical carcinoma (negative), or to identify neuroendocrine tumors
87
Inhibin
Adrenal cortical cells (cytoplasmic) To identify adrenal cortical tumors, stromal sex cord tumors, and fibrothecomas
88
Synaptophysin
Neuroendocrine cells (cytoplasmic), neuromuscular junction, Merkel cells To identify neuroendocrine tumors
89
(various neuroendocrine hormones like gastrin, insulin)
(cells that produce the respective hormone) To identify products of neuroendocrine tumors, such as islet cell tumors and others
90
CK903 | prostate
High-molecular-weight keratin (cytoplasmic and membranous) in basal cells To identify prostatic basal cells (lost in cancer) and urothelial carcinomas (positive)
91
p63 | prostate
Prostatic gland basal cells (nuclear) To identify basal cells (lost in cancer)
92
PSA
Prostatic epithelium (cytoplasmic), salivary gland To identify metastatic or ambiguous prostate cancer. Seminal vesicle is negative.
93
PSAP (PAP)
Prostatic epithelium (cytoplasmic) To identify metastatic or ambiguous prostate cancer and uroCA; also stains rectal carcinoids
94
Racemase (p504s)
Prostatic carcinoma To confirm prostate carcinoma; also stains nephrogenic adenoma of bladder
95
Alpha-actin | soft tissue
Smooth muscle actin (cytoplasmic) To identify smooth muscle differentiation, leiomyoma/leiomyosarcoma. Rhabdomyosarcoma is usually negative.
96
Actin (HHF-35)
Smooth, skeletal, and cardiac muscle, myoepithelial cells (cytoplasmic) To identify muscle differentiation
97
CD99 (O13)
A variety of mesenchymal cells (membranous) To identify PNET/Ewing's, lymphocytes in thymoma, plus other sarcomas and hematologic tumors. Neuroblastoma is negative.
98
Desmin
Intermediate filaments in smooth, striated, and cardiac muscle (cytoplasmic) To identify muscle differentiation
99
FXIIIa and CD68
Fibrohistiocytic cells (cytoplasmic) To identify fibrohistiocytic tumors, such as MFH and dermatofibroma (FXIIIa), giant cell tumor of tendon sheath
100
Myogenin
Regenerating, but not normal, skeletal muscle (cytoplasmic) To identify rhabdomyosarcoma
101
Vimentin
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
Calcitonin
C-cells of the thyroid (cytoplasm and extracellular) To identify medullary carcinoma of thyroid
103
Thyroglobulin
Thyroid follicles (cytoplasmic) To identify metastatic thyroid carcinoma

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