1
|
Ren XC, Liu W, Hu LR, Mao M. Mesothelial cyst of uterus in a nullipara patient: A case report. Medicine (Baltimore) 2023; 102:e33159. [PMID: 36862889 PMCID: PMC9981359 DOI: 10.1097/md.0000000000033159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION Uterine mesothelial cysts represent a diagnostic challenge because of their low incidence, with very few cases reported in the English literature. PATIENT CONCERNS We report the case of a 27-year-old nullipara woman complaining of self-discovery of a mass in the abdomen for 1 week. Supersonic examination revealed a pelvic cystic lesion measuring 8.9 × 8.2 cm. The patient underwent exploratory single-port laparoscopic surgery and had a large uterine cystic mass located within the posterior wall of the uterus. DIAGNOSIS After excision of the uterine cyst, the final histopathological diagnosis was uterine mesothelial cyst. INTERVENTIONS We treated her with a single-port laparoscopic uterine cystectomy. OUTCOMES Close follow-up of the case for 2 years showed that the patient was free of any symptoms, and no recurrence was noted. LESSONS Uterine mesothelial cysts are extremely rare. They are often misdiagnosed by clinicians as extrauterine masses or cystic degeneration of leiomyomas. This report aims to share a rare case of uterine mesothelial cyst and improve gynecologists' academic vision of the disease.
Collapse
Affiliation(s)
- Xiu-Cong Ren
- Department of Gynecology, Chengdu First People’s Hospital, Chengdu, Sichuan Province, China
| | - Wei Liu
- Department of Pathology, Chengdu First People’s Hospital, Chengdu, Sichuan Province, China
| | - Li-Rong Hu
- Department of Ultrasound, Chengdu First People’s Hospital, Chengdu, Sichuan Province, China
| | - Min Mao
- Department of Gynecology, Chengdu First People’s Hospital, Chengdu, Sichuan Province, China
- * Correspondence: Min Mao, Department of Gynecology, Chengdu First People’s Hospital, Chengdu, Sichuan Province, China (e-mail: )
| |
Collapse
|
2
|
Coe SE, Garner MM, Kiupel M. Immunohistochemical characterization of mesothelioma in 6 large felids. J Vet Diagn Invest 2021; 33:767-771. [PMID: 33980074 DOI: 10.1177/10406387211015640] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Mesothelioma has been reported frequently in large felids. These neoplasms present a diagnostic challenge given their highly variable morphology that mimics carcinomas or sarcomas at different locations. Our goal was to characterize mesotheliomas morphologically and immunohistochemically to determine if a panel of antibodies could be used to more accurately support the diagnosis of these neoplasms in large felids. Mesotheliomas from 6 large felids, including 4 clouded leopards, 1 Bengal tiger, and 1 cheetah, were immunohistochemically labeled for vimentin, E-cadherin, pancytokeratin, Wilms tumor 1 (WT1), MUC-1, and calretinin. The mesotheliomas of the 4 clouded leopards and the tiger were of the epithelial subtype; the mesothelioma from the cheetah was biphasic. All 6 mesotheliomas had strong immunohistochemical labeling for vimentin, E-cadherin, and pancytokeratin. All cases had cytoplasmic labeling for WT1, and 2 also had nuclear labeling. The 3 mesotheliomas with distinct papillary fronds were weakly positive for MUC-1. These and one other epithelial mesothelioma were also positive for calretinin. Our study demonstrates that the morphologic and immunohistochemical phenotypes of mesothelioma that have been identified in humans and domestic species can occur in large felids, and a panel of pancytokeratin, vimentin, WT1, and calretinin can be utilized to support the diagnosis of these neoplasms.
Collapse
Affiliation(s)
- Sarah E Coe
- Michigan State University Veterinary Diagnostic Laboratory and Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Lansing, MI, USA
| | | | - Matti Kiupel
- Michigan State University Veterinary Diagnostic Laboratory and Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Lansing, MI, USA
| |
Collapse
|
3
|
Huang C, Yang X. Simultaneous tongue metastasis from malignant pleural mesothelioma: Case report and literature review. Thorac Cancer 2020; 12:391-396. [PMID: 33289348 PMCID: PMC7862793 DOI: 10.1111/1759-7714.13769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/29/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is a rare neoplasm of the serosal membranes. MPM usually manifests as local invasion, rarely with distant haematogenous metastases in different organs. Few cases of tongue metastasis have been documented. Here, we report the case of a 68-year-old man diagnosed with malignant pleural epithelioid mesothelioma together with a simultaneous tongue lesion, which was found to be metastatic malignant mesothelioma. Tongue metastasis from MPM is rare and the oral symptoms it causes could be an early sign of clinical manifestation. For patients with oral symptoms and a newly discovered tongue lesion, clinicians should be aware of the possibility of tongue metastasis and search for a primary malignancy.
Collapse
Affiliation(s)
- Chuan Huang
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Xue Yang
- Department of Thoracic Medical Oncology, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education)Peking University Cancer Hospital and InstituteBeijingChina
| |
Collapse
|
4
|
Diagnostic accuracy of BRCA1-associated protein 1 in malignant mesothelioma: a meta-analysis. Oncotarget 2017; 8:68863-68872. [PMID: 28978163 PMCID: PMC5620303 DOI: 10.18632/oncotarget.20317] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 08/06/2017] [Indexed: 01/11/2023] Open
Abstract
Background Conventional measurements are not always helpful in the diagnosis of malignant mesothelioma (MM). Increasing studies indicate that loss of BRCA1–associated protein 1 (BAP1) detected by immunohistochemistry (IHC) is a useful diagnostic marker for MM. In this meta-analysis, we investigated the diagnostic accuracy of BAP1 in MM. Results In total, 12 eligible studies with a total of 1824 patients were selected. Results indicated that loss of BAP1 sustained a pooled sensitivity of 0.56 (95% CI, 0.50–0.62), specificity of 1.00 (95% CI, 0.95–1.00), PLR of 548.82 (95% CI, 11.31–2.7 × 104), NLR of 0.44 (95% CI, 0.39–0.50), DOR of 1247.78 (95% CI, 25.08 −6.2 × 104) in discriminating MM from non-MM. The AUC of 0.72, reflecting the SROC, indicated moderate diagnostic accuracy. Subgroup analysis showed that BAP1 detection in histological specimens owned the higher diagnostic performance than cytological ones. In addition, BAP1 showed superior diagnostic accuracy in epithelioid MM than biphasic or sarcomatoid MM. Materials and Methods PubMed, Embase and the Cochrane Library and reference lists of related articles were searched, and studies that evaluated the utility of BAP1 in MM were included. Data from eligible studies were pooled to estimate sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR). Summary receiver operating curves (SROC) was applied to estimate overall diagnostic accuracy. Conclusions Current meta-analysis indicates that detection of BAP1 by IHC is a useful diagnostic marker for MM. Loss of BAP1 almost provides confirming diagnosis for MM, while positive staining for BAP1 is not enough to exclude non-MM.
