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Imaging and Quantitative Immunohistochemistry

Overview Pathologists frequently use immunohistochemistry (IHC) to evaluate antigen location and expression patterns in tissue for diagnostic and/or prognostic purposes. This process often also requires quantification of these immunostains to assist in therapeutic drug selection. Traditional scoring systems for IHC have relied on manual subjective interpretation and semiquantification of immunostains by pathologists examining microscopic glass slides. With the advent of digital images, multispectral imaging, and immunofluorescent…

Immunohistology of Pediatric Neoplasms

Overview Solid neoplasms of childhood and adolescence comprise a diverse group of diagnostically challenging entities with the basic morphologic themes of round cell, spindle cell, and epithelioid tumors. Immunohistochemistry (IHC) and molecular diagnostic tests have greatly improved our ability to classify these lesions. Ancillary diagnostic techniques have become increasingly important in the diagnosis and evaluation of recurrent or metastatic disease and, in some cases, in genomic…

Immunocytology

Acknowledgment The authors thank Dr. Sara Monaco, who was a co-author of this chapter in the previous edition. Immunocytology, or immunocytochemistry (ICC), involves the use of ICC in diagnostic cytopathology. The application of immunostains in cytology cases has expanded and improved our ability to make definitive and accurate diagnoses beyond prior special stains. As seen in surgical pathology, a great deal of progress and expansion has…

Immunohistology of the Nervous System

Acknowledgments The following colleagues provided particularly valuable assistance. Drs. Noah Brown, Sandra Camelo-Piragua, Katherine McFadden, Jeanne Bell, Larry Junck, and Ricardo Lloyd. Peter Ouillette, Sr BSA provided digital slide preparations, and assistance with Aperio. Linda Cisco carefully scanned slides. We thank our Transcription Team for their skill and patience in preparing this chapter. Mr. Mark Deming and Ms. Elizabeth Walker carefully prepared some of the illustrations.…

Immunohistology of the Breast

Introduction Perhaps the most frequent use of diagnostic immunohistochemistry (IHC) in the surgical pathology laboratory pertains to breast biopsies by virtue of the volume and sheer difficulty of cases. In addition to utilizing IHC for diagnostic problems with breast biopsies, breast biopsies lend themselves to the frequent use of IHC for prognostic and predictive tests. In addition, the diagnosis of breast carcinoma in the metastatic setting…

Immunohistology of the Female Genital Tract

This chapter focuses on the use of immunohistochemistry (IHC) in the setting of diagnostic gynecologic pathology. The first section describes the properties and applications of most useful antibodies for the evaluation of lesions in the gynecologic tract. The second section discusses immunohistochemical stains in the context of specific tumors by anatomic site: (1) vulva, vagina, and cervix; (2) uterus; (3) ovary and fallopian tube; and (4)…

Immunohistology of the Bladder, Kidney, and Testis

Overview The unprecedented advances in cancer genetics and genomics are rapidly affecting the clinical management of solid tumors. Molecular diagnostics are now an integral part of routine clinical management for patients with lung, colon, breast, and gynecologic malignancies among others. In sharp contrast, until recently, molecular biomarkers were noticeably absent from management algorithms for urologic malignancies, including bladder and renal cancers. Integrated genomic analyses of bladder…

Immunohistology of the Prostate

Overview Used in the proper setting, ancillary techniques can be a great adjunct to light microscopy to obtain an accurate diagnosis in urologic pathology. In the last decade, a plethora of molecular biomarkers have been evaluated for their potential role in enhancing our ability to predict the disease progression, response to therapy, and survival in prostate cancer (PCa) patients. These research efforts have been greatly facilitated…

Immunohistology of Pancreas and Hepatobiliary Tract

Acknowledgment The authors thank Dr. Hulya Sahin Ozkan for her contributions in the preparation of this chapter. In the ensuing chapter, the cellular lineage markers and the application of immunohistochemistry (IHC) in the diagnosis and management of specific tumor types are reviewed. We feel obliged to provide a cautionary statement. It is our strong bias that IHC is an extremely powerful tool, but only if it…

Immunohistology of the Gastrointestinal Tract

Acknowledgment We would like to acknowledge and thank Jeffrey Goldsmith, MD, for his significant contributions to prior editions of this chapter. This chapter divides the discussion of immunohistochemistry (IHC) of the luminal gastrointestinal (GI) tract into three sections: (1) epithelial pathology, (2) neuroendocrine lesions, and (3) spindle cell lesions. We have attempted to compile the innumerable IHC studies that have been applied to these organs into…

