Classification of the unknown primary tumour: the primary IHC panel

Transcription

1 CIQC/CAP-ACP SEMINAR 2013: DIAGNOSTIC IHC AND MOLECULAR PATHOLOGY Classification of the unknown primary tumour: the primary IHC panel Aalborg University Hospital Denmark Tumours of unknown origin: Histology Brain tumour - biopsy Tumours of unknown origin: Immunohistochemistry Pan-CK S-100 CD45 VIM 1

2 Tumours of unknown origin: Utility Pathologist - knowledge, acceptance, skill Tumour material - diagnostic markers Antibodies available - applic. in diagnostic algorithms Methods - protocol: sensitivity, specificity, reliability - interpretation: cut-off level for positivity clinical relevance GIST: S-100B Protease GIST: S-100B MWO Tumours of unknown origin: Utility Pathologist - knowledge, acceptance, skill Tumour material - diagnostic markers Antibodies available - applic. in diagnostic algorithms Methods - protocol: sensitivity, specificity, reliability - interpretation: cut-off level for positivity clinical relevance positive = any staining CK 20 negative = < 50% stained cells CK 20 Planning diagnostic immunohistochemistry Likelihood of a given diagnosis Relevant differential diagnoses Optimal selection of antibodies for a diagnostic algorithm Primary and secondary antibody panels Turn-around-time Laboratory expenses 2

3 March

4 Planning diagnostic immunohistochemistry Planning diagnostic immunohistochemistry 4

5 my.statdxpathiq.com 5

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9 Human protein Atlas AE1/AE3 Applied Immunohistochemistry A Handbook and On-line Atlas Vyberg, Klos & Dabbs Primo 2014 Primary panel for the unknown primary tumour Haematolymphoid Epithelial CD45 CK S-100 VIM +/(-) -/(+) -/(+) +/(-) - +/(-) -/+ -/+ Mesothelial Mesenchymal - -/(+) -/+ + Neuroepithelial - -/(+) + + Germ cell - -/+ -/+ + 9

10 CD45 - Leucocyte common antigen (LCA) Transmembrane protein tyrosin phosphatase essential for haematopoietic signal transduction and cell activation Membrane associated component: 5 isotypes Intracellular component: one common type CD45 - Leucocyte common antigen (LCA) Transmembrane protein tyrosin phosphatase essential for haematopoietic signal transduction and cell activation Membrane associated component: 5 isotypes Intracellular component: one common type Large majority of haematolymphoid cells Lost in maturing erythocytes, y megakaryocytes y and plasmacells Never found in non-haematolymphoid cells CD45 - Leucocyte common antigen (LCA) Liver Brain Critical stain quality indicators 10

11 CD45 NordiQC run assessment-cd45.htm Which is best? CD45 NordiQC run assessment-cd45.htm Optimal Insufficient CD45 NordiQC run assessment-cd45.htm B-CLL 56% of labs 18% of labs Optimal Insufficient 11

12 CD45 - Leucocyte common antigen (LCA) CD45 RO ~Tcells T-cells Lymph node/tonsil CD45 RA ~ B-cells CD45 - Leucocyte common antigen (LCA) CD45 - Leucocyte common antigen (LCA) 12

13 CD45 - Leucocyte common antigen (LCA) Primary panel for the unknown primary tumour Haematolymphoid Epithelial CD45 CK S-100 VIM +/(-) -/(+) -/(+) +/(-) - +/(-) -/+ -/+ Mesothelial Mesenchymal - -/(+) -/+ + Neuroepithelial - -/(+) + + Germ cell - -/+ -/+ + Cytokeratins in diagnostic pathology Cytokeratins (CKs) belong to the most fundamental markers of epithelial differentiation CKs comprise a large family of subtypes. Different cell types express different patterns of CK subtypes Cancers generally express CK patterns that at least in part represent the pattern of the putative cell of origin Metastases express CK patterns fairly concordant with those of the primary tumours 13

14 Cytokeratins are intermediate filaments Group of mainly cytoplasmic filaments 7 11 nm in diameter Part of the cytoskeleton in virtually all cells, creating as meshwork and connecting nuclear membrane with cell membrane Often associated with microfilaments (6 nm) and microtubules (23 nm) Important for mechanical strength and cellular functions Intermediate filaments - 5 classes I II III acidic cytokeratins basic-neutral cytokeratins vimentin, desmin, glial fibrillary acidic protein, peripherin IV neurofilament protein, α-internexin, nestin V lamins Cytokeratins as tonofilaments Cytokeratin intermediate filaments attached to desmosomes Drochmans et al. J Cell Biol. 1978, 79:427 14

15 Micrometastases identified by cytokeratin HE CK CK in carcinoma frozen sections HE-frozen CK-frozen CKs in carcinomas with aberrant growth patterns Sarcomatoid carcinoma CK 15

