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346 terms

Immunohistochemistry

STUDY
PLAY
CK7+, CK20+
Pancreaticobiliary, Stomach, Rectum
Bladder
Ovary - mucionous carcinoma
CK7+, CK20-
Endometrium, Ovary (non-mucinous)
Breast
Salivary gland, Thyroid, Lung
Mesothelioma, Kidney - papillary RCC
(BLOK MEST)
CK7-, CK20+
Colon
Merckel cell carcinoma
CK7-, CK20-
Liver (HCC), Kidney (clear cell RCC)
Prostate
Adrenal cortex
CK+, EMA-
HCC, Embryonal carcinoma, Yolk sac carcinoma
Adrenocortical neoplasms, Neuroendocrine neoplasms
Thyroid
(HEY, ANT)
CK-, EMA+
Meningioma, Perineurioma
Plasma cell neoplasms, Anaplastic large cell lymphoma, Lymphocyte predominant cells
RCC
CEA+
Stomach, Colorectum, Pancreaticobiliary
HCC (canalicular)
Lung adenocarcinoma
CEA-
Mesothelioma
Kidney, Adrenal, Prostate
Ovary, Endometrium
(POEMKA)
Vimentin (+) carcinomas
Endometrium
Thyroid, Salivary gland, Sweat gland
Spindle cell carcinoma, Mesothelioma, RCC, clear cell
(SSSR MET)
Vimentin (-) carcinomas
RCC, chromophobe, Prostate
Endocervix (adenocarcinoma), Ovary
Lung carcinoma, Breast
Colorectum, HCC
(REP BLOCH)
Skeletal muscle
Positive (+) Desmin, MyoD
Negative (-) SMA
Smooth muscle
Positive (+) Desmin, SMA, Calponin, Caldesmon
Negative (-) MyoD
Myoepithelial cells
Positive (+) Desmin, SMA, Calponin, Caldesmon
Negative (-) MyoD
Myofibroblast
Positive (+) Desmin, SMA,
Negative (-) MyoD, Calponin, Caldesmon
Neuroendocrine differentiation
Synaptophysin, Chromogranin
NSE
CD56
Melan-A
Positive (+)
Epitheloid melanoma, normal melanocytes, nevi
Adrenocortical neoplasms, Sex-cord stromal tumors
Pecomas (angiomyolipoma, sugar tumor, )
Pigmented tumors

Negative (-)
Spindle cell melanoma, Desmoplastic melanoma
HMB45
Positive (+)
Epitheloid melanoma
Pecomas (angiomyolipoma, sugar tumor, )

Negative (-)
Spindle cell melanoma, Desmoplastic melanoma, normal melanocytes
Adrenocortical neoplasms, Sex-cord stromal tumors
Mature nevus cells (matures toward the base)
S100
Positive (+)
Melanomas, normal melanocytes
Myoepithelial, Nerve sheath ,Granular cell tumors, glioma
Chordoma ,Lipomatous tumors, Cartilage
Langerhans cell histiocytosis
Gliomas
Positive (+) GFAP , S100
Negative (-) CK8, CK18, MNF-116
Vascular differentiation
CD31
CD34
Factor VIII
CD34 (+)
Vascular
Solitary fibrous tumor, DFSP
GIST, Epitheliod sarcoma
Nerve sheath tumor
Granulocytic sarcoma
Prostate cancer (Basal cells vs Acinar)
Basal cells - CK903 (-), p63 (+)
Malignant acinar cells - Racemase (+)
Breast (myoepithelial cells)
Positive (+) SMA, Calponin, p63, S100, CD10
Panel for undifferentiated malignant neoplasms
CK
EMA
S100
CD45
Prostate
PSA
PSAP
P501S
Lung
TTF-1
Thyroid (papillary, follicular)
TTF-1
Thyroglobulin
PAX8
Thyroid (medullary)
TTF-1
Calcitonin
Liver
HepPar-1
Canalicular CD10
Kidney
PAX2
PAX8
RCC
CD10
Adrenal
Inhibin
Melan-A
GYN tract
PAX8
ER/PR (Endomerioid - 100%, serous 50%)
WT1 (serous carcinoma)
Pituitary
Prolactin
GH
ACTH
TSH
LH/FSH
Parathyroid
PTH
Pancreatic islet
Insulin
Glucagon
Somatostatin
Bladder
p63
Thrombomodulin
Uroplakin
GATA3
Intestine
CDX2
Villin
SCC (cervix, anus, tonsil)
HPV
p16
TTF-1
Lung (non-squamous), Small cell lung
Thyroid
Small cell extrapulmonary
Subset ot GYN
CDX2
Large and small bowel
Carcinomas of GI phenotype (adenoca of bladder, mucinous BAC) - variable
PAX2
Pan-renal
PAX8
Pan-renal
Pan-Mullerian (uterus, ovary)
Thyroid
HepPar1
Hepatocellular differentiation
HCC
Hepatoid carcinomas
Panel for small round blue cell tumors
CK EMA
CD45
CD99
SYN, CHR,
TTF1
WT1
Desmin
Lymphoblastic lymphoma
CD45
CD99
TdT
CD34
CD3
Rhabdomyosarcoma, solid alveolar
Desmin
