A basic immunohistochemical panel for the diagnosis of soft tissue tumors

Czech version

Authors: Michael Michal ^1,2
Authors‘ workplace: Bioptická laboratoř, s. r. o., Plzeň ¹; Šiklův ústav patologie LF UK v Plzni a FN Plzeň ²
Published in: Čes.-slov. Patol., 57, 2021, No. 1, p. 12-18
Category: Reviews Article

Overview

There is no universal immunohistochemical panel which would be useful for the diagnosis of soft tissue tumors in all circumstances. Nevertheless, especially when faced with an uncharacteristic spindle cell neoplasm, a basic immunohistochemical panel can be recommended consisting of CD34, desmin, epithelial membrane antigen, broad-spectrum cytokeratins, S100 protein and smooth muscle actin. This review will address the utility and pitfalls of this panel. The use of MDM2 immunohistochemistry and fluorescence in situ hybridization in the diagnosis of lipomatous tumors will be discussed as well.

Keywords:

soft tissue tumors – immunohistochemistry – MDM2

Sources

1. Miettinen M. Immunohistochemistry of soft tissue tumours - review with emphasis on 10 markers. Histopathology 2014; 64(1): 101-118.

2. Ordonez NG. Immunohistochemical endothelial markers: a review. Adv Anat Pathol 2012; 19(5): 281-295.

3. Dagrada GP, Spagnuolo RD, Mauro V, et al. Solitary fibrous tumors: loss of chimeric protein expression and genomic instability mark dedifferentiation. Mod Pathol 2015; 28(8): 1074-1083.

4. Mentzel T, Beham A, Katenkamp D, Dei Tos AP, Fletcher CD. Fibrosarcomatous (“high-grade”) dermatofibrosarcoma protuberans: clinicopathologic and immunohistochemical study of a series of 41 cases with emphasis on prognostic significance. Am J Surg Pathol 1998; 22(5): 576-587.

5. Volpicelli ER, Fletcher CD. Desmin and CD34 positivity in cellular fibrous histiocytoma: an immunohistochemical analysis of 100 cases. J Cutan Pathol 2012; 39(8): 747-752.

6. Hornick JL, Fletcher CD. Soft tissue perineurioma: clinicopathologic analysis of 81 cases including those with atypical histologic features. Am J Surg Pathol 2005; 29(7): 845-858.

7. Miettinen MM, Antonescu CR, Fletcher CDM, et al. Histopathologic evaluation of atypical neurofibromatous tumors and their transformation into malignant peripheral nerve sheath tumor in patients with neurofibromatosis 1-a consensus overview. Hum Pathol 2017; 67: 1-10.

8. Fletcher CDM. Diagnostic Histopathology of Tumors (5th ed). Philadelphia: Elsevier; 2021: 47.

9. Svajdler M, Bohus P, Baumohlova H, Sokol L, Bielek J. Epiteloidný hemangióm nohy.Cesk Patol 2006; 42(2): 86-90.

10. Parham DM, Webber B, Holt H, Williams WK, Maurer H. Immunohistochemical study of childhood rhabdomyosarcomas and related neoplasms. Results of an Intergroup Rhabdomyosarcoma study project. Cancer 1991; 67(12): 3072-3080.

11. Qiu X, Montgomery E, Sun B. Inflammatory myofibroblastic tumor and low-grade myofibroblastic sarcoma: a comparative study of clinicopathologic features and further observations on the immunohistochemical profile of myofibroblasts. Hum Pathol 2008; 39(6): 846-856.

12. Marino-Enriquez A, Wang WL, Roy A, et al. Epithelioid inflammatory myofibroblastic sarcoma: An aggressive intra-abdominal variant of inflammatory myofibroblastic tumor with nuclear membrane or perinuclear ALK. Am J Surg Pathol 2011; 35(1): 135-144.

13. Hisaoka M, Wei-Qi S, Jian W, Morio T, Hashimoto H. Specific but variable expression of h-caldesmon in leiomyosarcomas: an immunohistochemical reassessment of a novel myogenic marker. Appl Immunohistochem Mol Morphol 2001; 9(4): 302-308.

14. Schoolmeester JK, Fritchie KJ. Genital soft tissue tumors. J Cutan Pathol 2015; 42(7): 441-451.

15. Fanburg-Smith JC, Miettinen M. Angiomatoid “malignant” fibrous histiocytoma: a clinicopathologic study of 158 cases and further exploration of the myoid phenotype. Hum Pathol 1999; 30(11): 1336-1343.

16. Schneider N, Fisher C, Thway K. Ossifying fibromyxoid tumor: morphology, genetics, and differential diagnosis. Ann Diagn Pathol 2016; 20: 52-58.

17. Folpe AL, Weiss SW, Fletcher CD, Gown AM. Tenosynovial giant cell tumors: evidence for a desmin-positive dendritic cell subpopulation. Mod Pathol 1998; 11(10): 939-944.

18. Thway K, Noujaim J, Zaidi S, et al. Desmoplastic small round cell tumor: pathology, genetics, and potential therapeutic strategies. Int J Surg Pathol 2016; 24(8): 672-684.

19. Agaimy A, Buslei R, Coras R, Rubin BP, Mentzel T. Comparative study of soft tissue perineurioma and meningioma using a five-marker immunohistochemical panel. Histopathology 2014; 65(1): 60-70.

20. Bohman SL, Goldblum JR, Rubin BP, Tanas MR, Billings SD. Angiomatoid fibrous histiocytoma: an expansion of the clinical and histological spectrum. Pathology 2014; 46(3): 199-204.

