Dr Sarma’s guide to immunostains in Dermatopathology
Dr Sarma’s guide to immunostains for Dermatopathology
Dr Sarma’s guide for immunostains for Dermatopathology
- Melanocytic tumors:
S100………Nuclear/cytoplasmic stain: all melanomas, desmoplastic melanoma HMB-45…..Cytoplasmic stain
Melan-A…..Cytoplasmic stain MITF………Nuclear stain Tyrosinase…Fine granular cytoplasmic stain
Ki-67 ……..Nuclear stain : < 5% in nevi, 10-30% in melanoma and Spitz nevus.
- Soft tissue tumors:
Vimentin….Cytoplasmic stain (mesenchymal cells, fibroblasts, endothelial cells,
macrophages)
CD34……..Cytoplasmic stain: DFSP, blood vessels, MFH, epitheliod sarcoma
SMA………Cytoplasmic stain: Smooth muscle (Leiomyoma, leiomyosarcoma,
Glomus tumor)
Desmin……Cytoplasmic stain: Striated and smooth muscle.
MSA………Cytoplasmic stain: Striated and smooth muscle.
CD68… …..Cytoplasmic stain: .Histiocytic cells (MFH, AFX)
CD99………Cytoplasmic stain: AFX, DFSP
Factor XIIIa..Cytoplasmic stain: DF, juvenile xanthogranuloma
- Vascular tumors:
CD31………Cytoplasmic membrane stain: Endothelial cells
CD34 ……..Cytoplasmic : Endothelial cells
Factor VIII…Cytoplasmic : Endothelial cells
- Neural and neuroendocrine tumors:
S100……..Nuclear/cytoplasmic stain: all neural
NSE…… Cytoplasmic stain: Neuroendocrine & Merkel cell
Chromogranin..Cytoplasmic stain: Neuroendocrine & Merkel cell
Synaptophysin: Cytoplasmic stain: Neuroendocrine & Merkel cell
Cytokeratin 20: Perinuclear dot staining for Merkel cell (MOST SPECIFIC)
Thyroid transcription factor 1: Nuclear stain: Negative for Merkel cell
- Epidermal and adnexal tumors:
AE1/AE3…Cytoplasmic stain: SCC
CK 5/6 (high mol wt): squamous differentiation, adnexal tumors
CK 903: Poorly differentiated SCC
CK 7: Paget’s disease (SPECIFIC)
CEA: Glandular differentiation
EMA: Eccrine, apocrine, sebaceous tumors
Gross cystic disease fluid protein 15: Apocrine tumors
CAM 5.2: Stains LMW keratins in glandular tumors
Ber-EP4: Positive for BCC and sebaceous tumors, Negative for SCC.
BCL-2: Positive for BCC
BCC vs SCC: AE1/AE3, CK 5/6, BCL-2, Ber-EP4
- Lymphocytic tumors:
For all leukocyte: CD45 (Leukocyte Common Antigen, LCA)
For T-cells: CD3, CD5, CD30
For B-cells: CD20, 79a
For Plasma cell: CD138
- Infectious disease:
CMV …..Nuclear/cytoplasmic stain HSV ……Nuclear/cytoplasmic stain
HHV 8…..Nuclear/cytoplasmic stain: Kaposi’s sarcoma
USUAL SCREENING ORDER FOR MELANOMA
S100, HMB-45, Melan-A, MITF
FOR SPINDLE CELL TUMOR
AE1/AE3 (SCC), S-100 (Melanoma and neural tumor), SMA (Leiomyosarcoma), CD34 (DFSP), CD68 (Superficial MFH)