Myo D
Wilms tumor blastema predominant
CK
EMA
WT1
Desmin (blastema)
PNET/Ewing
CD99
NSE
SYN
PAS
Neuroblastoma
SYN (+)
CD99 (-)
Medulloblastoma
SYN (+)
GFAP variable
Small cell carcinoma
CK, EMA (dotlike, perinuclear)
SYN, CHR, NSE, CD56
TTF1
Merckel cell carcinoma
CK, EMA (dotlike, perinuclear)
SYN, CHR, NSE, CD56
CD20+
Desmoplastic small round cell tumor
CK, EMA
NSE
WT1
Desmin
Mesenchymal chondrosarcoma
CD99
S100
Panel for spindle cell tumors
CK, EMA
S100
SMA
Desmin
CD34
Leyomyoma
Desmin
SMA
Leyomyosarcoma
Desmin
SMA
CD99 variable
Rhabdomyosarcoma
Desmin
MyoD
Neurofibroma
S100 (focal)
CD34
Schwannoma
S100 (diffuse)
CD34
MPNST
S100 (focal)
CD34
CK, EMA (focal)
Vascular
CD34
CD31
Fibromatosis
SMA
B catenin
Nodular fasciitis
SMA
CD68
Inflammatory myofibroblastic tumor
SMA, Desmin - (+/-)
Dermatofibroma
CD34 (-)
Factor XIII (+)
Dermatofibrosarcoma protuberans
CD34 (+)
Factor XIII (-)
GIST
c-kit
CD34
DOG1
Bcl-2
Solitary fibrous tumor
CD34
Bcl-2
Hemangiopericytoma
CD34
Bcl-2
Synovial sarcoma
CK, EMA (focal)
Calponin
Bcl-2
CD56

CD34 (-) always
Spindle cell carcinoma
CK, EMA
Spindle cell melanoma
S100 (diffuse)
Estrogen/Progesteron receptor Expression Breast
>1% - Positive
<1% - Negative
HER2 receptor Expression (Breast)
Only membrane
<30% - 0 - Negative
>30% partial membrane staining - 1+ - Negative
>30% complete membrane staining (weak to moderate) - 2+ - Weakly positive
>30% complete membrane staining (moderate to strong) - 3+ - Strongly positive
Breast carinoma, general
Positive (+) CK7+, ER/PR, Her2
Negative (-) CK20-
Metaplastic breast carcinoma
Positive (+) CK903, p63
Phyllodes tumor (stromal)
Positive (+) CD34, ER +/-, B-cathenin +/-
Negative (-) CK903, SMA
Breast fibromatosis
Positive (+) SMA, B-cathenin,
Negative (-) CK903, CD34, ER
Undifferentiated tumors panel
Pan-keratin
CD 45 (CLA)
S-100
Vimentin
Carcinoma panel
Pan-keratin
CK5/6
MNF-116
CK8, CK18
CK903
Sarcoma panel
Pan-keratin
Vimentin
S-100
Desmin
CD45
SMA
Myoglobin
Factor VIII antigen
CD34
CD31
CD99
Lung panel
CK7
CK20
TTF-1
Gastrointestinal panel
CEA
CDX-2
CK7
CK20
Mesothelioma
Positive (+) Calretinin, WT1, CK 5/6, Thrombomodulin, EMA (membranous), MNF (perinuclear), Vimentin
Negative (-) CEA, CD15
Melanoma panel
S-100
HMB-45
Melan A
Vimentin
Pan-keratin
CNS/neural panel
GFAP
S-100
NSE
Vimentin
Pan-keratin
Synaptophysin
Neuroendocrine panel
NSE
Chromogranin
Synaptophysin
Nonsquamous keratin
CD57
Urothelial panel
p63
Uroplakin
Lung squamous cell carcinoma
CK7 -
CK20 -
TTF-1 - (90%)
Lung adenocarcinoma
Positive (+) CK7, 8, 18, 19, CEA, TTF-1
Negative (- ) CK20 (-)
Lung neuroendocrine carcinomas
Positive (+) CK7, TTF-1
Negative (- ) CK20
Pulmonary blastoma
Positive (+) Cytokeratin , TTF-1, CEA, EMA, AFP
Solitary fibrous tumor
Positive (+) CD34, Bcl-2, Vimentin
Negative (- ) Cytokeratins, S-100, Actin, Desmin
Epithelioid mesothelioma
Positive (+) Calretinin, WT1, keratin 5/6
Negative (- ) CEA, TTF-1
Thymoma
Positive (+) CK19, EMA, CEA, CD57. In lymphocyte-rich - CD1, TdT
Negative (- ) CK20
Paraganglioma
Positive (+) Chromogranin, synaptophysin,NSE. S-100- sustentacular cells
Neuroblastoma
Positive (+) NSE, chromogranin, synaptophysin
Negative (- ) CD99
PNET
Positive (+) CD99, NSE, CD57, synaptophysin, chromogranin
Breast acinar epithelial cells
Positive (+) CK18, CK19, EMA
Breast myoepithelial cells
Positive (+) calponin, p63, SMA, CD10,
Hepatocellular carcinoma
Positive (+) HepPar-1, AFP, Canalicular: CD10, CEA
Negative (- ) CK7, CK20, Chromogranin
Hepatoblastoma
Positive (+) HepPar-1, AFP
Cholangiocarcinoma
Positive (+) CK7, CK20 (+/-), Cytoplasmic: CEA.