Collapse
|
5
|
Mizutani N, Abe M, Matsuoka S, Kajino K, Wakiya M, Ohtsuji N, Hatano R, Morimoto C, Hino O. Establishment of anti-mesothelioma monoclonal antibodies. BMC Res Notes 2016; 9:324. [PMID: 27342200 PMCID: PMC4921032 DOI: 10.1186/s13104-016-2128-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 06/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mesotheliomas are aggressive, therapy-resistant tumors that are predicted to increase in incidence at least until 2020. The prognosis of patients with mesothelioma is generally poor because they are typically diagnosed at a late stage and their tumors are resistant to current conventional therapies. For these reasons, improved diagnosis and therapy are urgently required. To address these issues, the aim of our research was to develop novel mesothelioma-specific monoclonal antibodies (mAbs) as diagnostic and therapeutic agents. METHODS To develop anti-mesothelioma mAbs useful for diagnosis and therapy, we repeatedly immunized a BALB/c mouse with viable mesothelioma cells, alternating between those from three mesothelioma cell lines. We hybridized the spleen cells from this immunized mouse with P3U1 myeloma cells. We then screened supernatants harvested from the hybridoma clones by assessing whether they bound to a mesothelioma cell line not used for immunization and altered its morphology. We designed this developmental strategy to reduce the risk of obtaining clonotypic mAbs against a single mesothelioma cell line. RESULTS Our newly generated mouse anti-human mAbs immunostained clinical samples of mesotheliomas. One of the newly generated mAbs did not react with any other tumor cell line tested. Two other mAbs significantly inhibited the proliferation of mesothelioma cells. CONCLUSION These newly generated anti-mesothelioma mAbs are potentially useful as diagnostic and therapeutic agents for mesothelioma. Moreover, our novel strategy for establishing antitumor mAbs may facilitate the development of new diagnostic and therapeutic techniques for mesotheliomas and other malignancies.
Collapse
Affiliation(s)
- Natsuko Mizutani
- />Department of Pathology, Kyorin University School of Medicine, 6-20-2, Shinkawa, Mitaka-shi, Tokyo 181-8611 Japan
- />Departments of Pathology and Oncology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Masaaki Abe
- />Departments of Pathology and Oncology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Shuji Matsuoka
- />Departments of Pathology and Oncology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Kazunori Kajino
- />Departments of Pathology and Oncology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Midori Wakiya
- />Departments of Pathology and Oncology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
- />Department of Pathology, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachioji-shi, Tokyo 193-0998 Japan
| | - Naomi Ohtsuji
- />Departments of Pathology and Oncology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Ryo Hatano
- />Therapy Development and Innovation for Immune Disorders and Cancers, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Chikao Morimoto
- />Therapy Development and Innovation for Immune Disorders and Cancers, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| | - Okio Hino
- />Departments of Pathology and Oncology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421 Japan
| |
Collapse
|
6
|
Kushitani K, Amatya VJ, Mawas AS, Miyata Y, Okada M, Takeshima Y. Use of Anti-Noxa Antibody for Differential Diagnosis between Epithelioid Mesothelioma and Reactive Mesothelial Hyperplasia. Pathobiology 2016; 83:33-40. [PMID: 26735863 DOI: 10.1159/000442092] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 10/29/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The histological differential diagnosis between epithelioid mesothelioma (EM) and reactive mesothelial hyperplasia (RMH) is not always straightforward. The aim of the present study was to search for new immunohistochemical markers to distinguish EM from RMH. METHODS We evaluated and compared the expression of apoptosis-related genes in EM and RMH by real-time RT-PCR array analysis followed by clustering of significant gene expression. Immunohistochemical staining and statistical analysis of Noxa expression in 81 cases of EM and 55 cases of RMH were performed and compared with the utility of other previously reported antibodies such as Desmin, EMA, GLUT-1, IMP-3 and CD146. RESULTS Noxa mRNA expression levels were found to be increased in EM when compared to RMH by RT-PCR array analysis. In the immunohistochemical analysis, Noxa showed sensitivity of 69.0%, specificity of 93.6% and positive predictive value of 93.0% as a positive marker of EM in distinguishing it from RMH, and these values were almost similar to IMP-3. CONCLUSION Noxa is a marker with relatively high specificity, and can be used to distinguish EM from RMH. It would be a valuable addition to the current antibody panel used for the differential diagnosis of EM and RMH.
Collapse
Affiliation(s)
- Kei Kushitani
- Department of Pathology, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | | | | | | | | | | |
Collapse
|
7
|
BAP1 (BRCA1-associated protein 1) is a highly specific marker for differentiating mesothelioma from reactive mesothelial proliferations. Mod Pathol 2015; 28:1043-57. [PMID: 26022455 DOI: 10.1038/modpathol.2015.65] [Citation(s) in RCA: 187] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 04/20/2015] [Accepted: 04/24/2015] [Indexed: 01/18/2023]
Abstract
The distinction between malignant mesothelioma and reactive mesothelial proliferation can be challenging both on histology and cytology. Recently, variants of the BRCA1-associated protein 1 (BAP1) gene resulting in nuclear protein loss were reported in hereditary and sporadic mesothelioma. Using immunohistochemistry, we evaluated the utility of BAP1 expression in the differential diagnosis between mesothelioma and other mesothelial proliferations on a large series of biopsies that included 212 mesotheliomas, 12 benign mesothelial tumors, and 42 reactive mesothelial proliferations. BAP1 stain was also performed in 70 cytological samples (45 mesotheliomas and 25 reactive mesothelial proliferations). BAP1 was expressed in all benign mesothelial tumors, whereas 139/212 (66%) mesotheliomas were BAP1 negative, especially in epithelioid/biphasic compared with sarcomatoid/desmoplastic subtypes (69% vs 15%). BAP1 loss was homogeneous in neoplastic cells except for two epithelioid mesotheliomas showing tumor heterogeneity. By fluorescence in situ hybridization, BAP1 protein loss was paralleled by homozygous deletion of the BAP1 locus in the vast majority of BAP1-negative tumors (31/41, 76%), whereas 9/10 BAP1-positive mesotheliomas were normal. In biopsies interpreted as reactive mesothelial proliferation BAP1 loss was 100% predictive of malignancy, as all 6 cases subsequently developed BAP1-negative mesothelioma, whereas only 3/36 (8%) BAP1-positive cases progressed to mesothelioma. On cytology/cell blocks, benign mesothelial cells were invariably positive for BAP1, whereas 64% of mesotheliomas showed loss of protein; all 6 cases showing BAP1 negativity were associated with histological diagnosis of BAP1-negative mesothelioma. BAP1 stain also showed utility in the differential of mesothelioma from most common pleural and peritoneal mimickers, such as lung and ovary carcinomas, with specificity and sensitivity of 99/70% and 100/70%, respectively. Our results show that BAP1 protein is frequently lost in mesothelioma, especially of epithelioid/biphasic subtype and is commonly associated with homozygous BAP1 deletion. BAP1 immunostain represents an excellent biomarker with an unprecedented specificity (100%) in the distinction between benign and malignant mesothelial proliferations. Finding BAP1 loss in mesothelial cells should prompt to immediately reevaluate the patient; moreover, it might be useful in mapping tumor extent and planning surgical resection.
