CEA / CD66e

Stains & molecular markers
CEA / CD66e

Topic Completed: 1 November 2014

Minor changes: 12 November 2020

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PubMed Search: CEA[title]

Related topics: General, CD66b, CD66c, CD66d, CD66f

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Table of Contents

Cite this page: Pernick N. CEA / CD66e. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/stainscea.html. Accessed January 18th, 2021.

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