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Immunohistochemical Patterns of Zarovnaya and Black Distinguishing Pseudoepitheliomatous Hyperplasia (PEH) from Squamous Cell Carcinoma (SCC)

Description

Zavovnaya and Black identified 3 immunohistochemical stains that can help distinguish pseudoepitheliomatous hyperplasia (PEH) from squamous cell carcinoma (SCC). These stains can be helpful when the process is obscurred by inflammation or poor orientation of small biopsies. The authors are from Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire.


 

Biopsy sites: lip, oral cavity, pharynx, larynx

 

Features distinguishing pseudoepitheliomatous hyperplasia from squamous cell carcinoma:

(1) staining with routine hematoxylin and eosin (H and E)

(2) staining intensity for p53

(3) staining intensity for matrix metalloproteinase I (MMP-1)

(4) staining intensity for E-cadherin

 

Stain

PEH

SCC

H and E

mature with only occasional dyskeratosis

immature and/or dyskeratosis

p53 in nuclei

29% increased; limited to basal cells and sometimes adjacent cells in linear pattern (basal centric)

81% increased; positive throughout full thickness of tumor; also increased in adjacent areas of dysplasia

MMP-I in cytoplasm

6% increased; strongest in basal and adjacent cells with full thickness cytoplasmic blush

81% increased; positive staining in cytoplasm of tumor cells and adjacent stroma

E cadherin in membranes

18% decreased; membrane staining uniform even in deep tongues

69% decreased; decreased staining greater with loss of cohesion; completely absent in discohesive cells

 

In addition to the patterns described, increased staining with p53 and MMP-1 could identify invasive cells that might otherwise have been missed.

 

In small biopsies it was practical to cut additional blank slides at initial cutting and to sandwich the immunoperoxidase stains between H&E levels.

 

Performance:

• The sensitivity for SCC with MMP-1 was 81% with a specificity of 94%

 


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