Immunohistochemistry

What is Immunohistochemistry?

Immunohistochemistry or IHC refers to the process of detecting antigens (e.g., proteins) in cells of a tissue section by exploiting the principle of antibodies binding specifically to antigens in biological tissues. IHC takes its name from the roots "immuno," in reference to antibodies used in the procedure, and "histo," meaning tissue (compare to immunocytochemistry). The procedure was conceptualized and first implemented by Dr. Albert Coons in 1941.

Immunohistochemical staining is widely used in the diagnosis of abnormal cells such as those found in cancerous tumors. Specific molecular markers are characteristic of particular cellular events such as proliferation or cell death (apoptosis). IHC is also widely used in basic research to understand the distribution and localization of biomarkers and differentially expressed proteins in different parts of a biological tissue.

Visualising an antibody-antigen interaction can be accomplished in a number of ways. In the most common instance, an antibody is conjugated to an enzyme, such as peroxidase, that can catalyse a colour-producing reaction (see immunoperoxidase staining). Alternatively, the antibody can also be tagged to a fluorophore, such as fluorescein or rhodamine (see immunofluorescence).

Questions and answers on "Immunohistochemistry"

My mom had bloody sputum past couple of months and we have done many tests to diagnose problem including biopsy, it was identified that, oozing blood from right lower lobe.

Please find the attached biopsy report(2nd biopsy).

Note: First biopsy result was showing negative and no indication of malignancy.

Question : Does this report shows any indication of lung cancer?.

doctor1 MD

Brief Answer:
Yes, it points to words cancers.

Detailed Answer:
Hello,

Description few cells mentioned in report is pointing towards cancers.But doctor was probably not very sure since there are mixed inflammatory cells with theses suspicious celss.So doctor has suggested to get...

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XXXXPatient Details

Name : XXXXX
Gender : Female
Age : 61 years 11 months
Weight on 22nd January 2015 : 68.7 kgs (before surgery)
Weight on 14th February 2015 : 64.7 kgs (after surgery)
Height : 5' 3"
Children : 4 Daughters, 1 Son, (Age of eldest child : 42 years, yougest child age : 35 years)-all normal deliveries
She can walk, work and do household work in good manner without much problems

Patient History

From 1994 till 2010

hysterectomy done 1994 due to fibroid uterus.
Patient of hypertension since last 15 years (Blood pressure is under control due to medication.)
Patient of thyroid and cholesterol (both well under control).

Year 2011

On 25/12/2011 patient complained of severe abdominal pain, nausea, vomiting, uneasiness – admitted to hospital – administered inj. Zenflox, Rantec, Dynapar –IV, Tab. Rabium DSR 1-0-1 and discharged next day i.e. 26-12-11 at own request.

Advised :

Adv. CBS, SGPT, USG Abdomen
Adv. Repeat SOS USG, PPBS and urine complete

USG Abdomen concluded : Hepathomegaly with fatty change with minimum ascitis (of or relating to or resulting from an abnormal accumulation of protein and electrolyte rich fluid in the peritoneal cavity) – SGPT = 20 U/L

Year 2012 - 2014

She had feeling of mild abdominal pain very occasionally for last 2 years but since she did not feel it on continuous basis she felt that it could be due to acidity. On 5th December 2014 - during casual blood tests carried out through one laboratory her lipase was detected abnormal as 71.3 U/I as against reference range of 5.6 – 51.3. Referred to family physician who advised USG Abdomen.


27th December 2014 - USG Abdomen concluded: LARGE ILL-DEFINED INTRAPERITONEAL HYPOECHOIC SOL IN RIGHT SIDE OF ABDOMEN FROM RHC REGION TO RIF. IT SHOWS POOR VASCULARITY – POSSIBILITY OF LIPOMATOUS LESION APPEARS MOST LIKELY – adv. CT SCAN

29th December 2014 - MDCT of abdomen and pelvis carried out , suggested – EXTENSIVE ABNORMAL LIPOMATOSIS INVOLVING ALMOST COMPLETE RIGHT ABDOMINAL CAVITY - ? NATURE. NO EVIDENT HEPATIC INFILTRATION, FREE FLUID OR ADENOPATHY SEEN. Referred to oncologist (Dr - A)

30th December 2014 - CT guided biopsy carried out on suggestion of Dr - A – Fluid material specimen processed for block at pathology laboratory and microscopic examination concluded LIPOMATOUS TUMOR, RIGHT RETROPERITONEUM. WELL DIFFERENTIATED LIPOMA LIKE LIPOSARCOMA MOST LIKELY IN THIS LOCATION.