Immunohistology of Skin Tumors

Overview The skin is a complex microenvironment. The normal structures of the epidermis, dermis, and cutaneous adnexa are morphologically and functionally complicated, and the histologic entities that occur in this tissue compartment are also numerous. Furthermore, cutaneous lesions may also be a part of systemic proliferations, or they may have exact morphologic counterparts in other sites. Principal examples of such disorders are hematolymphoid diseases and mesenchymal…

Immunohistology of Pulmonary and Pleural Neoplasms

The use of immunohistochemistry (IHC) as an aid in the diagnosis of surgical pathology has changed the practice of pathology, as its use is more widespread with more available antibodies to enhance diagnostic specificity. In addition, with the current availability of IHC biomarkers, pathologists are often called upon for testing that will be used to determine treatment options. In 1981, Hsu and Raine suggested a method…

Immunohistology of the Mediastinum

Introduction In general, mediastinal pathology is rich in terms of the diversity of neoplasms that may occur primarily in the mediastinal cavity. However, in the context of occurrence, mediastinal tumors are rare. In addition, over the last decades some of the most common tumors of the thymus have generated controversy regarding proper classification and staging. It is important, however, to state that the normal thymus is…

Immunohistology of Endocrine and Neuroendocrine Neoplasms

Acknowledgments We want to thank our former co-authors, Dr. Ronald A. DeLellis and Dr. Sandra J. Shin for their significant contributions to the previous versions of this chapter. Overview Immunohistochemical (IHC) methods have had a profound impact on the understanding of the endocrine system and its changes in a wide variety of disease states. In particular, these methods have led to the development of a series…

Immunohistology of Head and Neck Lesions

Acknowledgments My heartfelt appreciation to Ms. Hannah B. Herrera for her reference wrangling. The opinions or assertions contained herein are the private views of the author. Introduction The head and neck, by convention defined as the area above the clavicles and below the cranial cavity, is an anatomically complex region composed of a heterogeneous array of tissues and organs. Among the various tissues are mucosal surface…

Immunohistology of Carcinoma of Unknown Primary Site

The impact of diagnostic immunohistochemistry (IHC) for the surgical pathologist is legendary, and it is best appreciated when studying malignancies of unknown primary site. A cost-effective tool, IHC is performed in most hospital laboratories, is often automated, and provides for a rapid turnaround time, all desirable qualities for the pathologist. The number of antibodies that are available for diagnostic use rises exponentially each year, an attestation…

Immunohistology of Melanocytic Neoplasms

Overview Melanoma continues to represent one of the greatest diagnostic challenges in surgical pathology and is an important source of litigation. Both as a primary lesion in the skin and in metastatic sites, this neoplasm is capable of assuming many different macroscopic and histologic appearances that mimic other diseases, both benign and malignant. The four main histologic phenotypes of primary melanoma include (1) superficial spreading (intermittent…

Immunohistology of Lymph Node and Lymph Node Neoplasms

Only a little more than 30 years ago a popular, widely used classification system for non-Hodgkin lymphomas (NHLs) was initiated based solely on hematoxylin and eosin (H&E)–stained slide interpretation. The “Working Formulation for Clinical Usage” was used for over a decade before the ever-mounting evidence for immunophenotyping and genetic characterization of lymphoid neoplasms was recognized as necessary for a more precise and scientific system. , With…

Immunohistology of Bone Marrow, Spleen, and Histiocytic Disorders

Overview The hematologic system is complex and includes a diverse range of organs, including the bone marrow, spleen, and lymph nodes. Lymph node disease is covered in Chapter 6 . In this chapter, immunohistochemical evaluation of the bone marrow, spleen, and histiocyte/macrophage system will be covered. Where appropriate, immunohistochemical results will be discussed in the context of normal histology. Pathologic processes primary to the site (spleen)…

Immunohistology of Neoplasms of Soft Tissue and Bone

Acknowledgment We are grateful to Dr. Mark Wick, who was the author of this chapter in earlier editions and was responsible for much of the content in the sections on biology of antigens and antibodies. Overview Tumors of soft tissue and bone are a diverse family, and categorization continues to evolve as more insight is gained into their patterns of differentiation and the underlying molecular pathogenesis…