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.. Objectives: Objective of the study is to differentiate and sub-categorize malignant small round blue cell tumors by using immuneO-histochemistry. Study Design: Descriptive Observational study. Setting: Meezan Private Lab, Faisalabad, Pakistan. Period: 5 years, from July 2014 to June 2019. Material & Methods: 126 cases of Round blue cells tumors selected by non probability purposive sampling. 126 cases which fulfilled the inclusion and exclusion criteria were selected for the study. All these cases were subjected to immunohistochemistry. The IHC technique used was based on Peroxidase anti-peroxidase (PAP) method. Based on site and morphological clues, initially Leukocyte common antigen (LCA), Myogenin, Cytokeratin (CK), Desmin, chromogranin, Neuron specific enolase (NSE), S-100, Smooth muscle actine (SMA) and CD99 were used. Further immune stains panels were used afterwards, as and when needed like CD20, CD3, CD30, BCL2, CD117, Ki-67, Tdt, synaptophysin, SMA, CD56, Melan A, HMB45 and WT1. Results: Out of 126 cases of small round blue cell tumors, 35 (27.8 %) cases were diagnosed as diffuse large B cell lymphoma, 6 as Lymphoblastic lymphoma, 4 as Burkitt’s lymphoma, and 6 cases as NK/T cell lymphoma. Ewing’s sarcoma/PNET (12/126, 9.5%) was the 2nd highest in frequency, followed by Rhabdomyosarcoma, Synovial sarcoma, Malignant melanoma, and Germ cell tumor, which were all 9/126 each with 7.1 %. Conclusion: Immunohistochemistry is an important tool for appropriate and clear differential diagnosis of malignant small round blue cell tumors of childhood.

Use of Immunohistochemistry in the differential diagnosis of Small Round Blue cell tumors.