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Reviewer: Nat Pernick, M.D. (see Reviewers page)
Revised: 13 December 2011, last major update December 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.


● Calcium binding protein structurally related to S100 and inhibin


● Nuclear and cytoplasmic staining

Uses by Pathologists

● Differentiate (as part of a panel) epithelioid pleural mesothelioma (positive) from lung adenocarcinoma (negative, Am J Surg Pathol 2003;27:1031)
● Differentiate (as part of a panel) epithelioid peritoneal mesothelioma (positive) from ovarian serous papillary carcinoma (usually negative, Am J Surg Pathol 2007;31:1139)
● Differentiate reactive mesothelial cells (positive) from carcinomas (negative) in effusion cytology (Am J Clin Pathol 2001;116:709, Cytopathology 2008;19:218), ascites fluid / peritoneal lavage (Tohoku J Exp Med 2005;206:31) or pleural biopsies (Am J Surg Pathol 2007;31:914)
● Differentiate (as part of a panel) mesothelioma (positive) from metastatic renal cell carcinoma (negative, Histopathology 2002;41:301)
● Differentiate (as part of a panel) adrenal cortical lesions (calretinin+) from metastatic clear cell renal cell carcinoma (negative, Am J Surg Pathol 2011;35:678)
● Differentiate (as part of a panel) adrenal cortical lesions (calretinin+) from pheochromocytoma (negative, Am J Surg Pathol 2010;34:423)
● Differentiate (as part of a panel) ovarian Sertoli-Leydig tumors (positive) from sertoliform endometroid carcinoma (negative, Arch Pathol Lab Med 2007;131:979)
● Differentiate schwannoma (strong staining) from neurofibroma (negative or weak / focal staining, Am J Clin Pathol 2004;122:552)
● Differentiate olfactory neuroblastoma (calretinin+, p63-) from other sinonasal small round blue cell tumors (calretinin-, p63+, Am J Surg Pathol 2011;35:1786)
● Differentiate ameloblastoma (calretinin+) from keratocystic odontogenic tumor (negative, Am J Surg Pathol 2008;32:256)
● Diagnosis of Hirschsprung disease (negative staining, Mod Pathol 2009;22:1379)
● Identify peritoneal invasive implants of serous borderline tumors of the ovary by lack of calretinin+ mesothelial cells (Mod Pathol 2006;19:364)
● Marker for normal functional endometrial stromal cells (Pathol Res Pract 2007;203:79)

Micro images

Mesothelium: hyperplastic mesothelium and submesothelial stromal cells are calretinin+

Mesothelioma: clear cell variant (pleura)

Mesothelioma-deciduoid variant: left - fig 6; right - fig d

Mesothelioma-epithelioid variant: left, middle-fig d; right-fig d


Mesothelioma: various images

Adenomatoid tumor

Adrenal gland corticomedullary mixed tumor (fig C/D)

Adrenal gland pheochromocytoma is negative, but ganglioneuromatous foci is positive (fig B)

Adrenocortical carcinoma (fig B)

Colonic wall neurons

Colonic medullary carcinoma (fig e)

Granular cell tumor

Ovarian fibroma

Ovarian granulosa cell tumor (adult)

Ovarian serous borderline tumor: invasive implants show loss of calretinin+ mesothelial cells

Ovarian serous borderline tumor: non-invasive implants are surrounded by calretinin+ mesothelial cells

Primary retroperitoneal mucinous cystadenoma (fig 7)

Rectal suction biopsy for Hirschsprung disease

Serous effusions

Positive staining - normal

● Adipocytes (Hum Pathol 2006;37:312), endometrial stromal cells, Leydig cells of testis
● Mast cells, mesothelial cells, nerves (good positive control, Nordic)
● Ovarian theca-lutein and theca interna cells, Sertoli cells (Hum Pathol 2003;34:994)

Positive staining - disease

● Mesothelial hyperplasia and cysts
● Mesothelioma (strong diffuse staining in almost all epithelioid and lymphohistiocytic subtypes, 57% of sarcomatoid subtypes, (Am J Surg Pathol 2007;31:711, Mod Pathol 2007;20:248)
● Also ameloblastoma (stellate reticulum-like epithelium, Histopathology 2000;37:27), adenomatoid tumors (Am J Surg Pathol 2003;27:969), adrenal cortical tumors (96%, Mod Pathol 2003;16:591)
● Cardiac myxoma (Am J Clin Pathol 2000;114:754), cervical mesonephric adenocarcinoma (88%, Am J Surg Pathol 2001;25:379), colonic medullary carcioma (73%, Hum Pathol 2009;40:398), colorectal adenocarcinoma (various by tumor differentiation, Am J Surg Pathol 1999;23:701)
● Desmoplastic small round cell tumors (20%, Mod Pathol 2003;16:229), FATWO (Hum Pathol 1999;30:856), granular cell tumor (Am J Clin Pathol 2003;119:259)
● Lipoma and liposarcoma (Hum Pathol 2006;37:312), lung carcinoma (adenocarcinoma-11%, giant cell carcinoma-67%, large cell-38%, small cell-49%, Am J Surg Pathol 2003;27:150)
● Schwannoma (Am J Clin Pathol 2004;122:552), sex cord stromal tumors (50-100%, including inhibin negative tumors, Am J Surg Pathol 2005;29:143, Am J Surg Pathol 2009;33:354)
● Synovial sarcoma (most, Am J Surg Pathol 2001;25:610), thymic carcinoma and thymoma (some, Hum Pathol 2003;32:1155)

Negative staining

● Adrenal medullary tumors including pheochromocytoma, mucinous cysts (Histopathology 2002;41:301), ovarian microcystic stromal tumor (Am J Surg Pathol 2009;33:367), renal cell carcinoma (usually)

End of Stains > Calretinin

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