Negative (- ) HepPar-1, AFP
Hemangioendothelioma
Positive (+) CD31, CD34, Factor VIII
Negative (- ) CEA
Angiosarcoma
Positive (+) CD31, CD34, Factor VIII
Hepatocytes
Positive (+) CK8, CK18, HepPar-1
Negative (- ) Vimentin, EMA, CK7, CK 20, CK19
Bile canaliculi
Positive (+) pCEA, CD10
Mallory hyalins
Positive (+) CK18 Occasionally CK7 , CK19
Negative (- )
Hepatic sinusoidal endothelial cells
Positive (+) in chronic diseases and HCC CD31, CD34, Factor VIII
Negative (- ) Normally CD31, CD34, Factor VIII
Bile ducts
Positive (+) CK7, CK19, CK8, CK18
Bile duct lesions panel
PAS diastase - basement membrane: bile duct injury, PBS
Trichrome - Collagen I - identification of bile ducts
CK 7, 8, 18, 19, EMA - bile duct epithelium - ductopenia
CEA - differentiation HCC from cholangiocarcinoma
Mycosis fungoides
Positive (+) CD4, CD3,
Negative (- ) CD8
MNF-116
Positive (+) All carcinomas
Negative (- ) HCC, adrenocortcal neoplasms,
(+/-) RCC (EMA+), NE (CK8,18+)
DD Paget vs SCC in situ
Paget CK8,18 +,CK903 -
SCC in situ CK8,18 -,CK903 +
DD prostate carcinoma vs urothelial carcinoma
Prostate carcinoma CK903 -
Urothelial carcinoma CK903 +
CK and EMA positive non carcinomas
Synovial sarcoma, epitheloid sarcoma, epitheloid angiosarcoma,
Yolk sac tumor, Embryonal carcinoma, trophoblastic tumors,
Mesothelioma, thymoma, chordoma
High grade MPNST, melanoma, leiomyosarcoma
Gliomas, reactive astrocytes (EMA negative)
DD RCC vs adrenocortical neoplasms
RCC - EMA +
Adrenocortical neoplasms EMA -
DD normal urothelium vs urothelial carcinoma in situ
Normal urothelium p53 -, CK20 (umbrella cells only), E-cadherin (all layers),
Urothelial carcinoma in situ p53 + CK20 (all llayers), E-cadherin (-),
DD bladder muscularis mucosa vs muscularis propria
Muscularis mucosa or desmoplastic myofibroblasts Vimentin +
Muscularis propria Vimentin -
DD primary bladder adenocarcinoma vs metastatic colorectal
Primary bladder adenocarcinoma B-cathenin +, CDX2 (+/-), CK7, (+/-), CK20 (+/-), Thrombomodulin (+/-),
Metastatic colorectal B-cathenin (+/-), CDX2 (+), CK7, (-), CK20 (+), Thrombomodulin (-),
DD urothelial carcinoma vs high grade prostatic
Urothelial carcinoma CK903 (+), Thrombomodulin (+), CK7 (+), CK20 (+), PSA (-), PSAP (-)
High grade prostatic CK903 (-), Thrombomodulin (-), CK7 (-), CK20 (-), PSA (+), PSAP (+)
Paget's disease
Positive (+) EMA, CEA, CK8, CK18, Her-2
Negative (- ) S100 (50%)
GIST
Positive (+) CD117, vimentin, CD34
Negative (- ) SMA, desmin, S-100, GFAP, NSE, CK (usually)
MALT lymphoma
Positive (+) CD20, Bcl-2
Negative (- ) CD5, CD10, CD23, Cyclin D1, Bcl-6
Follicular lymphoma
Positive (+) CD20, CD10, CD23, Bcl-2, Bcl-6
Negative (- ) CD5, CD43, Cyclin D1
Mantle cell lymphoma
Positive (+) CD20, CD5, CD43, Cyclin D1, Bcl-2
Negative (- ) CD10, CD23, Bcl-6
Burkitt's Lymphoma
Positive (+) CD20, CD10, Ki67
Negative (- )
RCC clear cell
Positive (+) PAX8, EMA, CD10, Vimentin
Negative (- ) CK7, CK20, c-kit
RCC papillary
Positive (+) PAX8, CK7, Racemase, Vimentin, CD10 (+/-)
Negative (- ) c-kit,
RCC chromophobe
Positive (+) PAX8, Hale colloidal iron, c-kit, CK7, CD10 (+/-)
Negative (- )
Angiomyolipoma
Positive (+) HMB45, Melan-A, S100 (30%), SMA, desmin, c-kit
Negative (- ) CK, EMA
Mixed epithelial stromal tumor
Positive (+) ER/PR, Desmin, CD10
Negative (- )
Wilms tumor
Epithelial - WT1, CK, EMA
Blastemal - desmin
Clear cell sarcoma kidney
Positive (+) Vimentin
Negative (- ) All other
Adrenocortical neoplasm
Positive (+) Melan-A, Inhibin, MNF, CK8, CK18,
Negative (- ) S100, HMB45, EMA
Pheochromocytoma
Positive (+) Chr, Syn, NSE, CD56, S100 (sustentacular)
Negative (- ) CK
Neuroblastoma
Positive (+) Chr, Syn, NSE, CD56, S100 (septae)
Negative (- ) CD99
Renal oncocytoma
Positive (+) PAX8, c-kit (+/-)
Negative (- ) CD10, RCC, vimentin, colloidal iron (apical)
DD Renal tumors with tubulo-pappilar architecture
Papillary RCC - CK7, racemase
Metanephric adenoma - WT1, CD57
Wilms tumor - WT1
DD renal clear cell tumors
