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IHC single marker with reporting Chromogranin A

Cancer
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Report in 144Hrs

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Tumor marker staining.

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IHC Single Marker with Reporting Chromogranin A - Comprehensive Guide

  • Why is it done?
    • Detects and identifies neuroendocrine cells and tumors using chromogranin A as a specific immunohistochemical marker on tissue samples
    • Diagnosis of neuroendocrine tumors (NETs) including carcinoid tumors, small cell lung cancer, and pheochromocytomas
    • Differentiation between neuroendocrine and non-neuroendocrine malignancies
    • Confirmation of NET diagnosis in patients with suspected neuroendocrine differentiation
    • Grading and classification of neuroendocrine tumors for prognostic and therapeutic purposes
    • Performed on biopsy or surgical specimens when neuroendocrine differentiation is clinically suspected
  • Normal Range
    • Negative Result: No chromogranin A immunostaining or staining in <5% of cells; indicates absence of neuroendocrine differentiation
    • Positive Result: Distinct cytoplasmic staining in ≥5% of cells; indicates presence of neuroendocrine differentiation
    • Intensity Scoring: Weak (1+), Moderate (2+), or Strong (3+) cytoplasmic staining patterns
    • Percentage Distribution: Reported as percentage of positive cells (0-100%)
    • Normal Context: Negative chromogranin A staining in non-neuroendocrine tissues; scattered positive cells may be seen in normal neuroendocrine tissue
  • Interpretation
    • Positive Chromogranin A Staining: Confirms neuroendocrine differentiation; highly suggestive of neuroendocrine tumor (NET), carcinoid tumor, small cell carcinoma, or other neuroendocrine malignancy
    • Negative Chromogranin A Staining: Does not exclude neuroendocrine differentiation; may indicate poorly differentiated NETs or non-neuroendocrine origin
    • Strong Diffuse Staining (80-100%): Well-differentiated neuroendocrine tumor; strong confirmatory evidence of neuroendocrine origin
    • Moderate Focal Staining (30-79%): Mixed or moderately differentiated neuroendocrine components; consider additional marker testing for classification
    • Weak or Sparse Staining (<30%): Minimal neuroendocrine differentiation; may indicate poorly differentiated tumor or mixed histology requiring additional studies
    • Factors Affecting Results: Tissue fixation quality, specimen handling, antibody specificity, tumor differentiation level, prior chemotherapy effects, and tissue degradation
    • Clinical Correlation: Results must be interpreted in context with morphology, clinical presentation, imaging findings, and additional immunohistochemical markers (synaptophysin, CD56)
  • Associated Organs
    • Primary Organ Systems: Gastrointestinal system (stomach, pancreas, small intestine, colon), lungs, and endocrine glands
    • Gastrointestinal Neuroendocrine Tumors: Gastric carcinoids, pancreatic NETs (insulinomas, gastrinomas), ileal and colonic NETs; chromogranin A positive in majority of cases
    • Pulmonary Neuroendocrine Tumors: Small cell lung cancer (SCLC), large cell neuroendocrine carcinoma (LCNEC), typical and atypical carcinoids
    • Adrenal Gland: Pheochromocytomas and paragangliomas with neuroendocrine features
    • Associated Diseases and Conditions: MEN-1 syndrome, neurofibromatosis type 1 (NF-1), von Hippel-Lindau (VHL) syndrome, sporadic NETs
    • Potential Complications with Abnormal Results: Carcinoid syndrome (flushing, diarrhea, bronchospasm), hormonal excess syndromes, metastatic spread, local tumor invasion, and Cushing's syndrome in some NETs
  • Follow-up Tests
    • Additional Immunohistochemical Markers: Synaptophysin, CD56, neuron-specific enolase (NSE), and specific hormonal markers (insulin, gastrin, serotonin)
    • Proliferation Rate Assessment: Ki-67 index evaluation for tumor grading and prognosis determination
    • Serum Chromogranin A Level: Blood test for baseline tumor burden and monitoring disease progression; elevated levels support NET diagnosis
    • Specific Hormone Testing: 24-hour urinary 5-HIAA, fasting gastrin, fasting glucose, insulin levels depending on tumor type
    • Imaging Studies: CT/MRI of involved organs, somatostatin receptor imaging (Octreoscan), PET-CT for staging and detecting metastases
    • Molecular Testing: Gene sequencing (MEN1, DAXX, ATRX mutations) for inherited syndrome evaluation and risk stratification
    • Monitoring Frequency: Serum chromogranin A and imaging surveillance every 3-6 months for diagnosed NETs; more frequent for high-grade tumors
  • Fasting Required?
    • Fasting Requirement: No - This is a tissue-based immunohistochemical test performed on biopsy or surgical specimens, not a blood test; fasting is not applicable
    • Patient Preparation: Standard pre-procedure preparation required for biopsy or surgery (NPO guidelines per procedural type, informed consent, routine blood work)
    • Specimen Handling: Tissue must be promptly fixed in formalin and properly processed for optimal immunostaining results
    • Medications: No medication restrictions specific to this IHC test; follow pre-procedure medication guidelines for biopsy or surgical procedure
    • Additional Instructions: Inform clinician of somatostatin analog therapy (may affect tumor staining patterns); avoid antacids before endoscopic biopsies

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