Collapse
|
8
|
Kotha VK, Yan AT, Prabhudesai V, Kirpalani A, Connelly K, Peerani R, Hill SJ, Streutker CJ, Latter DA, Pinter A, Deva DP. Benign intramyocardial mesothelial cyst in the right ventricular outflow tract: computed tomography and cardiovascular magnetic resonance imaging appearances. Circulation 2014; 130:e275-7. [PMID: 25602950 DOI: 10.1161/circulationaha.114.009658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Vamshi Krishna Kotha
- From the Departments of Medical Imaging (V.K.K., V.P., A.K., D.P.D.), Cardiology (A.T.Y., K.C., A.P.), Laboratory Medicine, Division of Pathology (R.P., C.S.S.), and Cardiovascular and Thoracic Surgery (S.J.H., D.A.L.), St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Andrew T Yan
- From the Departments of Medical Imaging (V.K.K., V.P., A.K., D.P.D.), Cardiology (A.T.Y., K.C., A.P.), Laboratory Medicine, Division of Pathology (R.P., C.S.S.), and Cardiovascular and Thoracic Surgery (S.J.H., D.A.L.), St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Vikramaditya Prabhudesai
- From the Departments of Medical Imaging (V.K.K., V.P., A.K., D.P.D.), Cardiology (A.T.Y., K.C., A.P.), Laboratory Medicine, Division of Pathology (R.P., C.S.S.), and Cardiovascular and Thoracic Surgery (S.J.H., D.A.L.), St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Anish Kirpalani
- From the Departments of Medical Imaging (V.K.K., V.P., A.K., D.P.D.), Cardiology (A.T.Y., K.C., A.P.), Laboratory Medicine, Division of Pathology (R.P., C.S.S.), and Cardiovascular and Thoracic Surgery (S.J.H., D.A.L.), St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Kim Connelly
- From the Departments of Medical Imaging (V.K.K., V.P., A.K., D.P.D.), Cardiology (A.T.Y., K.C., A.P.), Laboratory Medicine, Division of Pathology (R.P., C.S.S.), and Cardiovascular and Thoracic Surgery (S.J.H., D.A.L.), St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Raheem Peerani
- From the Departments of Medical Imaging (V.K.K., V.P., A.K., D.P.D.), Cardiology (A.T.Y., K.C., A.P.), Laboratory Medicine, Division of Pathology (R.P., C.S.S.), and Cardiovascular and Thoracic Surgery (S.J.H., D.A.L.), St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Samantha J Hill
- From the Departments of Medical Imaging (V.K.K., V.P., A.K., D.P.D.), Cardiology (A.T.Y., K.C., A.P.), Laboratory Medicine, Division of Pathology (R.P., C.S.S.), and Cardiovascular and Thoracic Surgery (S.J.H., D.A.L.), St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Catherine J Streutker
- From the Departments of Medical Imaging (V.K.K., V.P., A.K., D.P.D.), Cardiology (A.T.Y., K.C., A.P.), Laboratory Medicine, Division of Pathology (R.P., C.S.S.), and Cardiovascular and Thoracic Surgery (S.J.H., D.A.L.), St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - David A Latter
- From the Departments of Medical Imaging (V.K.K., V.P., A.K., D.P.D.), Cardiology (A.T.Y., K.C., A.P.), Laboratory Medicine, Division of Pathology (R.P., C.S.S.), and Cardiovascular and Thoracic Surgery (S.J.H., D.A.L.), St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Arnold Pinter
- From the Departments of Medical Imaging (V.K.K., V.P., A.K., D.P.D.), Cardiology (A.T.Y., K.C., A.P.), Laboratory Medicine, Division of Pathology (R.P., C.S.S.), and Cardiovascular and Thoracic Surgery (S.J.H., D.A.L.), St. Michael's Hospital, University of Toronto, Ontario, Canada
| | - Djeven Parameshvara Deva
- From the Departments of Medical Imaging (V.K.K., V.P., A.K., D.P.D.), Cardiology (A.T.Y., K.C., A.P.), Laboratory Medicine, Division of Pathology (R.P., C.S.S.), and Cardiovascular and Thoracic Surgery (S.J.H., D.A.L.), St. Michael's Hospital, University of Toronto, Ontario, Canada.
| |
Collapse
|
9
|
Value of PAX8, PAX2, claudin-4, and h-caldesmon immunostaining in distinguishing peritoneal epithelioid mesotheliomas from serous carcinomas. Mod Pathol 2013; 26:553-62. [PMID: 23196794 DOI: 10.1038/modpathol.2012.200] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Distinguishing between peritoneal epithelioid mesotheliomas and papillary serous carcinomas involving the peritoneum can be difficult on routine histological preparations, but this differential diagnosis can be facilitated by the use of immunohistochemistry. Recent investigations have indicated that PAX8, PAX2, claudin-4, and h-caldesmon are immunohistochemical markers that can assist in distinguishing between these two malignancies; however, much of the information published on the value of these markers is either insufficient or contradictory. The purpose of this study is to resolve some of the existing controversies and to fully determine the practical value of these markers for assisting in the differential diagnosis between peritoneal mesotheliomas and serous carcinomas. In order to do so, a total of 40 peritoneal epithelioid mesotheliomas and 45 serous carcinomas (15 primary, 30 metastatic to the peritoneum) were investigated. PAX8 and PAX2 nuclear positivity was demonstrated in 42 (93%) and 25 (56%) of the serous carcinomas, respectively, whereas none of the mesotheliomas expressed either marker. Forty-four (98%) of the serous carcinomas exhibited claudin-4 reactivity along the cell membrane, whereas none of the mesotheliomas were positive for this marker. All of the serous carcinomas and mesotheliomas were negative for h-caldesmon. Based on these results, it is concluded that PAX8 and claudin-4 have a higher sensitivity and specificity for assisting in discriminating between peritoneal epithelioid mesotheliomas and serous carcinomas when compared with all of the other positive carcinoma markers that are, at present, recommended to be included in the immunohistochemical panels used in this differential diagnosis. Even though it is highly specific, PAX2 has little practical value in the diagnosis of peritoneal epithelioid mesotheliomas as its sensitivity is low. The h-caldesmon is not useful.
Collapse
|
10
|
Ordóñez NG. Application of immunohistochemistry in the diagnosis of epithelioid mesothelioma: a review and update. Hum Pathol 2012; 44:1-19. [PMID: 22963903 DOI: 10.1016/j.humpath.2012.05.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Revised: 05/14/2012] [Accepted: 05/16/2012] [Indexed: 01/12/2023]
Abstract
A large number of immunohistochemical markers that can assist in the differential diagnosis of epithelioid mesotheliomas are currently available. Because these markers are expressed differently in the various types of carcinomas that can metastasize to the serosal membranes and can potentially be confused with epithelioid mesothelioma, their selection for inclusion in a diagnostic panel largely depends on the differential diagnosis, as well as on which ones work the best in a given laboratory. Traditionally, the panels used in the differential diagnosis of epithelioid mesothelioma have consisted of a combination of positive mesothelioma markers and broad-spectrum carcinoma markers. At present, a wide variety of organ-associated carcinoma markers such as thyroid transcription factor-1 and napsin A for the lung, PAX 8 and PAX 2 for the kidney, and Müllerian-derived tumors; gross cystic disease fluid protein-15 and mammaglobin for the breast; and CDX2 for intestinal differentiation are available, which can assist in establishing the site of origin of an adenocarcinoma when included in a diagnostic panel. This article provides updated information on the composition of the panels of markers recommended in the various differential diagnoses.