RCC clear cell - CD10, vimentin
Papillary RCC with clear cells - CK7, Racemase, CD10 (+/-)
Clear cell papillary RCC - CK7
Chromophobe RCC - CK7, colloidal iron, c-kit
Xp11 translocation RCC - CD10, Racemase
Angiomyolipoma - HMB45, MelanA, Actin
DD RCC vs Adrenocortical neoplasm
RCC - PAX8, CD10, RCC, EMA
Adrenocortical neoplasm - MelanA, Inhibin, SYN
Seminoma and ITGCN
Positive (+) OCT4, PLAP, PAS, c-kit
Negative (- ) MNF, EMA
Spermatocytic seminoma
Negative (- ) OCT4, PLAP, PAS, MNF, EMA
Embryonal carcinoma, testis
Positive (+) MNF, OCT4, PLAP, CD30
Negative (- ) EMA
Yolk sac tumor , testis
Positive (+) MNF, PLAP, CD30, AFP
Negative (- ) OCT4, EMA,
Choriocarcinoma , testis
Positive (+) MNF, B-HCG, Inhibin, EMA (+/-), PLAP (+/-)
Negative (- ) OCT4
Teratoma, testis
Positive (+) MNF, EMA
Negative (- ) OCT4, PLAP
Sertoli, Leidig, testis
Positive (+) Inhibin, MelanA, CD10, CD99, Calretinin
Negative (- ) EMA, OCT4, PLAP
DD HCC vs benign hepatocellular nodule
HCC CD34, Factor VIII, Glypican 3
Benign hepatocellular nodule - all these markers negative
DD lung tumors
Adenocarcinoma nonmucinous - TTF-1 (85%), CK7
Adenocarcinoma mucinous TTF-1 (20%), CK7, CK20, focally CDX2
Squamous cell carcinoma p63, CK5/6, CK903, CK7 (+/-) TTF-1 (-)
Small cell carcinoma TTF-1, CK7 (+/-), NE markers. If CK5/6, CK903 diffuse - exclude diagnosis,
Carcinoid TTF-1 (50%)
Mesothelioma TTF-1 (-), CK7, CK5/6, CK903, WT1, Calretinin
DD lung typical carcinoid vs atypical carcinoid vs large cell neuroendocrine carcinoma vs small cell carcinoma
Typical carcinoid Ki67<2%, TTF-1 (30%)
Atypical carcinoid Ki67<20%, TTF-1 (30%)
Large cell neuroendocrine carcinoma Ki67>20% , TTF-1 (50%)
Small cell carcinoma Ki67 Ki67>20%, TTF-1 (90%)
DD Thymoma vs Thymic carcinoma vs non-thymic carcinoma.
Thymoma TdT, CD99, CD1a, CD5 (lymphocytes), CK
Thymic carcinoma CD5 (epithelium and lymphocytes), c-kit, CK
Non-thymic carcinoma. c-kit (+/-), CK
DD Mesothelioma vs Reactive mesothelial proliferation...
Mesothelioma - p53, EMA
Reactive mesothelial proliferation - Desmin
Adenomatoid tumor
Positive (+) Calretinin, CK, EMA
Alveolar soft part sarcoma
Positive (+) Desmin, Actin, S100
Angiomatoid fibrous histiocytoma
Positive (+) Desmin, CD68 (+/-)
Clear cell sarcoma of tendon sheath
Positive (+) S00, HMB45, MelanA
Epitheloid sarcoma
Positive (+) CK, EMA, CD34, vimentin (CK+CD34 - unique)
Ewing sarcoma/PNET
Positive (+) CD99, focal CK (SYN/NSE -> PNET)
Fibromatosis
Positive (+) nuclear B-cathenin, actin,
Negative (- ) CD34,
Glomus tumor
Positive (+) SMA, calponin, caldesmon,
Negative (- ) desmin
Granular cell tumor
Positive (+) S100, CD68, Inhibin, PAS
Hemangiopericytoma
Positive (+) CD34 (weak), bcl-2
Negative (- ) EMA
Inflammatory myofibroblastic tumor
Positive (+) ALK, actin (tram-track), desmin, vimentin, CK (+/-)
Negative (- )
Desmoplastic small round cell tumor
Positive (+) WT1, CK, EMA, Desmin (dot-like), NSE
Negative (- ) Actin, SYN, CHR
Leyomyoma/Leyomyosarcoma
Positive (+) Desmin, actin, caldesmon
Nodular fasciitis
Positive (+) SMA, calponin,
Negative (- ) Desmin, caldesmon
PEComas
Positive (+) SMA, HMB45, MelanA, c-kit
(+/-) Desmin, S100
Rhabdomyosarcoma
Positive (+) Desmin, MyoD, p53 (anaplastic), CD99 (subset)
Solitary fibrous tumor
Positive (+) CD34, bcl2,
Negative (- ) SMA, Desmin, c-kit, EMA
Synovial sarcoma
Positive (+) TLE1, bcl2, calponin, S100, CD99 (poorly diff)
Focal CK, EMA
Negative (- ) CD34, desmin
Pancreatic adenocarcinoma
Positive (+) CK7, CK20, CA19.9, CEA
Pancreatoblastoma
Positive (+) NE, CK, CEA, trypsin, lipase
Mucionous cystic neoplasia
Positive (+) ER, PR, Inhibin
DD Intraductal Papillary Mucinous Neoplasm vs PanIN
Intraductal Papillary Mucinous Neoplasm - CDX2+, MUC2+, MUC1-
PanIN CDX2-, MUC2-, MUC1+
Serous cystadenoma
Positive (+) CK, EMA (30%), Calponin, Inhibin
Negative (- ) CD31, Factor VIII
DD Pancreatic NE tumor vs Acinar cell /Pancreatoblastoma vs Solid pseudopapillary neoplasm
