Immunohistochemistry: A valuable tool in the management of common female genital tract tumors—a clinicians’ perspective

Abstract

Immunohistochemistry (IHC) is a laboratory technique that can be used by the pathologist to add value to the diagnosis. The basic principle of IHC involves using specific antibodies to go and get attached to specific antigens present on biological tissue and then visualizing the antigen– antibody reaction thus identifying the cell type using its antigenic characteristics. The use of IHC in histopathological diagnosis can ensure a precise diagnosis thus helping the clinician to make appropriate therapeutic choices related to the management of common genital tract tumors. Cervix: IHC can help in differentiating reactive changes from cervical intraepithelial lesions. IHC can also improve the specificity of Pap smears while screening for squamous intraepithelial lesions. Corpus uteri: IHC has been used to identify cases of primary adenocarcinoma of the uterus metastasizing to the cervix and also to differentiate between type I and type II endometrial carcinoma. IHC can also be utilized to improve the positive predictive value of endometrial sampling to preoperatively diagnose uterine leiomyosarcomas. Ovary: One major problem faced by the clinician is the early intraoperative diagnosis of ovarian malignancy and IHC helps in obtaining an early and accurate diagnosis. Gestational trophoblastic diseases: The use of IHC techniques can help in accurate diagnosis of complete hydatidiform mole. Vulva: Coexistence of high-grade vulvar intraepithelial neoplasia or verrucous carcinoma of the vulva with condyloma acuminata, which is a benign condition, can be picked up using IHC and this is a big advantage to the clinician to plan a treatment protocol. Though IHC is an important tool, there are issues of standardization and reproducibility that need to be addressed. IHC is yet to evolve into a standalone method of laboratory diagnosis and must be used in conjunction with clinical assessment and histopathological findings.