Immunohistochemistry in Neurosurgery for Pathological Diagnosis: A Case Illustration of a Sellar Tumor
Journal Title: Nepal Journal of Neuroscience - Year 2007, Vol 4, Issue 1
Abstract
Immunohistochemistry is an essential clinical and research tool in medical science. It helps in making specific diagnosis by detecting the lesion specific markers. It also helps in predicting the final outcome of a neoplastic lesion by detecting various prognostic markers. Thirty four years old male with a huge sellar and suprasellar lesion with cystic and solid component presented with bitemporal hemianopia and 3rd ventricle compression and hydrocephalus. Provisional diagnosis of non-functioning pituitary adenoma with a differential diagnosis of craniopharyngioma was made. Tumor was excised by craniotomy and the specimen sent for histopathological diagnosis. The report showed confusing result mentioning the presence of signs of pituitary adenoma and low grade astrocytoma. Glial fibrillary acidic protein (GFAP), a marker of astrocytic tumor and Ki-67 (MIB-I), a marker of cellular proliferation in neoplastic lesion were investigated by immunohistochemistry to confirm the diagnosis. The indirect method of immunostaining, LSAB (Labeled Strept Avidin Biotin method), was employed using the histofine SAB kit. Immunostaining showed absence of GFAP positive cells and about 1% of MIB-I labeling index suggesting the tumor was not of astrocytic origin and thus was pituitary adenoma. Lower expression of MIB-I was also in the favor of pituitary adenoma. The final diagnosis of pituitary adenoma was made by excluding the possibility of astrocytoma. Thus immunohistochemistry is helpful in such situation. The histopathological evaluation of any neoplastic lesion is not complete without immunohistochemistry
Authors and Affiliations
Prabin Shrestha, MD
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Professor Upendra Prasad Devkota MBBS, FRCS, FNAMS (1953-2018)
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