When Is Immunohistochemistry Useful in Assessing Tumor Necrotic Tissue?

BACKGROUND/AIM: Immunohistochemistry (IHC) enables visualisation of the distribution of specific proteins, the differentiation of benign and malignant tumours, and the site and origin of a primary tumour. Surgical pathologists commonly examine tumours with extensive necrosis or non-viable tissue that may affect an accurate diagnosis. MATERIALS AND METHODS: We investigated the sensitivity and specificity of IHC on necrotic samples derived from adenocarcinoma, squamous cell carcinoma (SCC) and melanoma using different markers. RESULTS: Analysis of necrosis within tumours revealed 88% sensitivity and 56% specificity for melanoma, 95% and 92% for CK5/6, 95% and 83% for CK20, 37% and 95% for p63, 69% and 97% for Melan A, 88% and 92% for SOX-10, 98% and 56% for CKAE/AE3 and 75% specificity for CK7. CONCLUSION: Antibodies should be considered reliable markers for demonstrating the epithelial nature of a suspected tumour. Immunohistochemistry of necrotic tissues may provide clinically useful information.

Diagnostics of Mutations in MMR/EPCAM Genes and Their Role in the Treatment and Care of Patients with Lynch Syndrome.

Lynch syndrome (LS), also known as hereditary nonpolyposis colorectal cancer (HNPCC), is a disorder caused by an autosomal dominant heterozygous germline mutation in one of the DNA mismatch repair (MMR) genes. Individuals with LS are at an increased risk of developing colorectal and extracolonic cancers, such as endometrial, small bowel, or ovarian. In this review, the mutations involved with LS and their diagnostic methods are described and compared, as are their current uses in clinical decision making. Nowadays, LS diagnosis is based on a review of family medical history, and when necessary, microsatellite instability (MSI) or/and immunohistochemistry (IHC) analyses should be performed. In the case of a lack of MMR protein expression (dMMR) or MSI-H (MSI-High) detection in tumor tissue, molecular genetic testing can be undertaken. More and more genetic testing for LS is based mainly on next-generation sequencing (NGS) and multiplex ligation-dependent probe amplification (MLPA), which provide better and quicker information about the molecular profile of patients as well as individuals at risk. Testing based on these two methods should be the standard and commonly used. The identification of individuals with mutations provides opportunities for the detection of cancer at an early stage as well as the introduction of proper, more effective treatment, which will result in increased patient survival and reduced costs of medical care.