Stains & CD markers
CEA / CD66e
Copyright: 2003-2022, PathologyOutlines.com, Inc.
PubMed Search: CEA[title]
Related topics: General, CD66b, CD66c, CD66d, CD66f
CEA / CD66e
Author: Nat Pernick, M.D.
Last author update: 1 November 2014
Last staff update: 12 May 2022
Copyright: 2003-2022, PathologyOutlines.com, Inc.
PubMed Search: CEA[title]
Related topics: General, CD66b, CD66c, CD66d, CD66f
Table of Contents
Definition / general | Case reports | Uses by pathologists | Microscopic (histologic) images | Cytology images | Positive staining - normal | Positive staining - tumors | Negative stainingCite this page: Pernick N. CEA / CD66e. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/stainscea.html. Accessed May 18th, 2022.
Definition / general
- Also called CEA, carcinoembryonic antigen and CEACAM5
- Either polyclonal (pCEA) or monoclonal (mCEA)
- Normally detected in glycocalyx of fetal epithelial cells
- May play a role in the metastasis of cancer cells
- Usually considered an epithelial marker with strong staining in adenocarcinomas
Case reports
- 58 year old man with CEA immunostaining in benign multicystic mesothelioma of the peritoneum (not typical, Arch Pathol Lab Med 2001;125:944)
Uses by pathologists
- Adenocarcinoma (lung) vs. epithelioid mesothelioma: monoclonal CEA is 97% specific for lung adenocarcinoma (Histopathology 2006;48:223); exhibits diffuse cytoplasmic staining with membrane enhancement in adenocarcinoma, negative in mesothelioma
- Adenocarcinoma (lung) vs. reactive mesothelial cells in fluid cytology: positive staining is 76% sensitive (Am J Clin Pathol 2001;116:709)
- Breast cancer vs. benign breast disease in FNA fluid: high levels are suggestive of malignancy (Arch Pathol Lab Med 2004;128:1251, free full text)
- Colorectal carcinoma: monitor serum levels (elevated in 72-97%) to detect recurrence (World J Gastroenterol 2006;12:3891), elevated preoperative serum levels are poor prognostic factor (Int J Cancer 2002;101:545); caution - elevated levels also present in cirrhosis, biliary obstruction, hepatitis, inflammatory bowel disease, smokers and post-surgical bowel sequestration with mucocele (Arch Pathol Lab Med 2003;127:1376)
- Cysts (various): CEA levels over 5 ng/dl in ascites fluid are associated with malignancy (J Clin Pathol 2001;54:831); but fluid in cysts may be CEA+ even when benign (Mod Pathol 1998;11:1171)
- Hepatocellular carcinoma: canalicular pattern for polyclonal CEA is 50-90% sensitive for hepatocellular carcinoma, > 95% specific (Mod Pathol 2002;15:1279); CEA-Gold is 76% sensitive (Am J Surg Pathol 2002;26:978); monoclonal CEA is usually negative (Hum Pathol 2002;33:1175)
- Microvillous inclusion disease of small intestine: cytoplasmic staining of surface enterocytes (Am J Surg Pathol 2002;26:902)
- Pancreatic adenocarcinoma: monoclonal CEA is 92% sensitive for metastases vs. 0% for bile duct adenoma (Am J Surg Pathol 2005;29:381)
Microscopic (histologic) images
Contributed by Andrey Bychkov, M.D., Ph.D.
C cells in relation to thyroid follicle
Clustered C cells
Cervical adenoid cystic carcinoma
Images hosted on other servers:
Breast adenoid cystic carcinoma (fig 13)
Colon inverted
hyperplastic polyp
(normal colon at
upper right is CEA-)
Gastric
adenocarcinoma
metastatic to
colon (fig 4)
Medullary thyroid carcinoma (fig 7)
Paget disease of vulva (fig 11)
Secretory meningioma (left, fig 10; right, fig 11)
Various images: quality control
Cytology images
Images hosted on other servers:
Cholangiocarcinoma
Positive staining - normal
- Granulocytes and epithelial cells (apical surfaces)
- Also biliary tract including gallbladder, colon (fetal), hepatocytes, prostatic secretory cells (25%) and small intestinal crypts
- Small intestinal goblet cell mucin (not intracytoplasmic), thyroid cell nests and C cells
Positive staining - tumors
- Bile duct tumors (benign or malignant)
- Bladder adenocarcinoma and benign tumors
- Breast ductal and secretory carcinoma
- CASTLE (Am J Surg Pathol 2006;30:994)
- Cervical adenocarcinoma (Arch Pathol Lab Med 2003;127:1586) and squamous cell carcinoma
- Cholangiocarcinoma (monoclonal and polyclonal, cytoplasmic and luminal but not canalicular pattern)
- Chordoma (variable), choriocarcinoma of placenta and testes (25%, Am J Clin Pathol 1986;86:538)
- Clear cell papulosis of skin
- Colorectal carcinoma (almost all, throughout cell surface)
- Endometrial adenocarcinoma (50%, focal, Am J Surg Pathol 1982;6:151 but negative with monoclonal CEA, Mod Pathol 2006;19:1091)
- Gallbladder dysplasia / carcinoma (cytoplasmic and luminal staining)
- Gastric adenocarcinoma
- Hepatoblastoma (polyclonal antibody, canalicular pattern, particularly in fetal subtype)
- Hepatocellular carcinoma (polyclonal CEA, canalicular pattern, 90%, Hum Pathol 2005;36:1226)
- Hepatoid adenocarcinoma (Am J Surg Pathol 2003;27:1302)
- Lung adenocarcinoma
- Lung squamous cell carcinoma (non-keratinizing, 77%, Mod Pathol 2006;19:417)
- Neuroendocrine (including carcinoid) tumors (variable)
- Ovarian mucinous tumors including carcinoma (92%, Am J Clin Pathol 2001;116:246)
- Paget disease (breast, vulva, scrotum)
- Pancreatic adenocarcinoma (including foamy gland variant, Am J Surg Pathol 2000;24:493 and lining of cysts, Mod Pathol 2005;18:1157)
- Penile clear cell carcinoma (Am J Surg Pathol 2004;28:1513)
- Salivary gland tumors (various)
- Secretory meningioma
- Sweat gland tumors including carcinoma (73%, Arch Pathol Lab Med 2001;125:498)
- Synovial sarcoma (variable)
- Thymoma
- Thyroid medullary carcinoma and urothelial carcinoma
Negative staining
- Breast carcinoma (usually)
- Endometriosis
- Mesothelioma (including testis, Am J Surg Pathol 2006;30:1)
- Ovarian endometrioid and serous carcinoma (Arch Pathol Lab Med 1999;123:909)
- Prostate adenocarcinoma (Am J Clin Pathol 2002;117:471)
- Renal cell carcinoma
- Thymic carcinoma (usually)
- Thyroid carcinoma other than medullary
