Emerin Immunohistochemistry: A Useful Ancillary Test for the Identification of Papillary Thyroid Carcinoma
Benjamin H Hinrichs, Mary D Kinsella, Diane Lawson, Cynthia Cohen, Momin T Siddiqui. Emory University School of Medicine, Atlanta, GA
Background: Emerin immunohistochemistry (IHC) highlights unique nuclear membrane irregularities and nuclear shapes characteristic of papillary thyroid carcinoma (PTC). The present study investigates the diagnostic usefulness of emerin IHC in the differentiation of PTC from both follicular neoplasms and non-neoplastic thyroid in histological preparations.
Design: Tissue microarrays (TMAs) consisting of samples from PTC (classic and follicular variant) and non-PTC cases were stained with anti-emerin polyclonal antibody and evaluated for the presence of circumferential nuclear membrane irregularities (garlands), nuclei forming crescent shapes, nuclear grooves, nuclear shape (oval, round, or mixed), intra-nuclear pseudoinclusions, and deep, stellate nuclear membrane invaginations. Staining intensity (strong, intermediate, low, and absent) was also assessed.
Results: Of the 182 TMA cases examined, 95 were diagnosed as PTC (57 classic, 38 follicular variant), and 87 as non-PTC (18 follicular carcinoma, 23 Hurthle cell carcinoma, 6 follicular adenoma, 35 multinodular goiter, 5 normal thyroid).
Emerin garlands, crescent shapes, nuclear grooves, and oval shapes are nuclear features highly sensitive for both classic and follicular variant PTC. Emerin IHC also demonstrates high specificity for PTC: oval shape, specificity 95%; crescent shape, 92%; garlands, 72%; nuclear grooves, 66%. These observations are all statistically significant (p<0.05) determined by linear regression.
Conclusions: Emerin IHC yields patterns in PTC nuclei distinct from those seen in other common thyroid neoplasms and benign conditions. Detection of these patterns in the form of unique nuclear membrane irregularities and nuclear shapes by emerin staining is both sensitive and specific for classic and follicular variant PTC. Emerin IHC is a clinically useful ancillary test for the detection of PTC.
Monday, March 19, 2012 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 94, Monday Morning