Dr Sarma’s guide to immunostains in Dermatopathology

Dr Sarma’s guide to immunostains for Dermatopathology

 

            Dr Sarma’s guide for immunostains for Dermatopathology

 

 

  1. 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.

 

  1. 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

 

  1. Vascular tumors:

 

CD31………Cytoplasmic membrane stain: Endothelial cells

CD34 ……..Cytoplasmic                                 : Endothelial cells

Factor VIII…Cytoplasmic                                 : Endothelial cells

 

  1. 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

 

 

 

  1. 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

 

  1. 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

 

 

  1. 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)