30th December 2014 - Oncologist (Dr - A) opined it to be liposarcoma.

3rd January 2015 - As a second opinion - Consulted another Oncologist (Dr - B) who mentioned that he will review slide and block of biopsy done by Dr - A. His histopathology review mentioned A SMALL FRAGMENT OF MATURE FIBRO ADIPOSE TISSUE; INADEQUATE FOR A DEFINITIVE OPINION. Dr - B suggested another biopsy at his place.

5th January 2015 - USG guided truecut biopsy carried out by (Dr - B) from right sided retroperitoneal lesion - and his Histopathology report revealed possibility of a typical lipomatous tumor / well differentiated liposarcome likely. He suggested to get PET CT scan done.

8th January 2015 - PET-CT CARRIED OUT – FINDINGS : NON-FDG CONCENTRATING LIPOMATOSIS INVOLVING ABDOMINO-PELVIC CAVITY ON RIGHT SIDE - NO EVIDENCE OF METABOLICALL ACTIVE DISEASE ELSEWHERE IN THE BODY.

9th January 2015 - Dr B suggested for surgery - RADICAL RESECTION OF LIPOMETOUS TUMOR

10th January - Both Dr A and Dr B are surgeons. We decided to get opinion of separate histopathological specialist before getting ready for surgery. Hence we sent Blocks and slides of first and second Biopsy (done by Dr - A and Dr - B) to a histopathology specialst Dr - C.

13th January report of Dr - C mentioned following :

Review of Dr - A's sample - Biopsy reveals mature adipose tissue
Review of Dr - B's sample - Biopsy reveals infarcted fat with dystrophic calcifications
If both biopsies are representative of the lesion, this is a lipomatous tumor showing fact necrosis. However, there is no evidence of it being a liposarcoma.


22th January 2015 - PATIENT ADMITTED TO Dr B's hospital AND ON 23-01-15 SURGERY CARRIED OUT FOR RADICAL RESECTION OF LIPOMETOUS TUMOR. Tumor was sent to Dr - B's lab for further analysis. Approximate weight of tumor was around 1.2 kg. We have tumor image captured. If you need we can provide.

27th January 2015 - PATIENT DISCHARGED IN HAEMODYNAMICALLY STABLE CONDITION with advice to follow-up for dressing, soft diet, all liquids, coconut water twice a day.

2nd February patient complained of mild pain – N.A.D. – Mild collection in suture line found – cleaned.

4th February 2015 - Histopathology report from Dr - B's lab shows impression : well differentiated liposarcoma / a typical lipomatous tumor.

10th February 2015 - Patient complained pain and hence USG local part (Screening) carried out at Dr - B's place which revealed FOCAL ILL DEFINED NODULARITY DEEPLY ALONG THE ABDOMINAL SCAR WITH FAT STRANDING AND PROBE TENDERNESS – PoSSIBILITY OF INFLAMATORY ETIOLOGY SUGGETING FOLLOW-UP.

10th February 2015 - Block and Slides of extracted tumor preserved at Dr B's place were sent for review to Dr - C (histopathology specialist)

14th February 2015 - Review by Dr C says following -

Microscopy:

Gigantic Lipoma
The thick fibrous septae show histiocytes and lymphoplasmacytic infilterate.
Foci of fat necrosis and dystrophic calcification are noted

Impression
Right abdominal intraperitoneal SOL : Gigantic Lipoma


Questions :

What should we infer based no Dr C's histopathology review of 14th February 2015?

Is this information sufficient to tell us whether the said tumor is Lipoma (benign) or Liposarcoma (Malignant one) ? If yes, what is it, benign or malignant?

If it is benign what would you suggest as next course of treatment ?

If it is Malignant what would you suggest as next course of treatment ?

If above information is insufficient in order to decide about the nature of tumor what else needs to be done to understand its nature (considering the fact that tumor is not preserved now)

What should we infer about remarks based on USG local part (Screening) carried out on 10th February 2015 by Dr - B? Is this something to be concerned of OR not ?