Collapse
Affiliation(s)
- Nelson G Ordóñez
- The University of Texas MD Anderson Cancer Center, Department of Pathology, Houston, TX 77030, USA.
| |
Collapse
|
11
|
Washimi K, Yokose T, Yamashita M, Kageyama T, Suzuki K, Yoshihara M, Miyagi Y, Hayashi H, Tsuji S. Specific expression of human intelectin-1 in malignant pleural mesothelioma and gastrointestinal goblet cells. PLoS One 2012; 7:e39889. [PMID: 22768319 PMCID: PMC3388067 DOI: 10.1371/journal.pone.0039889] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 05/28/2012] [Indexed: 11/18/2022] Open
Abstract
Malignant pleural mesothelioma (MPM) is a fatal tumor. It is often hard to discriminate MPM from metastatic tumors of other types because currently, there are no reliable immunopathological markers for MPM. MPM is differentially diagnosed by some immunohistochemical tests on pathology specimens. In the present study, we investigated the expression of intelectin-1, a new mesothelioma marker, in normal tissues in the whole body and in many cancers, including MPM, by immunohistochemical analysis. We found that in normal tissues, human intelectin-1 was mainly secreted from gastrointestinal goblet cells along with mucus into the intestinal lumen, and it was also expressed, to a lesser extent, in mesothelial cells and urinary epithelial cells. Eighty-eight percent of epithelioid-type MPMs expressed intelectin-1, whereas sarcomatoid-type MPMs, biphasic MPMs, and poorly differentiated MPMs were rarely positive for intelectin-1. Intelectin-1 was not expressed in other cancers, except in mucus-producing adenocarcinoma. These results suggest that intelectin-1 is a better marker for epithelioid-type MPM than other mesothelioma markers because of its specificity and the simplicity of pathological assessment. Pleural intelectin-1 could be a useful diagnostic marker for MPM with applications in histopathological identification of MPM.
Collapse
Affiliation(s)
- Kota Washimi
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Japan
| | - Tomoyuki Yokose
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Japan
| | - Makiko Yamashita
- Molecular Diagnostic Project, Kanagawa Cancer Center Research Institute, Yokohama, Japan
| | - Taihei Kageyama
- Molecular Diagnostic Project, Kanagawa Cancer Center Research Institute, Yokohama, Japan
| | - Katsuo Suzuki
- Molecular Diagnostic Project, Kanagawa Cancer Center Research Institute, Yokohama, Japan
| | - Mitsuyo Yoshihara
- Division of Molecular Pathology and Genetics, Kanagawa Cancer Center Research Institute, Yokohama, Japan
| | - Yohei Miyagi
- Division of Molecular Pathology and Genetics, Kanagawa Cancer Center Research Institute, Yokohama, Japan
| | - Hiroyuki Hayashi
- Department of Pathology, Yokohama Municipal Citizen’s Hospital, Yokohama, Japan
| | - Shoutaro Tsuji
- Molecular Diagnostic Project, Kanagawa Cancer Center Research Institute, Yokohama, Japan
- * E-mail:
| |
Collapse
|
12
|
Sherman CG, Jani P, Marks A, Kahn HJ. D2-40 is expressed on the luminal surface of pulmonary airspaces in normal developing and adult lung but is lost in conditions associated with intra-alveolar infiltrates. Pediatr Dev Pathol 2012; 15:259-64. [PMID: 22150577 DOI: 10.2350/11-09-1087-oa.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The D2-40 antigen is a glycosylated sialomucin that is strongly expressed by lymphatic endothelial cells. Recently we observed the expression of D2-40 on the luminal surface of pulmonary airspaces in lung sections. The aim of the study was to assess the expression of D2-40 antigen in normal lung development and in various pathologic conditions in which abnormal alveolar infiltrates were present. Formalin-fixed lung tissue was selected from 42 fetal/neonatal autopsy cases ranging in gestational age from 12 to 41 weeks and from 10 adult lungs. In the fetal/neonatal group, 22 cases were histologically normal, whereas 20 were abnormal (including cases of pneumonia, alveolar hemorrhage, meconium aspiration, pulmonary hypoplasia, and pulmonary interstitial emphysema). In the adult group, 5 cases were histologically normal and 5 had pneumonia. Immunohistochemical staining was performed on all cases using antibody to D2-40. All cases of normal fetal/neonatal lung and normal adult lung showed diffuse strong expression of D2-40 on the luminal surface of the alveolar lining cells. D2-40 expression was also noted on the bronchiolar lining cells of normal fetal/neonatal lung. In all cases in which there was an abnormal infiltrate or foreign material within the airspaces, expression of D2-40 was lost in the alveolar lining. The production of the D2-40 antigen in the alveolar lining occurs as early as 12 weeks gestation and continues to be present throughout all other stages of lung development, as well as in adult lung. These results suggest that D2-40 may have a cell membrane protective function.
Collapse
Affiliation(s)
- Christopher G Sherman
- Department of Anatomic Pathology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Room E432, Toronto, ON, M4N 3M5, Canada.
| | | | | | | |
Collapse
|
13
|
|
14
|
Hai B, Yang Y, Xiao Y, Li B, Chen C. Diagnosis and prognosis of malignant mesothelioma of the tunica vaginalis testis. Can Urol Assoc J 2011; 6:E238-41. [PMID: 21914425 DOI: 10.5489/cuaj.10200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The objective of this study is to evaluate the diagnosis and prognosis of malignant mesothelioma of the tunica vaginalis testis through an additional 6 patients with urogenital mesothelioma. METHODS Six patients with urogenital mesothelioma who underwent adequate surgical procedures and histopathologic analysis from 1990 to 2009 were identified and retrospectively reviewed. RESULTS Six patients between the ages of 26 and 78 years with urogenital mesothelioma, 5 of which originated in the scrotum and 1 in the spermatic cord. Histopathologic analysis showed that CK5/6 and calretinin were positive in all cases, 5 cases were positive for vimentin, and 1 case showed focal weak positive reaction with MOC3, but none of the cases stained for CEA or CD15. The overall recurrence rate of urogenital mesothelioma after surgery was 5/6, including local recurrences and fatalities due to tumour. CONCLUSIONS In cases of mesothelioma of the tunica vaginalis testis, the histopathologic markers we chose helped confirm the histopathological diagnosis; adequate surgical procedures are typically not curative, and this tumour is often fatal.
Collapse
Affiliation(s)
- Bo Hai
- Department of Urology, Union Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | | | | | | | | |
Collapse
|
15
|
Nezhat FR, DeNoble SM, Brown DN, Shamshirsaz A, Hoehn D. Laparoscopic Management of Peritoneal Mesothelioma Associated with Pelvic Endometriosis. J Minim Invasive Gynecol 2010; 17:646-50. [DOI: 10.1016/j.jmig.2010.03.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Revised: 03/23/2010] [Accepted: 03/25/2010] [Indexed: 11/25/2022]
|
16
|
Hammar SP. Macroscopic, Histologic, Histochemical, Immunohistochemical, and Ultrastructural Features of Mesothelioma. Ultrastruct Pathol 2009; 30:3-17. [PMID: 16517466 DOI: 10.1080/01913120500313143] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Mesotheliomas are uncommon neoplasms that arise from the cells forming the serosal membranes of the body cavities. Approximately 90-95% of mesotheliomas arise in the pleural cavity and 5-10% in the peritoneal cavity. Rare mesotheliomas arise in the pericardium and in the tunica vaginalis. Unlike many neoplasms, mesotheliomas grow in a diffuse distribution and tend to encase the organs in the various body cavities. A combination of histochemical, immunohistochemical, and ultrastructural features are often necessary to accurately diagnose mesotheliomas. These techniques are highlighted in this review article on mesothelioma.
