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Immunohistochemistry as a diagnostic aid in cervical pathology
1Department of Pathology, Royal Group of Hospital Trust, Belfast, Northern Ireland. glenn.mccluggage@bll.n-i.nhs.uk
Insights
Immunohistochemistry aids cervical pathology diagnosis by identifying specific markers for various lesions. This review details markers for squamous and glandular cervical abnormalities, improving diagnostic accuracy.
Area of Science:
- Gynecologic Pathology
- Diagnostic Cytopathology
- Molecular Pathology
Background:
- Immunohistochemistry (IHC) is increasingly utilized in cervical pathology.
- It serves as an adjunct to routine morphological examination.
- No single marker is entirely specific or sensitive for all cervical lesions.
Purpose of the Study:
- To review the applications of IHC in diagnostic cervical pathology.
- To highlight recent developments in IHC marker utility.
- To discuss the role of IHC in differentiating benign from malignant cervical lesions.
Main Methods:
- Review of current literature on IHC applications in cervical pathology.
- Discussion of specific markers for squamous and glandular lesions.
- Emphasis on IHC as a complementary diagnostic tool.
Main Results:
- Specific markers (e.g., MIB1, p16, bcl-2, CD10, HIK1083) aid in distinguishing various cervical lesions, including adenocarcinoma in situ, dysplasia, and mesonephric lesions.
- IHC panels are valuable for differentiating primary cervical adenocarcinoma from metastatic disease and endometrial adenocarcinoma.
- Markers like p63 are crucial for classifying squamous versus neuroendocrine carcinomas.
Conclusions:
- Immunohistochemistry is a valuable adjunct in cervical pathology, enhancing diagnostic accuracy for both pre-invasive and invasive lesions.
- Careful selection and interpretation of marker panels are essential for reliable diagnosis.
- Continued research into novel markers will further refine diagnostic capabilities in cervical pathology.
Abstract:
As with biopsies from other sites in the female genital tract, immunohistochemistry is now being increasingly used in cervical pathology as an aid to diagnosis. In this review, I discuss applications of immunohistochemistry in diagnostic cervical pathology with a particular focus on recent developments. It is emphasised that immunohistochemistry is to be used as an adjunct to routine morphological examination and that no marker is totally specific or sensitive for a given lesion. Although much of this review focuses on glandular lesions, the value of markers, such as MIB1 and p16, in the assessment of pre-invasive cervical squamous lesions is discussed. In the broad field of cervical glandular lesions, topics covered include: the value of markers such as MIB1, p16 and bcl-2 in distinguishing adenocarcinoma in situ and glandular dysplasia from benign mimics; markers of mesonephric lesions, including CD10; markers of value in the diagnosis of minimal deviation adenocarcinoma, such as HIK1083; markers of value in distinguishing metastatic cervical adenocarcinoma in the ovary from primary ovarian endometrioid or mucinous adenocarcinoma. Rarely ectopic prostatic tissue occurs in the cervix, which can be confirmed by positive staining with prostatic markers. A panel of markers, comprising oestrogen receptor, vimentin, monoclonal carcinoembryonic antigen and p16, is of value in distinguishing between a cervical adenocarcinoma and an endometrial adenocarcinoma of endometrioid type. Markers of use in the diagnosis of cervical neuroendocrine neoplasms, including small cell and large cell neuroendocrine carcinoma, are discussed. It is stressed that small cell neuroendocrine carcinomas may be negative with most of the commonly used neuroendocrine markers and this does not preclude the diagnosis. p63, a useful marker of squamous neoplasms within the cervix, is of value in distinguishing small cell neuroendocrine carcinoma (p63 negative) from small cell squamous carcinoma (p63 positive) and in confirming that a poorly differentiated carcinoma is squamous in type.
