IMMUNOHISTOCHEMISTRY

ROLE OF HISTOCHEMISTRY AND

IMMUNOHISTOCHEMISTRY IN
DIAGNOSTIC PATHOLOGY
The mainstay in surgical pathology is
the examination of the specimen
after fixation in formalin, embedding
in paraffin and staining with
hematoxylinand eosin.
Special techniques are used for
difficult cases.
This includes histochemistry,
immunohistoche-mistry, electron

IMMUNOHISTOCHEMISTRY
AS A LABORATORY TEST
The objective of
immunohistochemistry is to use
antibodies to identify antigens,
imparting a much greater specificity
of the stain to the tissue with which it
reacts.
In doing so, immunohistology has
transformed surgical pathology from
a highly subjective discipline into a

ADVANTAGES OF
IMMUNOHISTOCHEMISTRY
Identification of the microanatomy
(cellular) location of the antigen.
Can identify the lineage of cell
populations.
Defining distinct populations of cells
within the same lineage
Defining functional differences.
To determine the presence of
infectious agents.

ADVANTAGES OF
IMMUNOHISTOCHEMISTRY
The technique has had success as a factor in
selecting treatment regimens.
Markers useful in this regard include tumor
cell prolife-ration markers, cell cycle
regulators, oncogene and tumor suppressor
gene products, microvessel density
determinations and occult metastasis
determination.
This technique preserves the histologic
architecture and enables the pathologist to

TECHNICAL CONSIDERATIONS
The quality of an immunohistochemical stain depends
on the integrity of an antibody-antigen interaction and
depends on the extent to which the relevant antigen
has been preserved during tissue fixation and
processing.
The reagents and techniques employed need
optimization and thorough validation to ensure
consistent, reliable and clinically meaningful results.
Pre-manufactured kits.
Automated staining.
Positive and negative controls.
Results and reporting.

LIMITATIONS OF
IMMUNOHISTOCHEMISTRY
Experience.
Availability of antibodies.
Loss of antigenicity in
stored cut paraffin
sections.
Antigen retrieval.

CURRENT APPLICATIONS OF
IMMUNOHISTOCHEMISTRY
Immunohistochemistry as a
Diagnostic Tool: Define origin.
1.Establish prognosis.
2.To determine treatment and response.

CURRENT APPLICATIONS OF
IMMUNOHISTOCHEMISTRY
Much more common is the diagnosis of tumor of
uncertain origin.

Such situations include when:

1. The tumor is identified first in a metastatic site
and the primary site is not apparent.
2. The tumor is so poorly differentiated that no
specific morphologic appearance of the tumor
is compatible with more than one pattern.
3. The histogenesis of a tumor is clear (e.g.
adenocarcinoma) but the primary site is in

CURRENT APPLICATIONS OF
IMMUNOHISTOCHEMISTRY
Current applications (contd)
Test selection
Keratin, vimentin, CD45, S-100
Keratin-positive tumors
Keratin-negative tumors: *Lymphomas *Melanomas
*Sarcomas and Soft tissue tumors *Myogenic sarcomas
*Fibrohistiocytic tumors *Neurogenic tumors *Normal and
neoplastic vessels *Anaplastic spindle cell tumors *Neural
and neuroendocrine tumors *Glial fibrillary acid proteinpositive tumors

PROGNOSTIC MARKERS IN CANCER

Microinvasion and
pseudoinvasion
Occult metastases
Tumor cell proliferation
Oncogenes growth factors
and receptors *Her-2/neu
Tumor suppressor genes and
gene products (*R b *p53
*CDK inhibitors)