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Test ID 2SC S-(2-Succinyl)-Cysteine (2SC) Immunostain, Technical Component Only

Ordering Guidance

This test includes only technical performance of the stain (no pathologist interpretation is performed). If diagnostic consultation by a pathologist is required order PATHC / Pathology Consultation.

Shipping Instructions

Attach the green pathology address label and the pink Immunostain Technical Only label included in the kit to the outside of the transport container.

Specimen Required

Supplies: Immunostain Technical Only Envelope (T693)

Specimen Type: Tissue

Preferred: 2 unstained positively charged glass slide (25- x 75- x 1-mm) per test ordered; sections 4-microns thick.

Acceptable: Formalin-fixed, paraffin-embedded (FFPE) tissue block

Useful For

Identification of high levels of aberrant S-(2-succino)-cysteine (2SC), secondary to pathogenic alterations of the fumarate hydratase (FH) gene

Testing Algorithm

For the initial technical component only immunohistochemical (IHC) stain performed, the appropriate bill-only test ID will be reflexed and charged (IHTOI). For each additional technical component only IHC stain performed, an additional bill-only test ID will be reflexed and charged (IHTOA).

Method Name


Reporting Name

2SC IHC, Tech Only

Specimen Type


Specimen Stability Information

Specimen Type Temperature Time Special Container
TECHONLY Ambient (preferred)

Clinical Information

A subset of aggressive renal tumors have pathogenic alterations of fumarate hydratase (FH) that do not result in the loss of FH expression. Typically FH alterations are associated with aberrantly high levels of S-(2-succino)-cysteine (2SC) expression observed in the nucleus. FH and 2SC immunohistochemistry assays may be used in combination to identify these pathogenic conditions. This is useful in the diagnosis of renal cell carcinomas, cutaneous and uterine leiomyomas, that occur secondary to somatic or germline (hereditary leiomyomatosis and renal cell cancer: HLRCC syndrome) alterations of the FH gene.


This test does not include pathologist interpretation; only technical performance of the stain. If interpretation is required order PATHC / Pathology Consultation for a full diagnostic evaluation or second opinion of the case.


The positive and negative controls are verified as showing appropriate immunoreactivity and documentation is retained at Mayo Clinic Rochester. If a control tissue is not included on the slide, a scanned image of the relevant quality control tissue is available upon request. Contact 855-516-8404.


Interpretation of this test should be performed in the context of the patient's clinical history and other diagnostic tests by a qualified pathologist.

Clinical Reference

1. Gupta S, Swanson AA, Chen YB, et al: Incidence of succinate dehydrogenase and fumarate hydratase-deficient renal cell carcinoma based on immunohistochemical screening with SDHA/SDHB and FH/2SC. Hum Pathol. 2019 Sep;91:114-122. doi: 10.1016/j.humpath.2019.07.004

2. Andrici J, Gill AJ, Hornick JL: Next generation immunohistochemistry: Emerging substitutes to genetic testing? Semin Diagn Pathol. 2018 May;35(3):161-169. doi: 10.1053/j.semdp.2017.05.004

3. Muller M, Guillaud-Bataille M, Salleron J, et. al: Pattern multiplicity and fumarate hydratase (FH)/S-(2-succino)-cysteine (2SC) staining but not eosinophilic nucleoli with perinucleolar halos differentiate hereditary leiomyomatosis and renal cell carcinoma-associated renal cell carcinomas from kidney tumors without FH gene alteration. Mod Pathol. 2018 June;31(6):974-983. doi: 10.1038/s41379-018-0017-7

4. Buelow B, Cohen J, Nagymanyoki Z, et. al: Immunohistochemistry for 2-succinocystine (2SC) and fumarate hydratase (FH) in cutaneous leiomyomas may aid in identification of patients with HLRCC (hereditary leiomyomatosis and renal cell carcinoma syndrome). Am J Surg Pathol. 2016 Jul;40(7):982-988. doi: 10.1097/PAS.0000000000000626

5. Trpkov K, Hes O, Agaimy A, et. al: Fumarate hydratase-deficient renal cell carcinoma is strongly correlated with fumarate hydratase mutation and hereditary leiomyomatosis and renal cell carcinoma syndrome. Am J Surg Pathol. 2016 Jul;40(7):865-875. doi: 10.1097/PAS.0000000000000617

Day(s) Performed

Monday through Friday

Report Available

1 to 3 days

Test Classification

This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

88342-TC, primary

88341-TC, if additional IHC

LOINC Code Information

Result ID Test Result Name Result LOINC Value
610032 2SC IHC, Tech Only No LOINC Needed


If not ordering electronically, complete, print, and send an Immunohistochemical (IHC)/In Situ Hybridization (ISH) Stains Request (T763) with the specimen.

Mayo Clinic Laboratories | IHC Catalog Additional Information: