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Anatomic Pathology’s Immunohistochemistry (IHC) on Paraffin-Embedded Tissues
Accession Number: / Ordering Physician:
Block(s): / H&E: Yes or No / Date of Request:
Patient Name: / Deliver Stained Slides to:
Fixative: / Return Blocks (circle): to file with slides
Tissue/Organ Type: / Total Antibodies Ordered:

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For Diagnosis / Special Interest / Antibody
a-1 ACT
a-1 AT
Actin, Smooth Muscle
Actin, Muscle Specific
Adenovirus
AFP
ALK Protein
Alpha B Crystallin
Alpha Synuclein
AMACR (P504S)
Androgen Receptor
Annexin A1
B72.3
BAP1
BCL-2
BCL-6
Ber-EP4
Beta Amyloid
Beta Catenin
Bob 1
Brachyury
BRAFV
BRST-2
C4d
Calcitonin
Caldesmon
Calponin
Calretinin
CAM5.2
Carbonic Anhydrase IX
Cat Scratch Fever
CD1a
CD2
CD3
CD3/CD20
CD3/SMA
CD4
CD4/CD8
CD5
CD7
CD8
CD10
CD13
CD14
CD15
CD19
CD20 (L26)
CD21
CD23
CD25
For Diagnosis / Special Interest / Antibody
CD30 (Ber-H2)
CD31
CD33
CD34
CD34 Heme
CD43 (LEU22)
CD45 (LCA)
CD45RA (4KB5)
CD45RO (UCHL-1)
CD56
CD57
CD61
CD68
CD68/CD8
CD79a
CD99 (MIC2)
CD117
CD123
CD138
CD163
CD163/CD4
CD163/CD8
Cdk4
CDX-2
CEA mono
CEA poly
Chromogranin A
Clusterin
CMV
C-Myc
Collagen IV
Cyclin D1
Cytokeratin 19
Cytokeratin 20
Cytokeratin 5/6
Cytokeratin 7
Cytokeratin AE1/AE3
Cytokeratin CAM5.2
Cytokeratin Cocktail (CAM5.2 & AE1/3)
D2-40
DBA.44
Desmin
DOG-1
EBER ISH
EBER RNA
E-Cadherin
EGFR
EMA
ER
ERG
For Diagnosis / Special Interest / Antibody
Factor 13A
Factor VIIIRA
Fascin
FOXP1
Fumarate Hydratase
Gastrin
GATA-3
GFAP
Glucagon
GLUT1
Glutamine Synthetase
Glycophorin A
Glypican-3
Granzyme
H. pylori
HBME
HCG
Hemoglobin A
Hep B Core
Hep B Surface
Hepatocyte
Her2/neu (4B5)
HHV8
HMB-45
HPL
HPV ISH
HSV I
HSV II
IDH1
IgA Heavy chain
IgD Heavy chain
IgG Heavy chain
IgG4
IgM Heavy chain
Inhibin
INI-1
Insulin
K903
Kappa (IHC)
Kappa probe (ISH)
Ki-67
KI67/GFAP
KI67/MART
Lambda (IHC)
Lambda probe (ISH)
Lysozyme
Mammaglobin
Mast Cell Tryptase
MDM2
Melan A
Mismatch Repair Panel (MLH1, MSH2, MSH6, PMS2)
MITF
MNF116
MOC-31
MUC2
MUC5AC
MUC6
Mucin 4
MUM1
Myelin Basic Protein
Myeloperoxidase
Myogenin
Myoglobin
Myosin, Fast
Myosin, Slow
Myosin, Smooth Muscle
Napsin-A
For Diagnosis / Special Interest / Antibody
NeuN
Neurofilament
NGFR
NKI/C3
NSE
Oct-2
Oct-4
p16
p53
p57
p63
Parathyroid Hormone
Parvovirus
PAX-2
PAX-5
PAX-8
PD-1
PGP9.5
PHH3
PIN-4 Cocktail (AMACR & p63 & 34BE12)
Pituitary Panel (ACTH, FSH, GH, LH, PRL, TSH)
PLAP
PR
PRAP
Prealbumin
Prostate cocktail (p63 & 34BE12)
PROX-1
PSA
PSMA
PTH
PU.1
Rb-1
RCC
S100
S100A1
Sall4
Serotonin
Somatostatin
SOX-10
Spirochete
SV40
Synaptophysin, AP Protocol
Synaptophysin, NP Protocol
Tau
TCL1
TCR Beta F1
TDP-43
TdT
TFE3
Thyroglobulin
TIA1
TLE-1
Toxoplasma
TRAP
TTF1
Tyrosinase
Ubiquitin
Varicella Zoster
Vimentin
WT1
WT1/EMA
Other

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