Collapse
Affiliation(s)
- Samuel P Hammar
- Diagnostic Specialties Laboratories, Bremerton, Washington 98310, USA.
| |
Collapse
|
17
|
Abstract
Mesothelial proliferations, either reactive or neoplastic in nature, often pose difficult diagnostic dilemmas. Electron microscopy continues to be a gold standard in the identification of mesothelial differentiation. However, it is very common to apply long panels of antibodies for that purpose. In most cases, light microscopy and immunohistochemistry will solve the problem. However, the definitive, specific, and sensitive immunohistochemical marker is still lacking. This is particularly true in peritoneal and testicular mesothelial tumors, in which common embryologic origin with epithelial elements results in overlapping immunohistochemistry and morphology. The particularities of peritoneal and testicular mesothelial proliferations, and the main tumors that may mimic them in these sites, as well as the value and limitations of immunohistochemistry and electron microscopy in their differential diagnosis are the subject of this review.
Collapse
Affiliation(s)
- Josep Lloreta-Trull
- Department of Pathology, Hospital del Mar-IMAS-IMIM, Universitat Pompeu Fabra, Barcelona, Spain.
| |
Collapse
|
18
|
Klebe S, Nurminen M, Leigh J, Henderson DW. Diagnosis of epithelial mesothelioma using tree-based regression analysis and a minimal panel of antibodies. Pathology 2009; 41:140-8. [PMID: 19152187 DOI: 10.1080/00313020802579250] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIMS Immunohistochemistry with panels of antibodies is a standard procedure to distinguish between malignant mesothelioma and metastatic adenocarcinoma. Most studies assess only the sensitivity and specificity for single antibodies, even when the paper concludes by recommending an antibody panel. It was the aim of this study to use a novel statistical approach to identify a minimal panel of antibodies, which would make this distinction in the majority of cases. METHODS Two hundred consecutive cases of pleural malignancy (173 pleural mesotheliomas of epithelial type and 27 cases of secondary adenocarcinoma) were investigated using a standard panel of 12 antibodies (CAM5.2, CK5/6, calretinin, HBME-1, thrombomodulin, WT-1, EMA, CEA, CD15, B72.3, BG8, and TTF-1). Regression and classification tree-based methods were applied to select the best combination of markers. The modelling procedures used employ successive, hierarchical predictions computed for individual cases to sort them into homogeneous classes. RESULTS Labelling for calretinin and lack of labelling for BG8 were sufficient for definite correlation with a diagnosis of malignant mesothelioma. CD15 provided further differentiating information in some cases. CONCLUSION A panel of three antibodies was sufficient in most cases to diagnose, or to exclude, epithelial mesothelioma. Calretinin exhibits the strongest correlative power of the antibodies tested.
Collapse
Affiliation(s)
- Sonja Klebe
- Department of Anatomical Pathology, Flinders Medical Centre, Adelaide, SA, Australia.
| | | | | | | |
Collapse
|
19
|
Takeshima Y, Inai K, Amatya VJ, Gemba K, Aoe K, Fujimoto N, Kato K, Kishimoto T. Accuracy of pathological diagnosis of mesothelioma cases in Japan: clinicopathological analysis of 382 cases. Lung Cancer 2009; 66:191-7. [PMID: 19232771 DOI: 10.1016/j.lungcan.2009.01.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2008] [Revised: 01/06/2009] [Accepted: 01/19/2009] [Indexed: 11/26/2022]
Abstract
Incidences of mesothelioma are on the rise in Japan. However, the accurate frequency of mesothelioma occurrence is still unknown. The aim of this study is to clarify the accuracy of pathological diagnosis of mesothelioma. Among the 2742 mesothelioma death cases extracted from the document "Vital Statistics of Japan" for 2003-2005, pathological materials were obtained for 382 cases. After these materials were reviewed and immunohistochemical analyses were conducted, mesothelioma was diagnosed by discussions based on clinical and radiological information. Sixty-five cases (17.0%) were categorized as "definitely not/unlikely" mesotheliomas, and 273 cases (71.5%) were categorized as "probable/definite" mesotheliomas. The percentage of "probable/definite" pleural and peritoneal mesothelioma cases in males was 74.3% and 87.5%, respectively, and that of pleural cases in females was 59.2%; however, the percentage of "probable/definite" peritoneal cases in females was only 22.2%. These results suggest that the diagnostic accuracy of mesothelioma is relatively low in females and in cases of peritoneal and sarcomatoid subtype mesotheliomas; furthermore, approximately 15% of cases of deaths due to mesothelioma in Japan are diagnostically suspicious.
Collapse
Affiliation(s)
- Yukio Takeshima
- Department of Pathology, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Attanoos RL, Gibbs AR. The comparative accuracy of different pleural biopsy techniques in the diagnosis of malignant mesothelioma. Histopathology 2008; 53:340-4. [PMID: 18647189 DOI: 10.1111/j.1365-2559.2008.03099.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To evaluate the diagnostic accuracy of closed and open pleural biopsies in diagnosing malignant pleural mesothelioma. METHODS AND RESULTS The autopsy study group comprised 45 malignant mesotheliomas. All prior pleural biopsy investigations were reviewed. Forty-one of 45 (91%) had had an antemortem diagnosis of malignant mesothelioma. In these 41 cases, 57 prior diagnostic pleural biopsies had been performed [36 closed needle biopsies: 31 blind; five computed tomography (CT)-guided and 21 open pleural biopsies]. For definitive diagnosis open pleural biopsy yielded a sensitivity of 95% and specificity of 100%. For definitive diagnosis closed blind pleural biopsies yielded a sensitivity of 16% and specificity of 94%. Thirty-two per cent of 'blind' biopsies were inadequate. CT-guided pleural biopsies yielded a definitive diagnostic accuracy of 100% (5/5). Biopsy specimen size was important in obtaining a positive definitive diagnosis. Diagnosis was attained in 75% of specimens >10 mm in size compared with 8% <10 mm in size. CONCLUSIONS Overall, all procedures had utility but definitive diagnostic accuracy for 'blind' closed pleural biopsy was low (16%), dependent on biopsy specimen size and tumour subtype. Sarcomatoid subtype malignant mesothelioma yielded the lowest diagnostic accuracy. For all subtypes of malignant mesothelioma, open pleural biopsy produced the highest diagnostic accuracy (100% sensitivity, 95% specificity).
Collapse
Affiliation(s)
- R L Attanoos
- Department of Histopathology, Cardiff and Vale NHS Trust, Llandough Hospital, Cardiff, UK.
| | | |
Collapse
|
21
|
Localized malignant mesothelioma in the middle mediastinum: report of a case. Surg Today 2008; 38:635-8. [PMID: 18612789 DOI: 10.1007/s00595-007-3679-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Accepted: 08/01/2007] [Indexed: 12/29/2022]
Abstract
Localized malignant mesothelioma in the mediastinum is rare and most known cases have been reported as "localized malignant pericardial mesothelioma." We report a case of a middle mediastinal tumor, which we were able to resect completely. Histopathological examination of the tumor confirmed that it was a malignant epithelial lymphohistiocytoid mesothelioma. We assumed that the tumor was derived from the pericardium. Local recurrence was detected 1 year after resection, and the patient died of the disease about 2 years later.