Pancreatic NE tumor CK(+), Vimentin (-), NE (+), tryps (-), CD10 (-), Nuclear B-cathenin (-), ER-, PR+
Acinar cell /Pancreatoblastoma CK(+), Vimentin (-), NE (+/-), tryps (+), CD10 (-), Nuclear B-cathenin (-/+), ER-, PR-
Solid pseudopapillary neoplasm CK(-), Vimentin (+), CHR (-), tryps (-), CD10 (+), Nuclear B-cathenin (+), ER-, PR+
DD DALM vs Tubular adenoma
DALM Nuclear B-cathenin (-), p53 (+)
Tubular adenoma Nuclear B-cathenin (+), p53 (-)
Gliomas
Positive (+) GFAP
Negative (- ) reticulin (pleomorphic xathoastrocytoma (+))
Meningioma
Positive (+) EMA, PR (50%)
Negative (-) CK
Fibrous meningioma S100+
Secretory meningioma CK+ (50%), cytoplasmatic inclusions CEA+, PAS+
Gangliocytoma
Positive (+) SYN
Ganglioglioma
Positive (+) SYN (neurons), GFAP (glia)
Central neurocytoma
Positive (+) SYN, GFAP
Medulloblastoma
Positive (+) SYN, GFAP
PNET CNS
Positive (+) SYN, GFAP
Negative (-) CD99
Atypical teratoid/rhabdoid tumor
Positive (+) EMA, GFAP, CK, VIM, SMA,
(+/-) SYN, CHR
Dysembryoplastic neuroepithelial tumor
Positive (+) S100
Negative (-) SYN
Pituitary neoplasm
Positive (+) SYN, CHR, hormones
Pineal neoplasms
Positive (+) SYN
Choroid plexus tumors
Positive (+) CK, S100, GFAP (+/-), patchy
Negative (-) EMA
Reticulin in CNS
Negative (-) - All gliomas except pleomorphic xathoastrocytoma
Pericellular - Hemangiopericytoma, Fibrosarcoma, Schwannoma, pleomorphic xathoastrocytoma , Lymphoma, Gliosarcoma (sarcomatous areas)
Nested - Hemangioblastoma, Pituitary
DD Astrocytoma vs Olygodendroglioma
Astrocytoma GFAP (+), p53 (+/-)
Olygodendroglioma GFAP (+/-), p53 (-)
DD CNS Hemangioblastoma vs Metastatic RCC
CNS Hemangioblastoma - Inhibin (+), Reticulin (+), EMA (-), CK (-), PAX8 (-), RCC (-), CD10 (-)
Metastatic RCC - Inhibin (-), Reticulin (-), EMA (+), CK (+/-), PAX8 (+), RCC (+), CD10 (+)
DD Fibrous meningioma vs Solitary Fibrous tumor vs Melanocytoma
Fibrous meningioma EMA, PR
Solitary Fibrous tumor CD34, bcl-2
Melanocytoma MelanA, HMB45
DD Chordoma vs Myxoid chondrosarcoma vs Myxopapillary ependymoma vs Chondroid meningioma
Chordoma CK, EMA, S100. GFAP(-)
Myxoid chondrosarcoma S100 (+/-), NEG (-): CK, EMA, S100
Myxopapillary ependymoma GFAP (+), S100(+/-) NEG (-): CK, EMA
Chondroid meningioma EMA (+), CK, S100 (-)
Marker of mets from GYN tract
ER/PR
Uterus, endometrioid carcinoma
Positive (+) PAX8, ER/PR, CA125
Negative (-) p16
Uterus, serous carcinoma
Positive (+) PAX8, ER/PR, p16, p53, ki67
Negative (-) WT1
Ovary, serous carcinoma
Positive (+) PAX8, WT1, ER/PR
Negative (-)
Ovary, mucinous carcinoma
Positive (+) CK7+
Negative (-) CK20 (may be focal), CDX2,
Ovary, sex cord stroma tumors
Positive (+) Inhibin, Melan-A, CD10, CD99, Calretinin
Negative (-) CK, EMA
Cervix, adenocarcinoma
Positive (+) p16
Negative (-) p53, ER/PR
Endometriosis
Positive (+) ER/PR (glands and stroma), CD10
Ovary, dysgerminoma
Positive (+) PLAP, c-kit, OCT-4, PAS
Negative (-) MNF, CK8, CK18, EMA
Ovary, Embryonal Carcinoma
Positive (+) PLAP, OCT-4, MNF, CD30
Negative (-) c-kit, EMA
Ovary, Yolk sac tumor
Positive (+) PLAP, MNF, AFP
Negative (-) c-kit, OCT-4, EMA
Ovary, Choriocarcinoma
Positive (+) MNF, EMA, B-HCG, Inhibin
Negative (-) c-kit, OCT-4
Tubal intraepithelial carcinoma
Positive (+) p53, Ki67 high (normal both negative)
Melanoma
Positive (+) S100, HMB45, MelanA, ki67
Negative (-) MNF
Melanoma desmoplastic
Positive (+) S100
Negative (-) HMB45, MelanA
Mycosis Fungoides
Positive (+) CD45, CD3, CD4
Negative (-) CD20
Granuloma annulare, LE
Positive (+) Alcian blue
Urticaria pigmentosa
Positive (+) c-kit, Giemsa
DD Merckel cell carcinoma vs metastatic small cell carcinoma
Merckel cell carcinoma CK20, NE, CK
Metastatic small cell carcinoma TTF1, NE, CK
DD skin spindle cell tumors
Atypical fibroxanthoma CD10
Sarcoma Desmin +/-
Spindle cell SCC CK, p63
Melanoma S100
DD pagetoid proliferation in skin
SCC in situ - CK903
Melanoma in situ S100, MelanA, HMB45
Sebacious carcinoma EMA, CK7
Paget's disease CK8/18, CK7, Alcian blue, EMA, (nipple HER2, ER)
Ovary, serous tumors