16 Carcinomas with low CK expression Carcinomas always CK-positive except some cases of Renal cell carcinoma Adrenal cortical carcinoma Small cell carcinoma CK8: Adrenal cortical carcinoma CK8: Renal cell carcinoma CK: renal cell carcinoma Primary panel for the unknown primary tumour Haematolymphoid Epithelial CD45 CK S-100 VIM +/(-) -/(+) -/(+) +/(-) - +/(-) -/+ -/+ Mesothelial Mesenchymal - -/(+) -/+ + Neuroepithelial - -/(+) + + Germ cell - -/+ -/+ + Cytokeratins in non-epithelial tumours CK8 CD20 and CD3 42 y, tumour infiltrating retroperitoneum Malignant lymphoma! CD45 and CD79a 16

17 Primary panel for the unknown primary tumour CD45 CK S-100 VIM +/(-) -/(+) -/(+) +/(-) - +/(-) -/+ -/+ Mesothelial Mesenchymal - -/(+) -/+ + Neuroepithelial - -/(+) + + Germ cell - -/+ -/+ + Cytokeratins in malignant mesothelioma CK8 CK5 Primary panel for the unknown primary tumour Haematolymphoid Epithelial Haematolymphoid Epithelial CD45 CK S-100 VIM +/(-) -/(+) -/(+) +/(-) - +/(-) -/+ -/+ Mesothelial Mesenchymal - -/(+) -/+ + Neuroepithelial - -/(+) + + Germ cell - -/+ -/+ + 17

18 Cytokeratins in sarcomas Synovial sarcoma angiosarcoma Cytokeratins in non-epithelial tumours Leiomyosarcoma Primary panel for the unknown primary tumour Haematolymphoid Epithelial CD45 CK S-100 VIM +/(-) -/(+) -/(+) +/(-) - +/(-) -/+ -/+ Mesothelial Mesenchymal - -/(+) -/+ + Neuroepithelial - -/(+) + + Germ cell - -/+ -/+ + 18

19 Cytokeratins in malignant melanoma CK Primary panel for the unknown primary tumour Haematolymphoid Epithelial CD45 CK S-100 VIM +/(-) -/(+) -/(+) +/(-) - +/(-) -/+ -/+ Mesothelial Mesenchymal - -/(+) -/+ + Neuroepithelial - -/(+) + + Germ cell - -/+ -/+ + Cytokeratins in germ cell tumours CK: Seminoma CK: Embr. carcinoma 19

20 Cytokeratin-Pan Abs/protocols Cytokeratins: retrieval causing false negativity HIER Proteolysis AE1 detects CK8 after HIER only AE1 does not detect CK18 AE3 does not detect CK8/CK18 SCLC CK: renal cell carcinoma Proteolysis 20

21 CK-PAN control: Liver ER CD45 Liver Critical Stain Quality Indicator: Liver cells Primary panel for the unknown primary tumour Haematolymphoid Epithelial CD45 CK S-100 VIM +/(-) -/(+) -/(+) +/(-) - +/(-) -/+ -/+ Mesothelial Mesenchymal - -/(+) -/+ + Neuroepithelial - -/(+) + + Germ cell - -/+ -/+ + S-100 protein Family of acid calcium binding proteins 9/13 kda Located in nuclei, cytoplasm and cell membranes at least 10 α-chains and one β-chain creating homo- and heterodimers S-100 β-chain mainly found in Melanocytes Glial cells Langerhans cells / interdigitating reticulum cells Fat cells Myoepithelial cells Polyclonal antibodies primarily detects the β-chain 21

22 S-100 protein brain chondrocytes S-100 protein Tonsil S-100 protein pancreas 22

23 S-100 in malignant tumours mal. melanoma breast carcinoma S-100 protein To HIER or not.. S100B Frozen IHC Proteolytic HIER Primary panel for the unknown primary tumour Haematolymphoid Epithelial CD45 CK S-100 VIM +/(-) -/(+) -/(+) +/(-) - +/(-) -/+ -/+ Mesothelial Mesenchymal - -/(+) -/+ + neuroepithelial - -/(+) + + Germ cell - -/+ -/+ + 23

24 Vimentin Cytoplasmic intermediate filament, 57 kda Present in all mesenchymal cells Present in early stages of all cells, replaced by other intermediate filaments in most non-mesenchymal cells Coexpressed with cytokeratin in some epithelia Endometrium, renal tubules, thyroid gland Coexpressed with cytokeratin in some non-epithelial cells Mesothelium Vimentin in normal tissue HE Normal brain VIM Vimentin in carcinomas clear cell sarcomatoid renal cell carcinoma endometrioid carcinoma 24

25 Vimentin in non-epithelial tumours mal. melanoma mal. mesothelioma Malignant melanoma Ovarian tumour: Serous carcinoma Malignant melanoma CK VIM Ovarian tumour: Serous carcinoma 25

26 Malignant melanoma MSA, MLA SOX10, MITF CK VIM Ovarian tumour: Serous carcinoma Coordinate cytokeratin-vimentin expression CK + VIM in carcinomas Thyroid, adrenal cortex ~ 100% Renal cell ~ 60% Serous, endometrioid ~ 50% Lung ~ 40% Prostate ~ 40% Pancreas, urothelium ~ 30% Breast ~ 10% Endocrine ~ 10% Colorectum ~ 0% CIQC/CAP-ACP SEMINAR 2013: DIAGNOSTIC IHC AND MOLECULAR PATHOLOGY Classification of the unknown primary tumour: the primary IHC panel Thank you for your attention Aalborg University Hospital Denmark 26