What's my stain, what's my stain Flashcards
Alveolar soft part sarcoma
TFE3 +, transcription factor PAS-D+ rhomboid crystals, t(X,17), ASPL-TFE3 fusion gene
Synovial sarcoma
TLE1, EMA, CK7 (epithelial and spindle component), t(X,18), SSX-SS18 fusion gene
Solitary fibrous tumor
STAT6 + BCL2 + CD34 + CD99+
Myofibroma
SMA+ MSA+ Desmin -
Paraganglioma
Chromo +, synapto + main tumor cells Sustentacular cells: s100+ ***same as a pheochromocytoma- these tumor are only different because paraganglioma is outside adrenal and pheochromcytoma is inside the adrenal medulla
Granular cell tumor
S100+, CD68+
Congenital epulis
S100-
Hemangioma of infancy
GLUT1 +
Leiomyoma
MSA +, SMA +, desmin +
Liposarcoma
MDM2 +, CDK4+….FISH to see amplification. IHC for these is less specific, especailly when done separate. MDM2 and CDK4 IHC together is more specific but less sensitive than MDM2 IHC alone
Angiosarcoma
Factor 8 +, CD31 +, CD34+ FLI-1 +, ERG +
Kaposi sarcoma
HHV 8 + aka LANA-1 + (protein encoded by HHV8) ERG+ CD34+ CD31 + (some but not all) FLI-1 + (so HHV8 differentiates from angiosarc)
Rosai-Dorfman Disease
CD68+ CD163+ S100 + CD1a -
Secretory Carcinoma
Secretory Material: PAS Alcean Blue Mammaglobin Tumor cells Mammaglobin S100 STAT5a BRST2 (aka GCDFP15) CKs Myoepithelial markers are negative Molecular: t(12,15) ETV6-NTRK3
Neurofibroma
S100 + CD34 +
Pleomorphic Adenoma
Myoepithelial markers: p63 + SMA + Epithelial markers: CAM5.2 CK7 Genetic mutation: PLAG1 + (IHC or ISH) Neuro / Dendritic markers: SOX10 + GFAP +
Melanoma
S100+ (spindle cell melanoma retains) Melan-A+ HMB45 + SOX10 + (spindle cell melanoma retains) Tyrosinase + MITF+
Small Round Blue Cell Tumor
MR SLEEP Melanoma (S100,SOX10,HMB45,Melan-A, etc) Rhabdomyosarcoma(Desmin,Myogenin, MyoD1) Sinonasal Undiff Ca (SNUC) (AE1/AE3, PanCK) Lymphoma (CD45, CD20, CD3) Ethesioneuroblastoma (olfactory) (S100, Synapto,Chromo,) Ewing Sarcoma (CD99, SMARCB1, FLI-1) Pituitary Adenoma (EGFR, Synapto,Chromo, Negative for most hormone markers (TSH,ACTH,LH,GH,FSH))
Langerhans Cell Histiocytosis
aka: eosinophilic granuloma (solitary) CD1a + S100 + Langerin + (AKA CD207)
Rosai-Dorfman
Aka: LN sinus histiocytosis with massive LAD CD68+ S100 + CD163 + CD1a - (emperipoesis on histo)
Osteosarcoma
MDM2 amplification on FISH
SATB2+ IHC
MDM2 and CDK4 coexpression (IHC or FISH amplification) to help diagnose low grade osteosarcomas and high grade osteosarcomas that progressed from low grade osteosarcomas
Plasma cell neoplasm
CD138+, CD79a+, Kappa / Lamda ISH
(since you always need a reminder: histiocytes are cd68, cd163)
Ectomesenchymal Chondromyxoid tumor
GFAP +
Granulomatous inflammation
AFB, GMS, PAS
DIF Patterns: Lupus Erythematosus
SHAGGY / GRANULAR band at basement membrane zone with IgM, IgG, C3
IIF Pattern: Wegner Granulomatosis
PR3-ANCA (Proteinase-3 antineutrophil cytoplasm antibodies, prev c-ANCA) and MPO-ANCA (myeloperoxidase, prev p-ANCA) directed against cytoplasmic components of neutrophils
IIF Pattern: Lichenoid drug reactions
string of pearls (annular pattern) along cell membrane of the basal cell layer with IgG
DIF Patterns: Pemphigus Vulgaris
“Chicken wire” IgG, IgM, C3 in intercellular spaces of epithelial cells
DIF Patterns: Paraneoplastic pemphigus
weakly positive IgG, C3 intercellular zones of the epithelium AND/OR a linear deposition at the basement membrane zone