Positive (+) CK, MNF, WT-1, CD15, CA-125, S100, CK7
Negative (-) CEA, CK20
Ovary, mucinous tumors
Positive (+) CEA, CK7, CK20
Negative (-) S100, WT-1
Ovary, endometrioid tumors
Positive (+) CK7, Vimentin, EMA, ER, PR,
Negative (-) WT-1, CEA, CK20
Ovary, clear cell tumors
Positive (+) CK7, CEA, CD15, Vimentin, p53, CA-125
Negative (-) CK20, PR
Ovary, Brenner tumors
Positive (+) CK7, CK20 (+/-), thrombomodulin
Negative (-) WT-1
Ovary, transitional cell carcinoma
Positive (+) CK7, WT-1
Negative (-) CK20, thrombomodulin
Ovary, mets of bladder transitional cell carcinoma
Positive (+) CK7, CK20 (+/-), thrombomodulin
Negative (-) WT-1
Ovary, Sertoli cell tumor
Positive (+) CK, inhibin
Negative (-) EMA, CA19-9, CA-125, CEA, S100
Ovary, sclerosing stromal tumor
Positive (+) Desmin, SMA, Vimentin, Inhibin, calretinin, CD34
Negative (-)
Ovary, fibroma
Positive (+) Vimentin, Inhibin, calretinin
Negative (-)
Ovary, thecoma
Positive (+) Vimentin, Inhibin
Negative (-)
DD ovarian yolk sac tumor vs clear cell carcinoma
yolk sac tumor CD15 (-)
clear cell carcinoma CD15 (+)
DD ovarian yolk sac tumor vs endometroid cell carcinoma
yolk sac tumor ER/PR (-)
endometroid cell ER/PR (+)
DD ovarian yolk sac tumor vs embryonal carcinoma
yolk sac tumor CD30 (+) focally
embryonal carcinoma CD30 (+) diffuse
Desmoplastic small round cell tumor
Coexpression of epithelial and mesenchymal markers
Positive (+) CK, EMA, NSE, vimentin, desmin (dot-like intracytoplasmic), WT1
Negative (-) MyoD, CD99 (not membranous)
DD lymphocyte predominant Hodgkin's lymphoma vs Progressive trasformation
Lymphocyte predominant Hodgkin's lymphoma CD20+ - irregular, broken-up. CD4+, CD57+ - wreath-like around L&H cells. L&H cells EMA (+)
Progressive trasformation - CD20+ - confluent, well circumscribed, residual large germinl center cells EMA (-)
DD Anaplastic large cell lymphoma vs Infectious mononucleosis
Anaplastic large cell lymphoma - ALK (+), CD3+, CD20-, (CD30+, CD43+)
Infectious mononucleosis - ALK (-), CD3-, CD20+(CD30+, CD43+)
CLL/SLL
Positive (+) CD20, CD5, CD19, CD79a, CD23, CD43
Negative (-) CD10
Mast cells
Positive (+) CD43, CD68, ckit,
Negative (-) CD20, CD3
Myeloid sarcoma
Positive (+) CD43,
CD68, C-kit, antimyeloperoxidase, CD15,
Negative (-)
Histiocytic sarcoma
Positive (+) CD68, CD163, lysozyme, a-antitrypsin
Negative (-) CD30, CD1a, CD3, CD20. CK, HMB-45
Follicular dendritic sarcoma
Positive (+) Vimentin, CD21, CD35, EMA
Negative (-) CD45, CD20, CD1a, desmin, HMB-45,
Langerhans cell histiocytosis
Positive (+) CD1, S100, langerin, some (CD68, PLAP)
Negative (-) CD30, CD15, CD45 (in paraffin)
Lymphoblastic lymphoma
Positive (+) TdT, CD10, CD45 (80%), [T lineage - CD43, CD2, CD7, CD3, CD16, CD57], [B-lineage - CD19, CD79a, CD20 (50%)
Negative (-)
Anaplastic large cell lymphoma
Positive (+) CD30, ALK (50%), CD45 (70%)
Negative (-)
DD reactive T cells vs peripheral T-cell lymphoma
Reactive T cells CD2, CD3, CD5, CD7
Peripheral T-cell lymphoma - loss of one or more of them
Nasal T-NK cell lymphoma
Positive (+) CD2, CD56, CD3 (cytoplas),
Negative (-) CD3 (surface)
Burkitt's lymphoma
Positive (+) CD20, Cd79a, CD10, KI67 (99%)
Negative (-) CD5, Bcl2, CD23, TdT
Diffuse large B-cell lymphoma
Positive (+) CD20, CD79a, CD45, Bcl-6, CD10, Bcl2, CD30
Negative (-)
Mantle cell Lymphoma
Positive (+) CD20, Cd79a, CD19, CD5, Cyclin D1,
Negative (-) CD10, CD23
Lymphoplasmacytic lymphoma
Positive (+) CD19, Cd20, CD43
Negative (-) CD5, Cd10, CD23
Marginal Zone B-cell lymphoma
Positive (+/-) CD43, Bcl-2
Negative (-) CD5, CD10, CD23
Follicular lymphoma
Positive (+) CD20, CD79a, Bcl-2, CD10
Negative (-) CD5, CD23
Classic Hodgkin's lymphoma
Positive (+) CD15, CD30, EBV
Negative (-) CD45 (90%), CD20 (80%), CD3 (95%), CD4, EMA
Lymphocyte predominance Hodgkin's lymphoma
Positive (+) CD45, CD20, EMA
Negative (-) CD15, CD30, CD3, CD4, EBV
Littoral cell angioma
Positive (+) CD31, VWF, CD68, CD163, CD21
Negative (-) CD34, CD8
Hepatoplenic T-cell lymphoma
