Immunohistochemistry in Bone and Soft Tissue Tumors. Sahar Rassi Zankoul, MD
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1 Immunohistochemistry in Bone and Soft Tissue Tumors Sahar Rassi Zankoul, MD
2 Introduction Bone tumors represent a wide variety of tumors of various origins and malignant potentials. These different tumor entities may display strong morphological resemblance to each other, thereby resulting in Profound difficulties in differential diagnosis
3 Introduction Since determining the best course of treatment for sarcomas of the bone and soft tissues is a complex process. Making an accurate diagnosis in those tumors is essential to have effective personalized treatment strategies. Besides appropriate radiographic imaging and histological findings, immunohistochemical studies can be important adjuncts to make an accurate diagnosis.
4 Primary Bone Tumors Although the diagnosis is based primarily on clinical, radiological and histological findings, the role of immunohistochemistry continues to be investigated for diagnostic and prognostic implications.
5 Most commonly used IHC stains in primary bone tumors - Vimentine mesenchymal benign and malignant Alkaline phosphatase bone forming tumors S100 cartilage forming tumors SMA some cases of high grade osteosarcoma Ki67 and P53 usually considered as indicators of malignant potentiel have been highly studied in bone tumors (benign vs malignant) MDM2 and CDK4 : Can distinguish low grade osteosarcoma (positive) from benign fibrous and fibro-osseous lesion (negative) Her2 neu prognostic issue
6 Osteoblastoma subclassified : Classical Atypical Based on histological parameters (in atypical osteoblastoma : high cellularity, prominent blue osteoid, and epithelioid osteoblasts).
7 Atypical osteoblastomas and osteosarcoma
8 Ki67 Osteosarcoma Atypical osteoblastoma
9 P53 Osteosarcoma Atypical osteoblastoma
10 Ki67 and P53 in bone tumors Ki67 and P53 dosen t have a significant role in distinguishing osteosarcomas from atypical osteoblastomas However, Ki67 and p53 can be used as predictors of recurrence in atypical osteoblastomas.
11 MDM2 in low grade osteosarcoma and fibrous dysplasia
12 CDK4 in low grade osteosarcoma
13 MDM2 and CDK4 in bone tumors Immunohistochemichal staining for MDM2 and CDK4 is not very sensitive on biopsic specimens!! - Can be misinterpreted as false negative
14 Her2/neu as prognostic tool Recent studies show that over-expression of Her2/neu by osteosarcoma is correlated with a significantly worse response to pre-operative chemotherapy and shorter survival
15 IHC in Anaplastic/poorly differentiated Osteosarcoma Micro description Bizarre and undifferentiated tumor cells with malignant osteoid. Foci carcinoma-like. Foci of undifferentiated sarcoma.
16 Osteosarcoma vs Metastasis 1- Osteosarcoma
17 Cytokeratin and EMA usually negative in osteosarcoma but positive cases exist. Some rare osteosarcomas show strong positivity Epithelioid osteosarcoma
18 Osteosarcoma v/s poorly differentiated metastatic carcinoma Osteoid formation is the KEY feature in the differentiation of osteosarcoma from metastatic poorly differentiated carcinoma and pleomorphic sarcoma. Special techniques are of little diagnostic help.
19 IHC in cartilage forming tumors Enchondroma and well differentiated chondrosarcoma can have similar morphology due to hypercellularity, binucleation, myxoid changes, erosion of cortex. Studies have shown that there is no reliable immunohistochemical panel for distinction between benign and malignant counterparts.
20 IHC in Round Cell Tumors IHC plays a major role in differentiating the various entities of round cell tumors in contrast to bone and cartilage forming tumors
21 Round cell tumor bone and soft tissue Ewing sarcoma/pnet Terms usually used interchangeably; some suggest to call Ewing if undifferentiated or a bone tumor and PNET if neural morphologically or a soft tissue tumor Lymphoma Multiple myeloma Metastatic small cell carcinoma Small cell osteosarcoma Embryonal rhabdomyosarcoma Metastatic neuroblastoma Malignant melanoma Desmoplastic round cell tumor..
22 Pancytokeratin : dot like pos Vimentin : pos CD99 : pos Ewing sarcoma/pnet
23 Lymphoma (CD20) Multiple Myeloma (CD138) Ewing Sarcoma (CD99, Vimentin)
24 Immunohistochemistry is not only essential but mandatory in the differential diagnosis of round cell tumors.
25 Metastatic carcinomas IHC is useful to target the primary PSA IN METAS PROSTATE
26 CK7 anf TTF1 in lung adenocarcinoma metastatic to bone CK7 TTF1
27 Metastatic clear renal cell carcinoma RCC vimentine
28 Metastatic malignant melanoma
29 Synovial sarcoma Cytokeratin,VIMENTIN, EMA, Bcl2
30 In Summary The role of immunohistochemistry in primary bone tumors is limited However, it is mandatory in round cell, biphasic, spindle cell tumors and melanomas to obtain a definitive diagnosis It is also essential in identifying and targeting the primary site in metastatic tumors
31 Thank you
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www.jmscr.igmpublication.org Impact Factor (SJIF): 6.379 Index Copernicus Value: 71.58 ISSN (e)-2347-176x ISSN (p) 2455-0450 DOI: https://dx.doi.org/10.18535/jmscr/v6i2.09 Original Research Article Role
Keywords solitary fibrous tumor, dedifferentiation, dedifferentiated solitary fibrous tumor, STAT6, GRIA2, cytokeratin, rhabdomyosarcomatous
758452IJSXXX10.1177/1066896918758452International Journal of Surgical PathologyCreytens et al research-article2018 Pitfalls in Pathology Multifocal Cytokeratin Expression in a Dedifferentiated Solitary