Collapse
|
22
|
Suchkov SV, Petrunin DD, Kostalevskaya AV, Kachkov IA, Elbeik T, Matsuura E, Paltsev MA. Cancer-associated immune-mediated syndromes: Pathogenic values and clinical implementation. Biomed Pharmacother 2007; 61:323-37. [PMID: 17656060 DOI: 10.1016/j.biopha.2007.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 06/07/2007] [Indexed: 11/30/2022] Open
Abstract
The ability of tumors to provoke formation of cancer-associated secondary immunodeficiency (CASID) with predominant suppression of CMI and cancer-associated secondary immunodeficiency with clinical autoimmunity syndrome (CASICAS) with triggering of a set of the autoimmune deviations is appearing to be a key event in the restriction of hosts' anti-tumor immunity. Earlier the existence of the above-mentioned syndromes was demonstrated in BCC and GBM patients. In order to reach a point where immunological phenotypes in GBM and BCC can be clarified clinically and, partly, pathogenically, we have conducted a series of studies of typical and atypical types of immune responsiveness in patients with GBM and BCC. For GBM and BCC three scenarios of the involvement of the immune responsiveness have been established in a series of our studies, i.e., (i) malignancy with no immunopathology, (ii) malignancy as CASID, and (iii) malignancy as CASICAS. All of those scenarios demonstrated significant differences in their immune-mediated manifestations which, in turn, were proven to reveal close associative relationships with a specific clinicopathologic type and clinical manifestations of the tumor. CASID and CASICAS share two common features, i.e., (i) signs of immunodeficiency and (ii) a tandem of the deviations within the adaptive and innate links of the host immune responsiveness. At the same time, CASID and CASICAS are distinct pathogenically and clinically, and in terms of depth of the immune deviations observed, CASID patients manifest a breakage in both links, whereas in CASICAS patients, a breakage in the adaptive link would dominate. To get these differences clarified, we summarized major types of the immune imbalances and sets of clinical and clinicopathologic manifestations to illustrate the above-mentioned features in CASID and CASICAS patients. There are distinct close correlations between clinicopathologic features of the disease course and sets of the immune-mediated imbalances in patients harboring the tumors. The latter implicates a panel of the new immunodiagnostic and immunoprognostic criteria for patients with solid tumors, i.e., BCC, MCC and GB, which is of great value for clinical practice. In particular, the blood levels of some of the immunocompetent cells, state of their functional activity, serum titers of the antigenic markers and autoantibodies, apoptotic parameters, and others may be accepted as additional and clinically informative criteria to be implemented for immunological monitoring and immunotherapy of patients with solid tumors.
Collapse
Affiliation(s)
- S V Suchkov
- I.M. Sechenov Moscow Medical Academy (MMA), Moscow, Russia.
| | | | | | | | | | | | | |
Collapse
|
23
|
Facchetti F, Lonardi S, Gentili F, Bercich L, Falchetti M, Tardanico R, Baronchelli C, Lucini L, Santin A, Murer B. Claudin 4 identifies a wide spectrum of epithelial neoplasms and represents a very useful marker for carcinoma versus mesothelioma diagnosis in pleural and peritoneal biopsies and effusions. Virchows Arch 2007; 451:669-80. [PMID: 17609977 DOI: 10.1007/s00428-007-0448-x] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2007] [Revised: 05/30/2007] [Accepted: 06/08/2007] [Indexed: 11/30/2022]
Abstract
We evaluated the usefulness of the tight-junction associated protein Claudin 4 (CL-4) in the diagnosis of mesothelioma and mimickers, analyzing biopsies from 454 tumors, including 82 mesotheliomas, 336 carcinomas of different origin (278 primary, 58 metastatic to serosae), 36 nonepithelial spindle cell neoplasms, as well as 97 cytological samples from reactive effusions (12), mesothelioma (23) and metastatic carcinomas (62). CL-4 was consistently negative in normal and reactive mesothelium, as well as in all 82 mesotheliomas. In contrast, strong reactivity was found in 57/58 serosal metastasis, and in 245/278 primary carcinomas, with uppermost expression (150/153) in those most frequently involved in the differential with mesothelioma (lung, breast, gastrointestinal tract, pancreas, ovary, primary serous papillary carcinoma of peritoneum). On effusions, reactive and neoplastic mesothelial cells were regularly negative, while metastatic tumor cells stained positively in 60/62 (96.8%) cases. Among spindle cell neoplasms, only 2/9 biphasic synovial sarcomas and 4/4 follicular dendritic cell sarcomas stained positively. Results indicate that CL-4 reacts with the majority of epithelial neoplasms that often metastasize to serous membranes, representing a pancarcinoma marker with extremely high sensitivity and specificity. CL-4 may be considered a primary immunohistochemical reagent to rule out the diagnosis of mesothelioma.
Collapse
Affiliation(s)
- Fabio Facchetti
- Department of Pathology I, University of Brescia, Spedali Civili Brescia, Piazzale Spedali Civili 1, Brescia, 25124, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Marchevsky AM, Wick MR. Evidence-based Guidelines for the Utilization of Immunostains in Diagnostic Pathology: Pulmonary Adenocarcinoma Versus Mesothelioma. Appl Immunohistochem Mol Morphol 2007; 15:140-4. [PMID: 17525624 DOI: 10.1097/01.pai.0000213148.62525.9a] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There are no firmly established guidelines for the use of antibodies in immunohistology as individual tests or panels. Practicing pathologists must rely on information available in individual publications, review articles, books, and internet-based databases to develop diagnostic immunohistochemical algorithms for their individual practices. In contrast, other medical specialties have crafted many evidence-based practice guidelines (EBG) that are widely used; these have helped to augment standardization and cost effectiveness. In particular, the use of several "epithelial" and "mesothelial" antibodies has been proposed to distinguish epithelioid malignant mesothelioma from metastatic pulmonary adenocarcinoma. Other authors have previously done systematic literature reviews of this subject up through 2004 and integrated the results of 88 publications into summarized test-performance values for 15 preselected immunohistochemical markers. The results suggested that 7 tests provide optimal sensitivity and specificity (MOC-31, BG8, CEA, TTF-1, CK5/6, WT-1, and HBME-1), but they provide no guidance for integration of such data into EBG. Odds ratios (ORs) were employed to compare the effectiveness of any single test, and chosen combinations thereof, in the differential diagnosis of malignant mesothelioma and metastatic pulmonary adenocarcinoma. Surprisingly, selected single immunostains or antibody pairs yielded ORs (varying from 96.34 to 1233.19) that were equal or better in efficacy when compared with more comprehensive panels. These results support the potential value of systematic reviews, meta-analysis, and OR calculations for development of EBG in diagnostic immunohistology.
Collapse
Affiliation(s)
- Alberto M Marchevsky
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
| | | |
Collapse
|
25
|
Ordóñez NG. What are the current best immunohistochemical markers for the diagnosis of epithelioid mesothelioma? A review and update. Hum Pathol 2007; 38:1-16. [PMID: 17056092 DOI: 10.1016/j.humpath.2006.08.010] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Revised: 08/14/2006] [Accepted: 08/18/2006] [Indexed: 01/23/2023]
Abstract
Numerous immunohistochemical markers that can assist in the diagnosis of epithelioid mesotheliomas, some of which have only recently been recognized, are currently available. Because the various types of carcinomas express these markers differently, their selection for inclusion in a diagnostic panel can vary according to the differential diagnosis. This article provides a critical review of all of the information that is presently available on those markers that are believed to have the greatest potential for assisting in distinguishing between epithelioid mesotheliomas and those carcinomas with which they are most likely to be confused. Information is also provided regarding the panels of immunohistochemical markers that are, at present, recommended in these differential diagnoses.