Positive (+) CD2, CD3, CD5, CD7, CD43, CD16, CD56,
Negative (-) CD4, CD8,
Cyclin D1
Mantle cell lymphoma
Bcl-2
Nongerminal center B cells,
T cells,
Follicular lymphomas,
Many B-cell lymphomas
Bcl-6
Positive (+)
Diffuse large B-cell lymphomas,
Follicular lymphomas (+/-),
Burkitt's lymphoma,
Lymphocyte predominant Hodgkin's lymphoma; Negative (-)
CLL,
hairy cell leukemia,
mantle cell or marginal zone lymphomas
EMA
Plasma cells and plasma cell neoplasms,
L&H lymphocyte predominance,
Anaplastic large cell lymphoma,
T-cell-rich B-cell lymphoma
TdT
Thymic lymphoid cells,
lymphoblastic neoplasms,
Myeloid neoplasms (+/-)
CD1a
Thymocytes,
Langerhans cells
T-lymphoblastic lymphomas(+/-),
CD2, CD3
T cells
T-cell lymphomas
CD5
Positive (+)
T cells
T-cell lymphomas,
SLL/CLL,
Mantle cell lymphoma
Negative (-)
Follicular lymphoma
Marginal zone lymphoma
CD10
Precursor B cells
B-lymphoblastic neoplasms,
Follicular lymphomas
CD21
Follicular dendritic cells and neoplasms
Mantle B cells
Marginal zone B cells
CD23
Mantle zone B cells
CLL/SLL
CD43
T cells,
Myeloid cells,
Mast cells,
T-cell lymphomas,
B-cell lymphomas,
Myeloid leukemia,
Mast cell neoplasms
CD45
Positive (+)
All hematolymphoid cells,
L&H lymphocyte predominance;
Anaplastic large cell lymphoma (+/-)lymphoblastic neoplasms (+/-);
Negative (-)
Reed-Sternberg cells
CD61
Megacaryocytes
CD68
Histiocytes,
Myeloid cells, Mast cells and neoplasms,
Some non-Hodgkin's lymphomas
CD79a
B cells and lymphomas,
Plasma cells and plasma cell neoplasms
Thymoma type A
Positive (+) CD20 (focal), few [CD3,CD1a, CD99]
Negative (-) CK20, CD5,
(+/-) EMA, BCL-2, CD57
Thymoma type B1
Positive (+) CD19, [focally: CK7, CK14, CK18]
Negative (-) CK20, CD5, CD20, CD70
Thymoma type B2
Positive (+) CD19, CK5/6, CK7
Negative (-) CK20
Thymoma type B3
Positive (+) CD19, CK5/6, CK7, CK10, CK8, CD57, EMA - focal
Negative (-) CK20
Intraepithelial lymphocytes (CD1a, CD4, CD8, CD5, CD99, TdT)
Mycosis fungoides
Positive (+) CD3, CD4, CD2, (CD4>CD8)
Negative (-) CD7
Thyroid follicular carcinoma
Positive (+) Thyroglobulin, CK, TTF-1
Negative (-) Calcitonin, NE markers
Thyroid papillary carcinoma
Positive (+) Thyroglobulin (patchy), CK, TTF-1
Negative (-) Calcitonin, NE markers
Thyroid medullary carcinoma
Positive (+) CK, Calcitonin, NE markers, TTF-1, CEA,
Negative (-) Thyroglobulin
CASTLE
Positive (+) CD5, c-kit, CK
Negative (-) Calcitonin, NE markers, Thyroglobulin, TTF-1
Thyroid poorly differentiated carcinoma
Positive (+) Thyroglobulin, CK, TTF-1, Bcl-2
Negative (-)
Thyroid anaplastic carcinoma
Positive (+) CK (50%), Factor VIII (focal)
Negative (-) Thyroglobulin, TTF-1, Calcitonin, NE markers
AFP
Yolk sac tumor
HCC (not fibrolamellar)
Hepatoblastoma
ALK
Inflammatory miofibroblastic tumor
Anaplastic large cell lymphoma
Lung adenocarcinoma
B-cathenin
Cytoplasmatic - in most cells
Significant - nuclear:
Colon cancer
Hepatoblastoma, Pancreatoblastoma
Pancreatic solid-pseudopapillary neoplasm
Craniopharyngioma
FAP associated tumors (nasal angiofibroma, fundic gland polyp)
DD Tubular adenoma (+) vs DALM (-)
Bcl-2
DD Follicular lymphoma (+) vs reactive follicles (-)
CLL, MCL, MZL
Synovial sarcoma
Bcl-6
Germinal center
Follicular lymphoma,
Burkitt lymphoma,
popcorn cells
T-lymphocytes in angioimmunoblastic lymphoma
Caldesmon
Positive (+) Leymyosarcoma
Negative (-) Fibromatosis
Calcitonin
Positive (+) Medullary carcinoma
Calretinin
Mesothelium
Sex-cord stromal tumor
Adenomatoid tumor
Adrenocortical tumors
Cardiac myxoma
Epithelial mesothelioma
CD1a
Langerhans cell histiocytosis
T-cell lymphoblastic lymphoma
Thymomas
CD2
T, NK lymphomas and leukemiae
CD3
T cell lymphomas and leukemiae
Often (-) in Anaplastic lymphoma
Medullary carcinoma of the thyroid
Calcitonin, CEA
Astrocytoma
Positive (+) GFAP S100 Vimentin
Negative (-)
Pleomorphic xanthoastrocytoma
Positive (+) GFAP S100 Vimentin Synaptophysin
Negative (-)
Ependymoma
Positive (+) GFAP EMA CD99 Vimentin S100
Negative (-)
Meningyoma
