Best practices in diagnostic immunohistochemistry: hepatocellular carcinoma versus metastatic neoplasms
Sanjay Kakar1, Allen M Gown, Zachary D Goodman
1Department of Pathology, Veteran Affairs and University of California Medical Center, San Francisco, CA 94121, USA. sanjay.kakar@ucsf.edu
Context:
Immunohistochemistry plays a crucial role in the diagnosis of hepatocellular carcinoma and in its distinction from other primary and metastatic neoplasms. Because limited tissue is available with fine-needle and core biopsies, appropriate selection of antibodies is imperative.
Objective:
To review the antibodies used for the diagnosis of hepatocellular carcinoma and to outline an immunohistochemical approach in commonly encountered clinical situations.
Data Sources:
Our experience and review of research articles published in the English literature between 1987 and 2006.
Conclusions:
Hep Par 1 and polyclonal carcinoembryonic antigen are the most reliable markers for hepatocellular differentiation, but they have low sensitivity for poorly differentiated cases. Immunohistochemistry for glypican-3 shows promise for the diagnosis of poorly differentiated hepatocellular carcinoma and for its distinction from benign processes such as hepatic adenoma. Further studies with a large number of cases are required before it can be widely used. The combination of Hep Par 1 and MOC-31 will allow for the diagnosis of hepatocellular carcinoma in most cases and will guide the selection of immunohistochemical markers for further workup.