Note :- We have all the physical as well as digital copies of CT scan, PET CT scan, Biopsy reports, Surgery reports, histopathology reports and slides+blocks of biopsies done by Dr A and Dr B (including biopsy of whole tumor after the surgery done by Dr - B.)

doctor1 MD

Brief Answer:
Correct histopathology report is key.

Detailed Answer:
Hi.
Thank you for your detailed description, it really helps. At this point, I do not need any report copies or films.
Your problem as I see it, entirely rests upon the differentiation between lipoma and liposarcoma, as the...

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yes. I just had surgery for met melanoma all results were neg accept lym notes they toke 3 out amd they were post. 1st one was 2mm then went to 1mm and the third was by immunohistochemistry. but the pet scan and nuclor med.and all surrounding areas were neg. what treatment would do.

doctor1 MD

Brief Answer:
You need further immunotherapy!

Detailed Answer:
Hi,

With positive lymph nodes, you need to receive systemic immunotherapy for better disease control. Also, the doctor might consider removing all the other lymph nodes as a few are already affected. The specifics drugs to be used...

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What kind of blood tests would you order for CLL other than a cbc ? I have had this for 15 years. My white blood count is about 140.

doctor1 MD

Brief Answer:
Hello dear. Flowcytometry is indicated

Detailed Answer:
Hello dear. Welcome to HCM. So in order to diagnose cll, one needs a flowcytometry test on peripheral or marrow blood. Moreover , a bone marrow examination and immunohistochemistry markers can also determine cll.
Thanks and...

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Hello.
I refuse to just stand by in case of Indolent Lymphoma!
Here is where I am at:
Male, 53, non smoker.
-3-4 years ago I sarted noticing many Sebhorreic K in my back, in the hundreds, all over and continue to increasy in my chest and stomach. Pseudo Lesser trelat because the did not appear Suddenly.

-At almost the same time, I broke out a rash that persists to this day, it's on my neck and arms, for 1 year I could only cotrol the itch with topical hidrocort 1% cream. Dermatologist put me on Cetirizine + ranitidie and that controls the itch but I can not suspend it. Been on that regimen for over a year.

-About a year ago, started noticing swolen lymph nodes, supraclavicular and jugulodigastric; doc, sent me to PET Scan and ALL came back OK,.... No cancer activity.

-6 mo. ago.. doc., did a byopsy /removed supraclavicular and it came back as UNSPECIFIC HYPERPLASIA. Doc. said it could be E. Barr syndrome and gave me pain medicine since the started to hurt.

-3 mo ago I noticed my right Popliteal nodes started hurting when I drank alcohol.

NOW.... Popliteal L. always have a dull pain, Inguinal of the same side are slightly swolen, neck vessels hurt and now the same side forearm feels the same. Jugulodigastric.. of the other side remains swollen and has a dull pain.

Here is the fun part.
NO B SYMPTOMS
ALL BLOD TEST ARE OK.
Had an Ches Xray yesterday and all is ok.. except for diaphragmatica eventration that developed 2-3 year ago.. Phrenic never involvment is unknown.

Doc. mentioned indolent lymphoma.. but I refuse to remain pasive.. just whaiting.. FOR WHAT? More pain? Ignore untill blood test com back with something? The pain on my lymph nodes/vessels could be an infection .. correct... but for 4 years?

I need to do somethig?
I welcome your reply.

doctor1 MD

Brief Answer:
You should go for immunohistochemistry.

Detailed Answer:
Hi, dear
I have gone through your question. I can understand your concern.
You have generalised lymphadenopathy. Your biopsy gives non specific hyperplasia. You may have Iindolent lymphoma or reactive hyperplasia of...

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I had an ultrasound and ctcn an my stated to me today i had cancerous cells all over my liver. He stated he did not know where it come from everything else and other organs was normal.i just started feeling pain on right side and stomach in the last week of august.in janurary all blood and exrays was normal.

doctor1 MD

Brief Answer:
USG guided biopsy with immunohistochemistry

Detailed Answer:
Hi

As you are having cancerous cells all over your liver it is very important to know whether those cells originated in the liver or has spread from other parts of the body.

I will advise u to do an Ultrasonography (USG)...