Collapse
Affiliation(s)
- Nelson G Ordóñez
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
| |
Collapse
|
26
|
Abstract
This paper reports on an unusual case of pleural epitheloid mesothelioma in a nine-month-old male, mixed breed dog. The dog was presented in-extremis and, on post mortem examination, multiple, exophytic, frequently pedunculated, yellowish-red, soft to firm masses ranging from 3 mm to 6 cm in diameter were diffusely distributed over, and attached to, the pericardial and parietal pleural surfaces. Microscopically, these masses consisted of round to partially polygonalshaped, anaplastic cells with minimal cytoplasm and hyperchromatic nuclei covering papillomatous projections or as part of more densely cellular masses. A supporting fibrovascular stroma and mitotic figures were also evident. Constituent tumour cells were labeled positively with antibodies against both vimentin and cytokeratin. In contrast, the same cells exhibited equivocal labeling with an antibody directed against calretinin antigen and did not label with antibodies against carcinoembryonic antigen (CEA) and milk fat globule-related antigen (MFGRA). Such tumours are rare in dogs, particularly in such a young animal.
Collapse
Affiliation(s)
- Sevil Atalay Vural
- Department of Pathology, Faculty of Veterinary Medicine, Ankara University, 06110 Diskapi/Ankara, Turkey.
| | | | | |
Collapse
|
27
|
Dong HP, Holth A, Berner A, Davidson B, Risberg B. Flow cytometric immunphenotyping of epithelial cancer cells in effusions—Technical considerations and pitfalls. CYTOMETRY PART B-CLINICAL CYTOMETRY 2007; 72:332-43. [PMID: 17226863 DOI: 10.1002/cyto.b.20172] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Data regarding the role of flow cytometry (FCM) in the characterization of malignant effusions are limited to date. In the present study, we optimized the conditions for FCM immunphenotyping of effusions using a four-color analysis and investigated aspects related to the advantages and limitations of this method in this setting. METHODS FCM analysis optimization for the study of epithelial cells was undertaken using five carcinoma cell lines, and subsequently applied to malignant pleural and peritoneal effusions using antibodies against epithelial and mesothelial markers (Ber-EP4 and EMA), CD138, and integrin subunits. FCM of frozen versus fresh specimens and the performance of FCM compared to immunhistochemistry were evaluated. RESULTS FCM optimization was achieved and applied to clinical specimens, with resulting detection of epithelial markers and adhesion molecules on cancer cells. Frozen clinical specimens and cell lines showed reduced CD138 expression compared to fresh specimens, with conservation of the remaining epitopes. FCM generally showed comparable performance to immunhistochemistry. CONCLUSIONS FCM is an effective method for characterization of cancer cells in clinical effusion specimens in both the diagnostic and research setting, and is comparable to immunhistochemistry in terms of sensitivity and specificity, with the additional advantage of providing quantitative data. The majority of epitopes are conserved in frozen cells, but a minority may be lost, suggesting that the thorough testing of each antibody in both conditions is mandatory.
Collapse
Affiliation(s)
- Hiep P Dong
- Pathology Clinic, Radiumhospitalet-Rikshospitalet Medical Center, University of Oslo, Montebello, N-0310 Oslo, Norway
| | | | | | | | | |
Collapse
|
28
|
Bhalla R, Siddiqui MT, Mandich D, Cartun RW, Fiel-Gan MD, Nassar A, Mandavilli SR. Diagnostic utility of D2-40 and podoplanin in effusion cell blocks. Diagn Cytopathol 2007; 35:342-7. [PMID: 17497664 DOI: 10.1002/dc.20633] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The distinction between malignant mesothelioma and adenocarcinoma is a diagnostic challenge in cytologic specimens of effusion fluids. As for today, no single antibody has demonstrated absolute sensitivity or specificity for Mesothelioma. D2-40 and podoplanin have recently been recognized to stain mesothelial cells. Our aim for this study was to evaluate the utility of these two markers as indicators of mesothelial cells using cell blocks by comparison with two other established mesothelial markers. A total of 40 cell blocks of effusion fluids including cases of epithelioid mesotheliomas, metastatic carcinomas and benign cases with reactive mesothelial cells were selected. A panel of immunostains including D2-40, podoplanin, CK5, and calretinin was performed. D2-40 and podoplanin were positive in 100% of mesothelioma cases in comparison to metastatic adenocarcinoma cases where the positivity was 0%. It is concluded that D2-40 and podoplanin are very useful markers for mesotheliomas. Since these markers are extremely helpful in differentiating epithelioid mesothelioma from metastatic adenocarcinoma, they shall be a valuable addition to the battery of markers used to differentiate the two entities.
Collapse
Affiliation(s)
- Ritu Bhalla
- Department of Pathology, Emory Univeristy Hospital, Atlanta, GA 30322, USA
| | | | | | | | | | | | | |
Collapse
|
29
|
Bassarova AV, Nesland JM, Davidson B. D2-40 is Not a Specific Marker for Cells of Mesothelial Origin in Serous Effusions. Am J Surg Pathol 2006; 30:878-82. [PMID: 16819331 DOI: 10.1097/01.pas.0000208280.29291.34] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The presence of effusion in a patient with a history of primary malignant tumor elsewhere in the body is generally accepted as a clinical manifestation of metastatic disease. Even in those cases, it is sometimes difficult to differentiate reactive mesothelial cells from carcinoma cells. Another challenging issue especially in the field of serous effusions is the differential diagnosis between malignant mesothelioma and metastatic adenocarcinoma. The aim of this study was to evaluate the potential use of the D2-40 antibody detecting the M2A oncofetal antigen in the diagnosis of malignant serous effusions. Two hundred and ninety effusion specimens (169 ovarian carcinomas, 44 breast carcinomas, 32 malignant mesotheliomas, 6 lung carcinomas, 8 reactive specimens, and 31 tumors of other origin) were assessed. Expression in reactive mesothelial cells was additionally assessed on 145 malignant effusions. Immunohistochemical analysis using the EnVision system was performed. M2A antigen was expressed in malignant mesotheliomas and reactive mesothelial cells in all specimens. Positive membranous staining was observed in 58% of ovarian carcinomas, 33% of lung carcinomas, and 30% of breast carcinomas. Pulmonary, breast, and nonovarian gynecologic tumors usually showed weak focal membranous staining, whereas the ovarian adenocarcinomas showed an expression pattern more similar to mesotheliomas. The results from the present study suggest low specificity for D2-40 as a mesothelial marker, especially in the context of differentiating mesothelial cells from ovarian carcinoma, and argue against its inclusion in the diagnostic panel of serous effusions.
