Recent advances in immunohistochemistry in the diagnosis of ovarian neoplasms

Abstract

This leader reviews recent advances in immunohistochemistry that are useful in the diagnosis of ovarian neoplasms. These include the value of different anticytokeratin antibodies in the distinction between a primary ovarian adenocarcinoma and a metastatic adenocarcinoma, especially of colorectal origin. These antibodies have also helped to clarify the origin of the peritoneal disease in most cases of pseudomyxoma peritonei. The value of antibodies against so called tumour specific antigens, such as CA125 and HAM56, in determining the ovarian origin of an adenocarcinoma is also reviewed. In recent years, several studies have investigated the value of a variety of monoclonal antibodies in the diagnosis of ovarian sex cord stromal tumours and in the distinction between these neoplasms and their histological mimics. These antibodies include those directed against inhibin, CD99, Mullerian inhibiting substance, relaxin like factor, melan A, and calretinin. Of these, anti-alpha inhibin appears to be of most diagnostic value. It is stressed that these antibodies should always be used as part of a larger panel and not in isolation.

Figure 1 (A) Primary ovarian mucinous adenocarcinoma in which there is strong positive staining for cytokeratin 7 (CK7). (B) Same primary ovarian mucinous adenocarcinoma showing no staining for CK20.

Figure 2 Metastatic colonic adenocarcinoma in ovary exhibiting strong positive staining for cytokeratin 20 (CK20).

Figure 3 Strong positive staining of ovarian serous adenocarcinoma for CA125.

Figure 4 Strong positive staining of adult granulosa cell tumour for α inhibin.

Figure 5 Strong membrane staining of a juvenile granulosa cell tumour with monoclonal antibody 013 (anti-CD99).