Stains - D2-40

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Stains

D2-40 (Podoplanin)

Last major update: June 2009

Revised: 2 July 2009

Authors: Kara Hamilton, M.S., Nat Pernick, M.D., PathologyOutlines.com, Inc.

Background

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● 38 kDa membrane mucoprotein originally detected on surface of rat podocytes

● Antibody D2-40 reacts to an O-linked, 40 kDa sialoglycoprotein found on lymphatic endothelium, fetal testis and on the surface of testicular germ cell tumors (also other cells as indicated below)

Uses

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● Identify lymphatic endothelium, to determine presence of lymphatics in various conditions, as well as origin of vascular tumors (J Histochem Cytochem 2009;57:643)

● Identify lymphatic endothelium, to determine lymphatic invasion (Ann Diagn Pathol 2009;13:168)

Note: prognostic significance of lymphatic invasion using D2-40 versus H&E only is unclear:

- Not clearly significant - breast carcinoma (Mod Pathol 2009;22:216)

- Appears significant - colon carcinoma (Int J Colorectal Dis 2009 Apr 23 [Epub ahead of print]), melanoma (J Cutan Pathol 2009 Feb 5 [Epub ahead of print], Arch Dermatol 2008;144:462)

● Differentiate mesothelioma (positive, even in effusions, Diagn Cytopathol 2007;35:342) from adenocarcinoma (negative, Cancer 2007;109:933)

Positive stains - normal tissue

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● Lymphatic endothelium (Am J Path 1999;154:385)

● Adrenal cortical cells (normal and neoplastic, J Clin Pathol 2008;61:293)

● Breast myoepithelium (patchy, Hum Path 2008;39:175) in normal and neoplastic breast

● Follicular dendritic cells (Appl Immunohistochem Mol Morphol 2009;17:102)

● Mesothelium - normal and reactive (Mod Pathol 2005;18:105)

● Skin - basal cells of hair follicle outer root sheath (J Cutan Pathol 2008;35:926)

● Developing testis (Virchows Arch 2006;449:200) and developing brain (Mod Pathol 2006;19:974)

Positive stains - disease

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● Angiomyolipoma - lymphatics are prominent (Mod Pathol 2006;19:669, Hum Pathol 2009;40:374)

● Angiosarcoma (most, Am J Path 1999;154:385)

● Atypical vascular proliferations of breast post-radiation (Cancer 2007;109:1584)

● Chondroid and chordoid tumors: skeletal myxoid chondrosarcoma (100%), enchondroma (96%), low grade chondrosarcoma (95%), chordoid meningioma (80%), chordoid glioma (75%) but not chordoma or extraskeletal myxoid chondrosarcoma (AJSP 2009;33:669)

● Crohn’s disease (due to increased lymphatics, Virchows Arch 2008;452:57)

● Dysgerminoma (Int J Gynecol Pathol 2009;28:347)

● Epithelioid hemangioendothelioma of liver (Mod Pathol 2008;21:125)

● Fibrous histiocytoma and cellular neurothekeoma (Am J Dermatopathol 2009;31:137)

● Follicular dendritic cell tumor (Int J Clin Exp Pathol 2008;1:276)

● Hemangioblastoma (Acta Neuropathol 2005;109:497)

● Kaposi’s sarcoma (Am J Path 1999;154:385), kaposiform hemangioendothelioma (J Cutan Pathol 2006;33:492)

● Lung - pleomorphic carcinomas (some, Pathol Int 2008;58:771)

● Lymphangioma (Histopathology 2005;46:396)

● Lymphatic invasion in tumors - examples include melanoma (Hum Path 2008;39:901), renal cell carcinoma-clear cell type (Mod Pathol 2006;19:746)

● Mesothelioma (Mod Pathol 2006;19:34, Mod Pathol 2005;18:105), including sarcomatoid subtype (Am J Surg Pathol 2008;32:123)

● Schwannoma, occasional neurofibromas or MPNST (Am J Clin Pathol 2008;129:886)

● Seminoma (Am J Clin Pathol 2007;128:767), some embryonal carcinomas of testis (Mod Pathol 2007;20:320)

● Serous cystadenocarcinoma / carcinoma of gynecologic tract (23%) (Mod Pathol 2008;21:1147)

● Sinonasal hemangiopericytoma (Virchows Arch 2006;448:459)

● Skin adnexal carcinoma (Am J Surg Pathol 2007;31:304)

● Solitary fibrous tumor (some, Pathol Int 2007;57:618, but see Virchows Arch 2006;448:459)

Negative stains

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● Capillary endothelium

● Retiform hemagioendothelioma (usually, Am J Dermatopathol 2008;30:31)

Micro images

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Lymphatics in normal lymph node (fig A) and normal breast Mesothelium (pleura)

Skin vessels (normal) Lymphatics versus endothelium

(site unspecified)

Angiomyolipoma - lymphatics are prominent Angiosarcoma and

lymphangioma

Colon-ulcerative colitis Colon-various polyps Colon-invasive carcinoma

Invasive breast carcinoma - lymphatics are D2-40 positive

Kaposi’s sarcoma Epithelioid Kaposiform

angiosarcoma hemangioendothelioma

Melanoma lymphatics Melanoma tumor emboli

Mesothelioma (fig b) Follicular dendritic cell tumors

Seminoma of testis Embryonal carcinoma of testis

Lymphatic invasion in clear cell renal cell carcinoma

Lymphatic invasion in gastric carcinoma

Lymphatic invasion: in papillary thyroid carcinoma in laryngeal squamous

within venous media cell carcinoma

EM images

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Dermal lymphatics

Additional references

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● Comparison of D2-40 and LYVE-1 antibodies (Lymphology 2008;41:103)

● Sources for D2-40 (advertisements): Covance

End of Stains chapter > D2-40

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