21. Guillou L, Benhattar J, Gengler C, et al. Translocation-positive low-grade fibromyxoid sarcoma: clinicopathologic and molecular analysis of a series expanding the morphologic spectrum and suggesting potential relationship to sclerosing epithelioid fibrosarcoma: a study from the French Sarcoma Group. Am J Surg Pathol 2007; 31(9): 1387-1402.

22. Folpe AL, Billings SD, McKenney JK, Walsh SV, Nusrat A, Weiss SW. Expression of claudin-1, a recently described tight junction-associated protein, distinguishes soft tissue perineurioma from potential mimics. Am J Surg Pathol 2002; 26(12): 1620-1626.

23. Pekmezci M, Reuss DE, Hirbe AC, et al. Morphologic and immunohistochemical features of malignant peripheral nerve sheath tumors and cellular schwannomas. Mod Pathol 2015; 28(2): 187-200.

24. Jo VY, Fletcher CD. Epithelioid malignant peripheral nerve sheath tumor: clinicopathologic analysis of 63 cases. Am J Surg Pathol 2015; 39(5): 673-682.

25. Pelmus M, Guillou L, Hostein I, Sierankowski G, Lussan C, Coindre JM. Monophasic fibrous and poorly differentiated synovial sarcoma: immunohistochemical reassessment of 60 t(X;18)(SYT-SSX)-positive cases. Am J Surg Pathol 2002; 26(11): 1434-1440.

26. Nakajima T, Watanabe S, Sato Y, Kameya T, Hirota T, Shimosato Y. An immunoperoxidase study of S-100 protein distribution in normal and neoplastic tissues. Am J Surg Pathol 1982; 6(8): 715-727.

27. Eisen RN, Buckley PJ, Rosai J. Immunophenotypic characterization of sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease). Semin Diagn Pathol 1990; 7(1): 74-82.

28. Graham RP, Dry S, Li X, et al. Ossifying fibromyxoid tumor of soft parts: a clinicopathologic, proteomic, and genomic study. Am J Surg Pathol 2011; 35(11): 1615-1625.

29. Miettinen M, Fetsch JF. Distribution of keratins in normal endothelial cells and a spectrum of vascular tumors: implications in tumor diagnosis. Hum Pathol 2000; 31(9): 1062-1067.

30. Bahrami A, Gown AM, Baird GS, Hicks MJ, Folpe AL. Aberrant expression of epithelial and neuroendocrine markers in alveolar rhabdomyosarcoma: a potentially serious diagnostic pitfall. Mod Pathol 2008; 21(7): 795-806.

31. Švajdler M ŠP, Michal M. Jaká je Vaše diagnóza? Vretenobunkový rabdomyosarkóm. Cesk Patol 2017; 53(2): 100;102-103.

32. Laskin WB, Fetsch JF, Miettinen M. Myxoinflammatory fibroblastic sarcoma: a clinicopathologic analysis of 104 cases, with emphasis on predictors of outcome. Am J Surg Pathol 2014; 38(1): 1-12.

33. Carter JM, Weiss SW, Linos K, DiCaudo DJ, Folpe AL. Superficial CD34-positive fibroblastic tumor: report of 18 cases of a distinctive low-grade mesenchymal neoplasm of intermediate (borderline) malignancy. Mod Pathol 2014; 27(2): 294-302.

34. Clay MR, Martinez AP, Weiss SW, Edgar MA. MDM2 and CDK4 immunohistochemistry: should it be used in problematic differentiated lipomatous tumors?: A new perspective. Am J Surg Pathol 2016; 40(12): 1647-1652.

35. Clay MR, Martinez AP, Weiss SW, Edgar MA. MDM2 amplification in problematic lipomatous tumors: analysis of FISH testing criteria. Am J Surg Pathol 2015; 39(10): 1433-1439.

36. Michal M, Agaimy A, Contreras AL, et al. Dysplastic lipoma: adistinctive atypical lipomatous neoplasm with anisocytosis, focal nuclear atypia, p53 overexpression, and a lack of MDM2 gene amplification by FISH; A report of 66 cases demonstrating occasional multifocality and a rare association with retinoblastoma. Am J Surg Pathol 2018; 42(11): 1530-1540.

37. Binh MB, Sastre-Garau X, Guillou L, et al. MDM2 and CDK4 immunostainings are useful adjuncts in diagnosing well-differentiated and dedifferentiated liposarcoma subtypes: a comparative analysis of 559 soft tissue neoplasms with genetic data. Am J Surg Pathol 2005; 29(10): 1340-1347.

38. Neuville A, Collin F, Bruneval P, et al. Intimal sarcoma is the most frequent primary cardiac sarcoma: clinicopathologic and molecular retrospective analysis of 100 primary cardiac sarcomas. Am J Surg Pathol 2014; 38(4): 461-469.

39. Demicco EG. Molecular updates in adipocytic neoplasms. Semin Diagn Pathol 2019; 36(2): 85-94.

40. Goldblum JR, Folpe AL, Weiss SW. Enzinger & Weiss’s Soft Tissue Tumors (7th ed). Philadelphia: Elsevier; 2020:129, 143.

41. Azumi N, Battifora H. The distribution of vimentin and keratin in epithelial and nonepithelial neoplasms. A comprehensive immunohistochemical study on formalin- and alcohol-fixed tumors. Am J Clin Pathol 1987; 88(3): 286-296.

42. Dabbs DJ. Diagnostic Immunohistochemistry: Theranostic and Genomic Applications (4th ed). Philadelphia: Elsevier; 2014: 202, 219.