LabCorp Diagnostic Immunohistochemical Staining Program To order, specify the option required, and supply the clinical information below. 484006 - Option I: Slides and controls are returned for your interpretation. 484006 - Option II: Slides and controls are returned with an immunostain interpretation. 980004 - Option IV: Full surgical pathology consultation (can be ordered with Option II.) Note: Cytokeratin 903, Racemase, hematopoietic group, lymphoma group, and infectious disease group stains are available only as Option I or Option II with Option IV. These stains cannot be ordered as Option II. Carcinoma Group Breast Carcinoma Sarcoma Group Liver Group Neuroendocrine Non-Hodgkin Group Group Lymphoma Group CD31 Ber-EP4 AFP Chromogranin BCL-2 CU-18 CD34 CDX2 A AT BCL-6 1 Pancytokeratin ER CD68 CEA CD117 LMW Cytokeratin NSE Kappa light chain PR (CAM 5.2) CK 7 Desmin Lambda light chain Serotonin HAM 56 CK 20 GCDFP-15 Factor VIII-related CD3 antigen Somatostatin Thyroid Group CU-18 E-Cadherin Factor XIIIa CD4 Synaptophysin LMW Cytokeratin Prostate Group HHV-8 Thyroglobulin CD5 (CAM 5.2) Germ Cell Tumor Myoglobulin Group Calcitonin CD7 HMW Cytokeratin Cytokeratin 903 Muscle-specific Actin AFP CD 8 Pancytokeratin PSA S-100 CEA β-hCG CD10 E-Cadherin Smooth-muscle Actin PSAP Chromogranin CEA CD20 EMA Vimentin Racemase Mesothelioma vs TTF-1 Pancytokeratin CD23 NSE Carcinoma Group CD43, MT1 P63 Hematopoietic PLAP OC125 Ber-EP4 Group CD45, Leukocyte PIN-3 Triple stain Infectious Disease B72.3 common antigen (LCA) PSA CD1a Group Melanoma Group Calretinin CD45 RA Helicobacter pylori PSAP CEA CD117 CD45 RO, UCHL-1 HMB45 HSV I & II (Cocktail) (T cell) P16 CK 5 & 6 Myeloperoxidase CD74 Melan-A Hodgkin Disease ProEx C Pancytokeratin Group CD79a Super Pancytokeratin Mel-5 E-Cadherin TdT CD30 (AE1/AE3, CAM 5.2) CD138 EMA S-100 CD34 TTF-1 CD20 CD15 Cyclin D1 Vimentin CD68 Villin Vimentin CD15 Ki67 Patient’s Name ______________________________________________ Surgical Pathology Case Number: _________________ Requesting Physician ___________________________________________________ Telephone: _________________________ For program options II and IV, please submit an H&E slide and complete the following information: Differential Diagnosis: ______________________________________________________________________________________ _________________________________________________________________________________________________________ Site of Specimen: __________________________________________________________________________________________ Clinical Information: ________________________________________________________________________________________ _________________________________________________________________________________________________________ Alphabetical Index A1AT (α1-antitrypsin) EMA (Epithelial membrane antigen) AFP (α-fetoprotein) ER (Estrogen receptor) B72.3 Factor VIII-related antigen BCL-2 Factor XIIIa BCL-6 GCDFP-15 Ber-EP4 HAM 56 β-hCG Helicobacter pylori Calcitonin HHV-8 Calretinin HMB45 CD1a HMW Cytokeratin (34ßE12) CD3 HSV I & II (cocktail) CD4 Kappa light chain CD5 Ki67 (MIB-1) CD7 Lambda light chain CD8 (T cell) LMW Cytokeratin (CAM 5.2) CD10 Mel-5 CD15 (LeuM1) Melan-A CD20 (B cell, L26) Muscle-specific Actin CD23 Myeloperoxidase CD30 (Ki-1 antigen/BerH2) Myoglobulin CD31 NSE (Neuron-specific enolase) CD34 OC125 (Celomic ovarian antigen) CD43, MT1 (T cell) P16 CD45 RA P63 CD45 RO, UCHL-1 (T cell) Pancytokeratin (AE1/AE3 & PCK26) CD45, Leukocyte common antigen (LCA) PIN-3 Triple stain (p504S/P63/HMW Cytokeratin) CD68 (KP-1) PLAP (Placental alkaline phosphatase) CD74, LN2 (B cell) PR (Progesterone receptor) CD79a (B cell) ProEx C CD117 PSA (Prostate-specific antigen) CD138 PSAP (Prostate-specific acid phosphatase) CDX2 Racemase (P504S) CEA (Carcinoembryonic antigen) S-100 Chromogranin Serotonin CK 5 & 6 Smooth-muscle Actin CK 7 Somatostatin CK 20 Super Pancytokeratin (AE1/AE3, CAM 5.2) CU-18 (Breast-related antigen) Synaptophysin Cyclin D1 TdT Cytokeratin 903 Thyroglobulin Desmin TTF-1 (Thyroid transcription factor-1) E-Cadherin Villin Vimentin Center for Molecular Biology and Pathology 1912 Alexander Drive Research Triangle Park, NC 27709 Customer Service: 800-735-4087 ©2008 Laboratory Corporation of America® Holdings All rights reserved. L6067-0408-1 Fax: 919-361-7201.