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Hi...I have a question regarding oncology field....
My aunt was found 15 days ago with metastasis cancer in her left armpit lymph nodes. She went through: complete blood work, chest x-rays, mammogram, ultrasound, MR, PET scan, gynocologist's check and 2 times citology punction. All the examinations showed only lymph nodes positive, no other body part with cancer proved yet. The oncologyst says now to go through core biopsy of the affected lymph nodes. Isthis the right way or should we go through other steps?

doctor1 MD

Brief Answer:
Yes this is one approach

Detailed Answer:
Hi
Thanks for your query.

It is a difficult but not uncommon scenario. We have two approaches.

One is we can do the core biopsy, do special tests like immunohistochemistry and try to find out the origin. It will mostly be like breast cancer...

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My mother's spine biopsy report:
Crishind artifacts suggestive of round cell tumour, fibrocollagenous and adipose tissue paravertebral region biopsy
Definite granulomas or atypical cells are not seen.
Immunohistochemistry study is suggested for further confirmation and typing.

Please tell me what it means

doctor1 MD

Brief Answer:
Round cell tumor

Detailed Answer:
Hi Npbala, thanks for asking from HCM.


I can understand your concern. Round cell tumor of thoracic vertebrae means any of these tumors like Ewing's sarcoma, peripheral neuroectodermal tumor, rhabdomyosarcoma, synovial sarcoma, non-Hodgkin's lymphoma...

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I had uterine cancer in 2005 the dr said he took every thing out and did not any other treament

Now I had a biopsy on my neck and was told I did not have neck or lung cancer but some kind of cancer to do with my uterus

doctor1 MD

Brief Answer:
Hello dear. It is possible though rare

Detailed Answer:
Hello dear. I have gone through the details. Im sorry to say but this is possible even after complete removal of tumor that some microscopic cells are left behind which later produce big tumor or nodes. It can further be...

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what are the anatomical alterations for hantavirus pulmonary syndrome

doctor1 MD

Brief Answer:
As mentioned

Detailed Answer:
Hi, thanks for using Healthcaremagic.

I went through your query and understood your concerns.

Immunohistochemistry analysis has shown that viral antigens are distributed primarily within the endothelium of vessels in the pulmonary microvasculature....

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Recent questions on  Immunohistochemistry

doctor1 MD

What kind of blood tests would you order for CLL other than a cbc ? I have had this for 15 years. My white blood count is about 140.

doctor1 MD

I have been on this site for several years and my worse fear came to pass. Since May of this year I was diagnosed with locally advanced pancreatic cancer. I have been devastated.My GI doctors have been following my IPMN lesions since 2014. How...

doctor1 MD

I was diagnosed with tumors on my omentum the largest of which is 3cm what could be the possible causes. I have crohns disease and all but 6 inches of my colon has been removed. In may I started having lower back pain and losing weight. I thought...

doctor1 MD

Hi...latest reports of biopsy states that "Section shows hyalinised fibrocollagenous fragments infiltrated by liner trabeculae, nests and ill defined glandular aggregates of pleomorphic and hyperchromatic cells with nucleo-cytoplasmic ratio and inconspicuous mitotic activity". Diagnosos says "right breast SOL: infiltrating ductal carcinoma, grade 1 (Score 5). Advised immunohistochemical work up (ER, PR, Her2 Neu, E-cadherin)".
What does this mean. Is this directing towards dreast cancer?

doctor1 MD

hi I am worried ecause i went to my dermatologist because i have alot of light pink almost skin colored spots growing around my belly,back,chest and arm. they don't ich or hurt but they been coming out for over a year now. my doc did a biopsy of one and now called to tell me that she needed to do a ihc analysis on the tissue sample. what does that mean?

doctor1 MD

Hi Doctor, My father aged 63 yrs has a tumour @ right supravaculear (Size 3 Cm) in ight side of the neck. After FNAC it was confirmed as Squamacell Carcinoma and we went on different tests( PET CT ,CEA, Ultrasound, Endoscopy , Chest CT plain and contrast). but everything normal and no confirmation on primary location. Now doctors suggesting for Biopsy of the node(may full or partial removal of neck node) for IHC and EGFR I m totally confused as I ve few doubts. 1)will removal of node any way disturbs the structure and it may leads to obstruction of tumour 2)Is there any strong chance/evidence we may get identify the Primay through this Biopsy. As a layman I m asking these doubts. Please suggest/guide us and many thanks for kind support!

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