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An advanced diagnostic method in surgical pathology

An advanced diagnostic method in surgical pathology. Mainstay of surgical pathology. Rosai : “The H & E technique”. Old mistress apologue. The H & E technique ,1998 pathologica. “Hemotoxylum campechianum” Bloody red bark tree. Mexico Campeche. H&E Advantages.

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An advanced diagnostic method in surgical pathology

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  1. An advanced diagnostic method in surgical pathology

  2. Mainstay of surgical pathology • Rosai : “The H & E technique” Old mistress apologue The H & E technique ,1998 pathologica “Hemotoxylum campechianum” Bloody red bark tree Mexico Campeche

  3. H&E Advantages • Relatively quick • Inexpensive • Suitable for most situations • Easy to master • Allows accurate Dx of the large majority of specimens • Nevertheless, Cannot answer all the questions

  4. SPECIAL TECHNIQUES • Special stains • Enzyme histochemistry • Tissue culture • Electron microscopy • Immunohistochemistry vs Immunocytochemistry ! • Flow cytometry • Cytogenetics • Molecular pathology • Histometry

  5. Chromogene Tag To detect target antigenscytoplasmic cytokeratin vimentin chromogranin A nuclear estrogen receptor progesterone receptor Ki-67 P-53 memebranous Her 2-neu E-cadherin EGFR 2nd Ab 1st Ab Ag Ag Basic structure: Polypeptide Glycoprotein Lipoprotein

  6. Antigen • The small site on an antigen • to which a complementary antibody • may specifically bind is called • an epitope. • This is usually one to six monosaccharides • or 5–8 amino acid residues on the surface • of the antigen.

  7. Antigen • Because antigen molecules exist in space, • specific three-dimensional antigenic conformation • (e.g., a unique site formed by the interaction • of two native protein loops or subunits), • or the epitope may correspond to a simple primary • sequence region. • Such epitopes are described as conformational and linear.

  8. Antigen • The range of possible binding sites is enormous, with each • potential binding site having its own structural properties • derived from: • covalent bonds, • ionic bonds and • hydrophilic and • hydrophobic interactions.

  9. Ag-Ab reaction For efficient interaction to occur between the antigen and the antibody: the epitope must be readily available for binding. If the target molecule is denatured, e.g. through fixation, reduction, osmolalaity changes, pH changes, temperature, chemical agents, the epitope may be altered and this may affect its ability to interact with an antibody.

  10. Characteristics of a Good Antigen Include: 1.Areas of structural stability and chemical complexity within the molecule. 2.Lacking extensive repeating units. 3.A minimal molecular weight of 8,000–10,000 Daltons, although haptens with molecular weights as low as 200 Da have been used in the presence of a carrier protein. 4.The ability to be processed by the immune system.

  11. Characteristics of a Good Antigen Include: 5.Immunogenic regions which are accessible to the antibody-forming mechanism. 6.Structural elements that are sufficiently different from the host. 7.For peptide antigens, regions containing at least 30% of immunogenic amino acids: K, R, E, D, Q, N. 8.For peptide antigens, significant hydrophilic or charged residues.

  12. Monoclonal vs. Polyclonal 2nd Ab : Mouse / goat / rabbit anti- 1st Ab 1st Ab : Mouse / goat / rabbit anti-human

  13. Antigen-Antibody Interaction The specific association of antigens and antibodies is dependent on hydrogen bonds, hydrophobic interactions, electrostatic forces, and van der Waals forces. These are all bonds of a weak, non-covalent nature-Like antibodies.

  14. Antigen-Antibody Interaction Antigens can be multivalent, either through multiple copies of the same epitope, or through the presence of multiple epitopes that are recognized by multiple antibodies. Interactions involving multivalency can produce more stabilized complexes, however multivalency can also result in steric difficulties, thus reducing the possibility for binding.

  15. Antigen-Antibody Interaction All antigen-antibody binding is reversible, however, and follows the basic thermodynamic principles of any reversible bimolecular interaction: where KA is the affinity constant, Ab and Ag are the molar concentrations of unoccupied binding sites on the antibody or antigen respectively, and Ab–Ag is the molar concentration of the antibody-antigen complex.

  16. Antigen-Antibody Interaction Affinity describes the strength of interaction between antibody and antigen at single antigenic sites. Within each antigenic site, the variable region of the antibody “arm” interacts through weak non-covalent forces with antigen at numerous sites; the more interactions, the stronger the affinity.

  17. Antigen-Antibody Interaction Avidity is perhaps a more informative measure of the overall stability or strength of the antibody-antigen complex. It is controlled by three major factors: 1.antibody-epitope affinity; 2. the valence of both the antigen and antibody; 3.and the structural arrangement of the interacting parts.

