IHC tumours

Question 1

PAX8 and WT1 are +ve in an Ovarian Ca. What are the likley Diagnosis

Answer 1

Ovarian Epithelial Carcinoma either HGSC, LGSC, CCC, less likely EMC - Not Mucinous

Question 2

PAX8, WT1 and mutated p53 +

Diagnosis

Answer 2

Likely HGSC

Question 3

A primary Ov Ca that is:
PAX8+ve,
WT1 -ve ,
p53 wt and
NAPSA +ve
HNK1B +ve
AMACR +

Answer 3

Ovarian CCC

Question 4

Primary Ovarian Cancer that is
PAX8+,
WT1 -ve,
ER/PR/Vimentin +ve
NAPSA/HNK1B/AMACR -ve
what is it

Answer 4

Endometriod Ovarian Carcinoma

Question 5

PAX8+ve
WT1-ve,
ER/PR/Vimentin -ve
NAPSA/HNF1B/ AMACR -ve

Answer 5

Mucinous Carcinoma of the Ovary

Question 6

Is the following a primary ovarian endometriod or metastatic from the uterus. PAX8 +ve, WT1 -ve, VIM +ve,

Answer 6

Uterine Endometriod Carcinoma in the Ovary

Question 7

Cervical Ca that is:
PAX8 +ve,
Vimentin –ve,
p16+ve

Answer 7

Endocervical Adenocarcinoma

Question 8

PAX8 -ve,
CK7+ve > CK20+ve, GCDFP15/Mmglb/ER/PR/HER2 +ve in an Ovarian tumour = ?

Answer 8

Mammary metatstic tumour in Ovary

Question 9

An ovarian tumour that is metastatic from?

PAX8-ve, CK7+ve > CK20+ve, CDX2/Fascin/SMAD4 loss

Answer 9

Biliopancreatic

Question 10

Ovarian tumour
PAX8 -ve,
CK20+ve > CK 7+ve,
CDX2 -ve
HER2/MUCSA/E-vecadherin loss

Answer 10

Gastric metastatic disease.

Question 11

in an ovarian Tumour

PAX8 -ve,
CK20+ > CK7+,
COX2/SATB2 /AMACR +ve

Answer 11

Appendical or colorectal Metastatic disease

Question 12

Ovarian clear cell carcinoma - most likely IHC result

Answer 12

PAX8 +ve,
WT1 -ve,
p53 wt,
NAPSA(NAPSIN) +ve
HNK1B +ve
AMACR +ve

Question 13

How will an endometrioid ovarian Ca be differentiated on IHC

Answer 13

PAX8+ve, WT1+ve, p53 wt, NAPSA/HNK1B, AMACR -v, PR/ER +ve, Vimentin +ve - often in conjunction with Endometriosis.

Question 14

Mucinous carcinoma of the ovary IHC

Answer 14

PAX8+ WT1+ NAPSA/HNF1B/ AMACR -ve ER/PR/Vimentin -ve

Question 15

Metastatic Renal Cell Carcinoma in the ovary is likely to be

Answer 15

PAX8 +ve, Vimentin +, WT1 + ALSO CD10+ve, HIF1B

Question 16

Metastatic Uterine Endometrioid to the Ovary likely to be

Answer 16

PAX8 + , VIM +, WT1 -ve, PTEN +ve, MMR loss

Question 17

Endocervical Adenocarcinoma IHC likely to be

Answer 17

p16+ve, PAX8 +, Vimentin -ve, CK7+, HPV+ve

Question 18

Mammary metastatic tumour in Ovary is likely to be?

Answer 18

PAX8 -v, e, CK7+ve > CK20+ve, GCDFP15/Mmglb/ER/PR/HER2 +ve

Question 19

Biliopancreatic metastatic tumour in an Ovary

Answer 19

PAX8-ve, CK7+ve > CK20+ve, CDX2/Fascin/SMAD4 +ve

Question 20

Gastric metastatic disease in an Ovary

Answer 20

PAX8 -ve,
CK20+ve > CK 7+ve,
CDX2/HER2/MUCSA+ve
E-cadherin loss

Question 21

By IHC how can you differentiate Appendical or colorectal Metastatic disease?

Answer 21

PAX8 -ve, CK20+ > CK7+, CDX2/SATB2 AMACR in an ovarian Tumour

Question 22

Small cell carcinoma - Hypercalcaemic type

IHC?

Answer 22

alfa1-antitripsin,
PAS +ve, and
focal laminin +ve

Question 23

Carcinosarcoma of Mullerian origin

Answer 23

Carcinomatous component:
PAX8, EMA, cytokeratin positive
Both serous and high grade endometrioid carcinomas show aberrant p53 expression
Endometrioid components can show ER, PR, vimentin positivity

Sarcomatous component:
Often aberrant p53 
Often expresses cytokeratins (more frequently focal)
Rhabdomyosarcoma: desmin and myogenin
Liposarcoma and chondrosarcoma: S100

Question 24

LMS

Answer 24

Positive stains
caldesmon, desmin and SMA, ER/PR and Keratins, EMA and CD10 common. P53 and p16 often overexpressed.

Smooth muscle markers including caldesmon, desmin and SMA, ER / PR, as well as keratins, EMA and CD10 are common (Am J Surg Pathol 2002;26:403)
p53 and p16 are often overexpressed
So

Question 25

CLear cell vs Serous

Answer 25

Serous WT1 +ve, Clear cell WT 1 -ve
Serous ER+ve, clear cell ER -ve
serous Napsin A -ve, clear cell +ve

Question 26

Endometrioid ovarian vs clear cell

Answer 26

EC Napsin A -ve and clear cell +Ve
EC WT1 -ve and clear cell Wt1 -ve
EC ER +ve, Clear cell ER -ve