DIF Patterns: Mucous membrane pemphigoid
linear band of immunoreactants )IgG, C3 at the basement membrane zone
DIF Patterns: Bullous pemphigoid
Continuous linear band of immunoreactants (IgG, C3) localized to the basement membrane zone
DIF Patterns: Erythema multiforme
Non-diagnostic (granular C3 + around blood vessels)
DIF Patterns: Lichen Planus
Fibrinogen basement membrane zone
DIF: Chronic Ulcerative Stomatitis
“speckled” IgG in the basal and parabasal nuclei
Ewing sarcoma
CD99, FLI-1, SMARCB1
Acinic Cell Carcinoma
DOG1, SOX10, PASD+ , NR4A3+ (due to t(4,9))
Adenoid Cystic Carcnoma
Biphasic (ducal and myoepithelial): Epithelial Markers: CAM5.2, CK7 Myoepithelial Markers: P63+, P40+ Others: CKIT
Polymorphous Adenocarcinoma
Monophasic (ducal proliferation only): Epithelial Markers: CAM5.2, CK7 Myoepithelial markers: P63+, P40-
Malignant peripheral nerve sheath tumor
S100, SOX10
CEOT
Congo red +, apple green birefringence
Nodular Faciitis
MYH9-USP6 gene fusion SMA+ MSA+ Calponin + S100 - Desmin -
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Pemphigus Vulgaris: “Chicken wire” IgG, IgM, C3 in intercellular spaces of epithelial cells
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Pemphigus Vulgaris
“Chicken wire” IgG, IgM, C3 in intercellular spaces of epithelial cells
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Mucous membrane pemphigoid
linear band of immunoreactants )IgG, C3 at the basement membrane zone
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Mucous membrane pemphigoid
linear band of immunoreactants )IgG, C3 at the basement membrane zone
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Erythema multiforme
Non-diagnostic (granular C3 + around blood vessels)
Regezi: “EM: non-specific fine granular basement membrane zone fluorescence for C3”
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Lichen Planus
Fibrinogen highlighted in basement membrane zone
Regezi: “BMZ and supericial LP fluor for fibrinogen and apoptotic body fluorescence for IgM”
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Lichen Planus
Fibrinogen (shaggy?), basement membrane zone
Regezi: “BMZ and supericial LP fluor for fibrinogen and apoptotic body fluorescence for IgM”
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Lupus Erythematosus
SHAGGY / GRANULAR band at basement membrane zone with IgM, IgG, C3
Regezi :”course-granular BMZ for IgM”
Metastatic Renal Cell Carcinoma
PAX 8+, CD10 +, CAIX +
Metastatic Prostate Adenocarcinoma
FOXA1+, HSD3B2+, ROCK1, AMACR, PSA, PAP, NKX3
Metastatic Breast, Invasive Ductal Carcinoma
MUC4, EMA, CK7, ER/PR, GATA3
Metastatic Lung Adenocarcinoma
CK7, NAPSIN-A, TTF-1
Metastatic Thyroid Carcinoma
TTF-1, Thyroglobulin, PAX8
Metastatic Colon Adenocarcinoma
CDX2, CK20, AMACR, CD10 (stromal cells)
Merkel Cell Carcinoma
CK20 (classic dot-like perinuclear), MCPyV, Chromo/Synapto, CD56
Myopericytoma
SMA +
h-caldesmon +
rare desmin
Myofibroma
muscle specific actin (MSA/HHF35) +
SMA +
Desmin -
pan-actin +
Inflammatory myofibroblastic tumor
POsitive: SMA, alpha smooth muscle actin, calponin, ALK
Glioma
GFAP
Fibrous Histiocytoma
CD163, CD168, FactorXIIIa
Histiocyte markers
CD68, CD163, CD168
Glomus Tumor
Positive for SMA, MSA, calponin, h-caldesmon, collagen type IV; negative for cytokeratin and S100