  18. Polyclonal vs monoclonal 1.Polyclonal antibodies often recognize multiple epitopes, making them more tolerant of small changes in the nature of the antigen.

  19. Polyclonal vs monoclonal 2.Polyclonal antibodies are often the preferred choice for detection of denatured proteins

  20. Polyclonal vs monoclonal 3.Polyclonal antibodies may be generated in a variety of species, including rabbit, goat, sheep, donkey, chicken and others, giving the users many options in experimental design.

  21. Polyclonal vs monoclonal 4.Polyclonal antibodies are sometimes used when the nature of the antigen in an untested species is not known.

  22. Polyclonal vs monoclonal 5.Polyclonal antibodies target multiple epitopes and so they generally provide more robust detection.

  23. Monoclonal vs polyclonal 6.Because of their specificity, monoclonal antibodies are excellent as the primary antibody in an assay, or for detecting antigens in tissue, and will often give significantly less background staining than polyclonal antibodies.

  24. Monoclonal vs polyclonal 7.When compared to that of polyclonal antibodies, homogeneity of monoclonal antibodies is very high. If experimental conditions are kept constant, results from monoclonal antibodies will be highly reproducible between experiments.

  25. Monoclonal vs polyclonal 8.Specificity of monoclonal antibodies makes them extremely efficient for binding of antigen within a mixture of related molecules, such as in the case of affinity purification.

  26. Basic concepts & Historical aspects

  27. Basic Concept Immunohistochemistry is 1.The localization of antigens in tissue sections by the use of 2.labeled antibody as specific reagents through 3.antigen-antibody interactions 4.that are visualized by a marker such as fluorescent dye, enzyme, radioactive element or colloidal gold.

  28. There are numerous immunohistochemistry methods that may be used to localize antigens. The selection of a suitable method should be based on parameters such as : the type of specimen under investigation and the degree of sensitivity required.

  29. ImmunohistochemistryHistorical aspect 1.Albert H. Coons 1944- 1955; fluorescent dye 2.Nakane and Pierce 1966 ; enzyme labels / peroxidase; Mason and Sammons 1978 alkaline phosphatase 3.Faulk and Taylor 1971; Colloidal gold by both light and electron microscopy level 4.Radioactive elements, and visualization by autoradiography.

  30. With the expansion and development of immunohistochemistry technique, enzyme labels have been introduced such as peroxidase(Nakane and Pierce 1966; Avrameas and Uriel 1966) and alkaline phosphatase(Mason and Sammons 1978).

  31. TO APPLY IHC OR ICC FOR …? • 1.Diagnostic purpose. • 2.Prognostic purpose • 3.Therapeutic purpose • 4.Preventive purpose?

  32. Applications of IHCDiagnostic purpose:

  33. Applications of IHCDiagnostic purpose:IHC profile for metastatic carcinoma of unknown origin

  34. Diagnostic purpose of IHC

  35. Diagnostic purpose of IHC

  36. Applications of IHCDiagnostic purpose:an exampleIHC profile for prostatic carcinoma

  37. IHC in prostate Cancer • Indications: 1- Distinction of Benign from Malignant • High molecular weight cytokeratin (34E12, CK5/6) • Negative cytoplasmic marker (in basal cells) • P63 • Negative nuclear stain (in basal cells) • AMACR (P504S) • Positive cytoplasmic marker (in tumor cells) • Also positive in HGPIN, 31% of Bladder Ca. & 70% of Colorectal Ca.

  38. HMW-CK (34E12) Normal Glands Negative in Carcinoma

  39. AMACR (P504S) stain in Carcinoma

  40. P63 / AMACR cocktail Increasing IHC resolution:

  41. 34E12 / P63 / AMACR 2-chromogen cocktail Increasing IHC resolution:

  42. IHC in prostate Cancer (Cont.) • Indications: 2- Differential Dx from urothelial carcinoma: PSA PSAP 34E12 Leu7 CK5/6 Prostate Ca + + – + - Urothelial Ca– – + – +

  43. IHC in prostate Cancer (Cont.) • Indications: 3- Differential Dx in metastatic carcinoma: Bone Tumor: PSA stain

  44. Applications of IHCPrognostic purposein breast carcinoma

  45. Prognostic purpose of IHC • ER/PR/pS2: • pS2 : Cystein-rich peptide induced by estrogen secreted from breast cells. • pS2 expression has been found to be associated with longer overall & disease free survival. • ER +/ PR +/ pS2 + : 85% to 97% have good prognosis • ER +/ PR +/ pS2 - : only 50% to 54% have good prognosis.

  46. Clinical data inconsistency How to Assess an IHC immunostain? reproducibility Inter-observer variation

  47. An example Assessment of Her2 status in breast cancer

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