Distinction between hepatocellular carcinoma, cholangiocarcinoma, and metastatic carcinoma based on immunohistochemical staining for carcinoembryonic antigen and for cytokeratin 19 on paraffin sections

Abstract

An antiserum to carcinoembryonic antigen (CEA) and a monoclonal antibody to cytokeratin 19 (CK 19) were studied for their suitability as diagnostic reagents for the differential diagnosis of primary and secondary malignant epithelial tumours of the liver, on paraffin sections. With the antiserum to CEA, positive bile canalicular structures were found in 60 per cent of the hepatocellular carcinomas. All the cholangiocarcinomas and 66.6 per cent of the metastatic carcinomas were positive for CEA, without displaying a canalicular staining pattern. All the hepatocellular carcinomas were negative for CK 19. All the cholangiocellular carcinomas and the metastatic carcinomas were positive for CK 19. This staining profile may prove helpful in difficult diagnostic cases.

Hepatocellular Carcinoma Producing Carcinoembryonic Antigen and Carbohydrate Antigen 19-9.

“…Immunohistochemical studies have revealed that CEA may be present among neoplastic hepatocytes, showing a bile canalicular pattern as seen in non-neoplastic parts of the liver (9,10). In those reports, polyclonal unabsorbed rabbit anti-CEA immunoglobulins was used for staining.…”

Immunohistochemical pitfalls and the importance of glypican 3 and arginase in the diagnosis of scirrhous hepatocellular carcinoma

“…Both HepPar-1 and polyclonal antibody against CEA show low sensitivity for poorly differentiated hepatocellular carcinoma. [19][20][21][22] In contrast, GPC3, an oncofetal antigen that is expressed in 480% of hepatocellular carcinomas, has high sensitivity for poorly differentiated hepatocellular carcinoma. [22][23][24] ARG1, a manganese metalloenzyme active in the urea cycle, has recently been identified as a sensitive and specific hepatocellular marker, 25 and also has not been evaluated in scirrhous hepatocellular carcinoma.…”

Cytokeratin 19 expression in hepatocellular carcinoma predicts early postoperative recurrence

“…7,8) In normal human liver, hepatocytes express CK8 and CK18, while bile duct cells also contain CK7 and CK19. [8][9][10][11] Since this CK pattern has been believed to be preserved during neoplastic transformation, HCC would be expected to express CK8 and CK18, but not CK7 or CK19. [8][9][10][11] Thus, expression of biliary-specific CK (CK7 and CK19) is widely used to distinguish ICC from HCC.…”

“…[8][9][10][11] Since this CK pattern has been believed to be preserved during neoplastic transformation, HCC would be expected to express CK8 and CK18, but not CK7 or CK19. [8][9][10][11] Thus, expression of biliary-specific CK (CK7 and CK19) is widely used to distinguish ICC from HCC. 6,[8][9][10][11][12] Maeda et al 6) recommended that HCC with "suggestive" CC components (incomplete gland formation without mucin production) should be categorized as cHCC-CC when "suggestive" CC components are positive for biliary markers.…”

“…[8][9][10][11] Thus, expression of biliary-specific CK (CK7 and CK19) is widely used to distinguish ICC from HCC. 6,[8][9][10][11][12] Maeda et al 6) recommended that HCC with "suggestive" CC components (incomplete gland formation without mucin production) should be categorized as cHCC-CC when "suggestive" CC components are positive for biliary markers. However, some HCCs have been reported to express biliary markers even with typical HCC growth pattern and morphologic appearance, [13][14][15][16][17] although the histogenesis of such biliary marker-positive HCC is not wellunderstood.…”