Practical Applications in Immunohistochemistry: Carcinomas of Unknown Primary Site

Context.--Identification of the site of origin of carcinoma of unknown primary using immunohistochemistry is a frequent requirement of anatomic pathologists. Diagnostic accuracy is crucial, particularly in the current era of targeted therapies and smaller sample sizes. Objectives.--To provide practical guidance and suggestions for classifying carcinoma of unknown primary using both proven and new antibodies, as well as targeting panels based on integration of morphologic and clinical features. Data Sources.--Literature review, the authors' practice experience, and authors' research. Conclusions.--With well-performed and interpreted immunohistochemistry panels, anatomic pathologists can successfully identify the site of origin of carcinoma of unknown primary. It is crucial to understand not only the diagnostic uses of the many available antibodies but also the potential limits and pitfalls. (Arch Pathol Lab Med. 2016; 140:508-523; doi: 10.5858/arpa.2015-0173-CP)
It is estimated that approximately 4% of all patients with cancer present with carcinomas of unknown primary (CUPs), representing a higher incidence than known malignancies such as non-Hodgkin lymphoma or [...]