Application of Immunohistochemistry in Gastrointestinal and Liver Neoplasms: New Markers and Evolving Practice

Abstract

Context Diagnosis of primary gastrointestinal and liver neoplasms is usually straightforward. Immunohistochemistry is most helpful to differentiate metastatic carcinomas with morphologic similarity and to resolve tumors of unknown origin. Recently, several new markers highly sensitive and specific for primary liver and gastrointestinal tumors have been discovered. Their potential diagnostic application has not been widely appreciated by general practicing pathologists. In addition, a new trend in immunohistochemistry application has started, focusing on assessing predictive markers (such as human epidermal growth factor receptor 2) and mutation-specific markers (v-raf murine sarcoma viral oncogene homolog B V600E) to directly guide clinical management. Practicing pathologists need to be aware of and prepared for this evolving trend. Objectives To summarize the usefulness of several recently discovered immunohistochemical markers in the study of gastrointestinal and liver tumors; to suggest the most current and effective immunohistochemical panels addressing common diagnostic challenges for these tumors; to share practical experience and useful tips for human epidermal growth factor receptor 2 testing in gastric and gastroesophageal junction adenocarcinoma and v-raf murine sarcoma viral oncogene homolog B V600E immunohistochemistry in colorectal carcinoma. Data Sources Sources include literature review, and authors' research data and practice experience. The cases illustrated are selected from the pathology archives of the Geisinger Medical Center (Danville, Pennsylvania). Conclusions Application of immunohistochemistry in gastrointestinal and liver tumors continues to evolve. New tumor-specific markers constantly emerge and help pathologists to further improve diagnostic accuracy. Assessment of predictive and prognostic markers by immunohistochemistry in routine pathologic diagnosis is a new trend and will greatly facilitate the advancement of personalized cancer therapy.

Fade to black!

“…The serum alkaline phosphatase, total bilirubin and aspartate aminotransferase were also elevated. The patient's age, sex, tumour marker profile, immunohistochemical profile, liver function profile, and imaging data fit the possibility of metastasis from a hepatobiliary origin, likely intrahepatic bile duct carcinoma [2][3][4][5].…”

Protective Effect of Ursolic Acid on the Intestinal Mucosal Barrier in a Rat Model of Liver Fibrosis

“…The sections were observed under a microscope. Based on the criteria proposed by Chen and Lin (2015), immunohistochemical staining was analyzed by two pathologists in a blind manner.…”

Quantitative mass spectrometry analysis reveals a panel of nine proteins as diagnostic markers for colon adenocarcinomas

“…Over the years, several tissue and serum specific biomarkers have been identified. Histological evaluation of tissue samples from gastrointestinal neoplasms are commonly carried out by immunohistochemistry (IHC) analysis of target proteins against CDX2 [ 6 ], Mucins (MUC2) [ 7 ], Special AT-rich sequence binding protein 2 (SATB2) [ 8 ], Cytokeratins [ 9 , 10 ], β-catenin [ 11 ], Carcinoembryonic antigen (CEA) [ 12 ], and Cadherin 17 [ 13 , 14 ]. Furthermore, protein targets like CDX2 and SATB2 have also been linked to be important prognostic markers for colorectal cancer patients.…”