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Stains

Cytokeratin CAM 5.2


Reviewer: Nat Pernick, M.D. (see Reviewers page)
Revised: 8 May 2013, last major update December 2011
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.

Definition
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● Commonly used antibody to cytokeratins 8 and to a lesser extent CK7, but not to cytokeratin 18 or 19 (Am J Clin Pathol 2010;133:514)
● A low molecular weight cytokeratin

Uses by pathologists
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● Confirm or rule out epithelial nature of tissue, tumors or components of tumors
● Identify metastatic carcinoma in lymph nodes (Int J Gynecol Cancer 2006;16:1336), but also stains reticulum cells (Appl Immunohistochem Mol Morphol 2001;9:297), so AE1-AE3 may be better
● Identify micrometastases / isolated tumor cells, a poor prognostic factor in bile duct (hilar) carcinoma (World J Gastroenterol 2006;12:2549), esophageal carcinoma (Ann Thorac Surg 2004;78:1161), rectal carcinoma (Dis Colon Rectum 2003;46:333) and stomach carcinoma (Am J Surg Pathol 2005;29:1135)
● Identify metastases in bone marrow (Br J Cancer 2002;86:1047), although false positives may also occur (Eur J Surg Oncol 2001;27:740)
● Identify residual tumor post-treatment, but must pay attention to nature of cells, since CAM 5.2 may stain myofibroblasts and smooth muscle cells (Am J Surg Pathol 2007;31:390)
● Distinguish metastatic (CAM 5.2+, GFAP-) from primary (CAM 5.2-, GFAP+) CNS tumors (Arch Pathol Lab Med 1999;123:917)
● Part of a panel to distinguish uterine tumors resembling ovarian sex cord tumors (CAM 5.2+) from smooth muscle neoplasms (negative, Mod Pathol 2006;19:17)
● Distinguish Pagetís disease (CAM 5.2+) from pagetoid squamous cell carcinoma in situ (negative, J Cutan Pathol 2003;30:449)

Micro images
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Bladder: osteoclast-like giant cell carcinoma of urinary tract


Breast: left-normal, right-carcinoma


Breast: metaplastic carcinoma


Choroid plexus: papilloma-pigmented


CNS: gliosarcoma with epithelial differentiation (fig 3a)


Ovary: female adnexal tumor of wolffian origin (fig 3A)


Liver: Mallory bodies in acute alcoholic hepatitis (fig 3)


Pancreas: ductal adenocarcinoma

   
Skin: left-dermatopathic lymphadenitis (dendritic cells are CAM 5.2+); right-Merkel cell carcinoma (fig c)


Small cell carcinoma: dot like staining


Soft tissue: desmoplastic small round cell tumor


Squamous cell carcinoma is CAM5.2 negative (fig 7-left side) but basal cell carcinoma is CAM 5.2+ (fig 7-right side)


Quality control-various images

Positive staining - normal
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● Most epithelial cells including dendritic cells (J Clin Pathol 1989;42:271), apocrine glands
● Hepatocytes
● Toker cells (Virchows Arch 2002;441:117)
● Trophoblast

Positive staining - disease
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● Most carcinomas, including sarcomatoid carcinoma; dot-like perinuclear pattern for small cell carcinoma
● Adenomatoid tumor: Am J Surg Pathol 2003;27:969
● Adrenal tumors: oncocytic (Am J Surg Pathol 1998;22:603, Am J Surg Pathol 2000;24:1552)
● Appendix: myofibroblasts in appendicitis (Med Mol Morphol 2006;39:209) and gastric ulcer (Histol Histopathol 2006;21:697)
● Breast: benign proliferative nipple duct lesions (Am J Surg Pathol 1999;23:1349)
● CNS: astroblastoma (J Korean Med Sci 2004;19:772), choroid plexus papilloma (Histopathology 1989;15:61), meningioma-malignant (75%, Mod Pathol 2004;17:1129), meningioma-secretory
● Esophagus: gangliocytic paraganglioma
● Eye: melanoma of uvea (38%, Am J Pathol 1992;141:169)
● GU: inflammatory myofibroblastic tumor (67%, Am J Surg Pathol 2006;30:1502), post-operative spindle cell nodule
● Heart: cardiac myxoma with glandular elements (Ir J Med Sci 1993;162:95)
● Liver: Mallory bodies (Histopathology 1988;13:605)
● Mesothelioma-malignant (Semin Diagn Pathol 2006;23:15) and benign cystic
● Ovary: dysgerminoma (19%, Hum Pathol 2006;37:1015), ependymoma (60%), female adnexal tumours of probable Wolffian origin (Histopathology 2001;38:237), granulosa cell tumor-adult type (33-50%, Am J Surg Pathol 1992;16:962), Sertoli cell tumor
● Prostate: adenocarcinoma-neuroendocrine cells (Prostate 2006;66:1399)
● Skin: Pagetís disease (mammary and extramammary, J Cutan Pathol 2003;30:449, Am J Surg Pathol 1992;16:58)
● Soft tissue: alveolar rhabdomyosarcoma (52%, Mod Pathol 2008;21:795), angiosarcoma (variable), desmoplastic round cell tumor (Mod Pathol 2003;16:229), epithelioid sarcoma (J Cutan Pathol 2003;30:242), leiomyosarcoma-myxoid (25%), schwannoma-glandular (Br J Dermatol 2001;145:834), synovial sarcoma (Histopathology 1986;10:1315)
● Squamous cell carcinoma: usually (Semin Diagn Pathol 2006;23:15)
● Testis: seminoma with atypia (Int J Surg Pathol 2002;10:23); 48% of mediastinal seminomas (Am J Surg Pathol 2008;32:146)
● Trophoblastic tumors (Int J Gynecol Pathol 1986;5:345)
● Uterus: endometrial stromal sarcoma (variable, Hum Pathol 2008;39:1459)

Negative staining
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● CNS: glioblastoma (Arch Pathol Lab Med 1999;123:917), most meningiomas, supratentorial primitive neuroectodermal tumor
● Melanoma: usually (Histopathology 1986;10:1315, Int J Dermatol 2003;42:123), Am J Surg Pathol 1997;21:1196, but uveal tumors are CAM 5.2+
● Most sarcomas: exceptions indicated above

End of Stains > Cytokeratin CAM 5.2


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