Positive (+) Vimentin EMA PR
Negative (-) GFAP CAM5.2 Synaptophysin
Angiomyolipoma
Positive (+) HMB-45, MART-1, SMA
Negative (-) S100
Melanoma
Positive (+) S100, HMB-45, MART-1,Vimentin
Negative (-)
GIST
Positive (+) CD117 (c-kit), DOG1
Negative (-)
Thymic carcinoma
Positive (+) CD5, p63
Negative (-)
Colorectal carcinoma
Positive (+) CK20, CDX-2, beta-catenin,
Negative (-)
Langerhans cell histiocytosis
Positive (+) CD1a, S100
Negative (-)
Prostatic adenocarcinoma
Positive (+) PSA, PSAP, P504S
Negative (-)
Chordoma
Positive (+) CK, EMA, S100
Negative (-)
Seminoma
Positive (+) OCT4/CD117/PLAP/D2-40
Negative (-) AE1/AE3, CK7, and CK20
Mast cells
Positive (+) CD117 (c-kit), tryptase
Negative (-)
Normal parathyroid gland
Positive (+) PTH, Chr A
Negative (-) p53
Adrenal cortical neoplasms
Positive (+) MART-1, Calretinin, Inhibin
Negative (-) CD10
Pheochromocytoma
Positive (+) Synapto, Chromo, CD56, NSE
Negative (-) calret Mart-1
Neuroblastoma
Positive (+) NSE CD56 Chromogranin ALK-1 CD57
Negative (-)
Lung squamous cell carcinoma
Positive (+) p63 CK 5/6
Negative (-) CK7 CK20 TTF1
Lung carcinoid
Positive (+) TTF-1 CD56 CD57 Synaptophysin Chromogranin
Negative (-)
Lung small cell carcinoma
Positive (+) TTF-1 CD56
Negative (-) p63
Inflammatory myofibroblastic tumor
Positive (+) Vimentin SMA ALK-1 Calponin Desmin
Negative (-)
Lung adenocarcinoma
Positive (+) CK7 TTF1
Negative (-) CD20 CDX-2 WT1 Calretinin
Mesothelioma
Positive (+) Calretinin CK5/6 WT1 D2-40
Negative (-) CEA TTF-1 CD15 Ber-EP4
Solitary fibrous tumor
Positive (+) CD34 Bcl2 CD99
Negative (-)
Desmoplastic small round cell
tumo
Positive (+) Cytokeratins EMA Desmin (Dot-like pattern) Vimentin WT1 NSE
Negative (-)
Thymoma B
Positive (+) CK19, CK5/6, CAM 5.2, CK7,
CK14, and CD18 CD57 EMA
Negative (-) CK20, CD5, CD70,TTF-1, and Bcl-2
Thymic carcinoma
Positive (+) CD5, CD70, and CD117
Negative (-)
Normal breast ductal/lobular epithelium
Positive (+) CK7, CK8/18, CK19 E-cadherin
Negative (-) CK5/6, CK14, CK903 (ER PR) - scattered
Invasive breast carcinoma
Positive (+)
Negative (-) p63 Calponin SMA
Medullary carcinoma of breast
Positive (+) Ki67 (High ) EMA S100
Negative (-) ER, PR, Her-2/neu
Metaplastic carcinoma of breast
Positive (+) Pan-CK (MNF-116) + HMWCK (CK5/6, CK14, CK17, CK903) + Myoepithelial markers (p63, CD10, SMA)Negative (-) ER, PR, Her-2/neu
Paget disease of breast
Positive (+) CK7 HER2 EMA ER Mucicarmine
Negative (-) S100 HMB-45
Adenomatoid tumor
Positive (+) Calretinin Pan-CK WT1
Negative (-) CD 34 CD15
PEComa
Positive (+) HMB45 MelanA
Negative (-) S100 Inhibin Pan-CK
Serous ovarian tumors
Positive (+) WT1 p53 ER
Negative (-)
Clear cell ovarian tumor
Positive (+) p53
Negative (-) WT1
Prostatic adenocarcinoma
Positive (+) P504S PSA
Negative (-) p63 CK5/6 CK903
Nodular fasciitis
Positive (+) SMA MSA Calponin CD68
Negative (-) Desmin h-Caldesmon S100
Glomus tumor
Positive (+) SMA Caldesmon
Negative (-) Desmin Keratin CD34
Granular cell tumor
Positive (+) Vimentin NSE calretinin S100 CD68 Inhibin
Negative (-)
Schwannoma
Positive (+) S100 CD56 CD57 Calretinin
Negative (-) CD34 EMA
Clear cell sarcoma of soft parts
Positive (+) S100 HMB45
Negative (-)
Synovial sarcoma
Positive (+) TLE1 EMA Bcl-2 CK7 CK19 Calponin CD99
Negative (-) Desmin CD34 h-Caldesmon
Ewing/PNET
Positive (+) CD99 FLI-1
Negative (-) TDT
Desmoplastic small round cell tumor
Positive (+) Vimentin Desmin CK AE1/AE3/CAM5.2 EMA Ber-Ep4 WT-1 NSE
Negative (-)
Mesenchymal chondrosarcoma
Positive (+) SOX9 S100 Vimentin CD99
Negative (-)
Rhabdoid tumor
Positive (+) Vimentin CD99
Negative (-) INI1
Langerhans cell histiocytosis
Positive (+) S100 CD1a CD207 (Langerin) CD68
Negative (-)
Rhabdomyosarcoma
Positive (+) Myogenin MyoD1 Desmin
Negative (-) CD99
Paraganglioma
Positive (+) NSE, chromogranin
Negative (-)
Angiosarcoma
Positive (+) Thrombomodulin, CD31, CD34, and Fli-1
Negative (-)
Epitheloid sarcoma
Positive (+) Cytokeratin or EMA Vimentin CD34 S-100
Negative (-)INI1