Review
Immunohistochemistry of soft tissue tumours – review with emphasis on 10 markers
Markku Miettinen,
Corresponding Author
Markku Miettinen
Laboratory of Pathology, National Cancer Institute, Bethesda, MD, USA
Address for correspondence: M Miettinen MD, Laboratory of Pathology, NCI 9000 Rockville Pike, Building 10, Room 2B50, Bethesda, MD 20892, USA. e-mail: [email protected]Search for more papers by this authorMarkku Miettinen,
Corresponding Author
Markku Miettinen
Laboratory of Pathology, National Cancer Institute, Bethesda, MD, USA
Address for correspondence: M Miettinen MD, Laboratory of Pathology, NCI 9000 Rockville Pike, Building 10, Room 2B50, Bethesda, MD 20892, USA. e-mail: [email protected]Search for more papers by this authorAbstract
Immunohistochemistry is an integral component in the proper analysis of soft tissue tumours, and a simple panel of six markers is useful in practical triage: CD34, desmin, epithelial membrane antigen (EMA), keratin cocktail AE1/AE3, S100 protein and alpha smooth muscle actin (SMA). These markers frequently assist in the differential diagnosis of fibroblastic, myoid, nerve sheath and perineurial cell tumours, synovial and epithelioid sarcoma and others. However, they all are multispecific, so that one has to be cognizant of their distribution in normal and neoplastic tissues. Four additional useful markers for specific tumour types are discussed here: CD31 and ERG for vascular endothelial tumours, and KIT and DOG1/Ano-1 for gastrointestinal stromal tumours (GISTs). However, hardly any marker is totally monospecific for any one type of tumour. Furthermore, variably lineage-specific markers do not usually distinguish between benign and malignant proliferations, so that this distinction has to be made on histological grounds. Immunohistochemical evaluation is most useful, efficient and cost-effective when used in the context of careful histological evaluation by an experienced pathologist, aware of all diagnostic entities and their histological spectra. Additional diagnostic steps that must be considered in difficult cases include clinicoradiological correlation and additional sampling of remaining wet tissue, if possible.
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