Collapse
Affiliation(s)
- Assia V Bassarova
- Pathology Clinic, The National Hospital-The Norwegian Radium Hospital, University of Oslo, Montebello 0310 Oslo, Norway.
| | | | | |
Collapse
|
30
|
Pereira TC, Saad RS, Liu Y, Silverman JF. The diagnosis of malignancy in effusion cytology: a pattern recognition approach. Adv Anat Pathol 2006; 13:174-84. [PMID: 16858151 DOI: 10.1097/00125480-200607000-00004] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This review presents a pattern recognition approach for the diagnosis of malignant effusions. The cytomorphologic features of reactive mesothelial proliferation, mesothelioma and metastatic carcinoma are presented. In addition, the role of ancillary studies in challenging cases and the importance of integrating clinical findings are stressed. An algorithmic approach to the workup of serous effusions as well as pitfalls for false-positive diagnosis are discussed.
Collapse
Affiliation(s)
- Telma C Pereira
- Department of Pathology and Laboratory Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, and Drexel University College of Medicine, USA.
| | | | | | | |
Collapse
|
31
|
Bacci B, Morandi F, De Meo M, Marcato PS. Ten cases of feline mesothelioma: an immunohistochemical and ultrastructural study. J Comp Pathol 2006; 134:347-54. [PMID: 16712862 DOI: 10.1016/j.jcpa.2006.02.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2005] [Accepted: 02/07/2006] [Indexed: 11/21/2022]
Abstract
In the cat only 10 cases of mesothelioma, mainly of the peritoneum, have been previously reported. This paper describes a further 10 cases, eight pleural and two peritoneal, in males and females aged 1-17 years. Histologically, five tumours were epithelial, three fibrosarcomatous and two biphasic. Immunohistochemical markers used in human pathology for the identification of mesotheliomas include vimentin, cytokeratin (CK) AE1/AE3, HBME-1, CK 5/6, calretinin, thrombomodulin, carcinoembryonic antigen (CEA), CD15, E-cadherin and desmin. All 10 feline mesotheliomas were positive for vimentin and CK AE1/AE3, six were positive for HBME-1, two for CK5/6, three for CEA and four for E-cadherin. All were negative for desmin and calretinin. Antibodies to thrombomodulin and CD15 failed to cross-react with feline tissues. Electron microscopy, performed in four cases, revealed microvillar structures, desmosomes and intracytoplasmic lumina, confirming its value as a diagnostic tool. The study showed that mesothelial marker antibodies commonly used in human patients can be used for the diagnosis of feline mesothelioma, preferably as a panel of antibodies rather than only one.
Collapse
Affiliation(s)
- B Bacci
- Dipartimento di Sanità Pubblica Veterinaria e Patologia Animale, Alma Mater Studiorum Università di Bologna, Via Tolara di Sopra 50, Ozzano Emilia, 40064 Bologna, Italy
| | | | | | | |
Collapse
|
32
|
Fulgenzi G, Graciotti L, Faronato M, Soldovieri MV, Miceli F, Amoroso S, Annunziato L, Procopio A, Taglialatela M. Human neoplastic mesothelial cells express voltage-gated sodium channels involved in cell motility. Int J Biochem Cell Biol 2006; 38:1146-59. [PMID: 16458569 DOI: 10.1016/j.biocel.2005.12.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2005] [Revised: 11/26/2005] [Accepted: 12/08/2005] [Indexed: 02/07/2023]
Abstract
Given the pivotal role of ion channels in neoplastic transformation, the aim of the present study has been to assess possible differences in the expression patterns of voltage-gated monovalent cationic (Na(+) and K(+)) currents between normal and neoplastic mesothelial cells (NM, MPM, respectively), and to evaluate the role of specific ion channels in mesothelioma cells proliferation, apoptosis, and motility. To achieve this aim, membrane currents expressed in NM and MPM cells derived from surgically-removed human specimens were investigated by means of patch-clamp electrophysiology. NM cells were found to express three main classes of K(+) currents, which were defined as K(IR), maxiK(Ca), and K(V) currents on the basis of their biophysical and pharmacological properties. Each of these K(+) currents was absent in MPM cells; by contrast, MPM cells revealed the novel appearance of tetrodotoxin (TTX)-sensitive voltage-gated Na(+) currents undetected in normal mesothelial cells. Reverse transcriptase-polymerase chain reaction (RT-PCR) and real-time PCR analysis of MPM cells transcripts showed significant expression of the mRNAs encoding for Na(V)1.2, and Na(V)1.6, and Na(V)1.7 (and less so for Na(V)1.3, Na(V)1.4, and Na(V)1.5) main voltage-gated sodium channel (VGSC) alpha-subunit(s). Interestingly, blockade of VGSCs with TTX decreased mesothelioma cell migration in in vitro motility assays; on the other hand, TTX failed to interfere with cell viability, proliferation, and apoptosis progression triggered by UV exposure. In summary, the results of the present study suggest that VGSCs expression in MPM cells may favor the increased motility of the neoplastic cells, a phenotypic feature often associated with the malignant phenotype.
Collapse
Affiliation(s)
- Gianluca Fulgenzi
- Department of Molecular Pathology and Innovative Therapies, Polytechnic University of Marche, Via Ranieri, Ancona 60131, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Ordóñez NG. Value of immunohistochemistry in distinguishing peritoneal mesothelioma from serous carcinoma of the ovary and peritoneum: a review and update. Adv Anat Pathol 2006; 13:16-25. [PMID: 16462153 DOI: 10.1097/01.pap.0000201832.15591.1d] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
At present, a large number of immunohistochemical markers that can be used in the differential diagnosis between epithelioid peritoneal mesotheliomas and serous carcinomas are available. However, great differences of opinion exist regarding the individual value of some of these markers. This article provides a critical review of all of the information that is currently available on those markers that have the greatest potential for assisting in distinguishing between peritoneal mesotheliomas and serous carcinomas. The conclusion of this review indicates that the positive serous carcinoma markers, by and large, have a higher degree of sensitivity and specificity in assisting in discriminating between these malignancies than the positive mesothelioma markers. From a practical point of view, a combination of MOC-31 (or Ber-EP4), estrogen receptors, and calretinin immunostaining should allow a clear distinction to be made between epithelioid peritoneal mesotheliomas and serous carcinomas in most cases.
Collapse
Affiliation(s)
- Nelson G Ordóñez
- University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
| |
Collapse
|
34
|
Saad RS, Lindner JL, Lin X, Liu YL, Silverman JF. The diagnostic utility of D2-40 for malignant mesothelioma versus pulmonary carcinoma with pleural involvement. Diagn Cytopathol 2006; 34:801-6. [PMID: 17115439 DOI: 10.1002/dc.20556] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Differentiating malignant mesothelioma (MM) from pulmonary carcinoma in pleural fluid cytology can be challenging. Recent studies have suggested that D2-40, a novel lymphatic marker, may be a useful marker for mesothelial differentiation in surgical specimens. However, there are no available data regarding its utility in effusion cytology specimens. We investigated the utility of D2-40 in pleural fluid cytology in differentiating MM from pulmonary carcinomas. Twenty cases of pleural effusion smears of surgically confirmed MM with their corresponding cell blocks were retrieved from the database of the hospital computer system. We also included 10 cases of metastatic pulmonary adenocarcinoma (PA) and 10 cases metastatic pulmonary squamous cell carcinoma (PSCC) involving the pleural fluid. Cell blocks were formalin-fixed, paraffin embedded, and immunostained for TTF1, p63, calretinin, CK5/6, WT-1, and D2-40. Cases were scored as negative (<5% positivity) or positive (>5% moderate/strong positivity). The positive rates for TTF1, p63, calretinin, CK5/6, WT-1, and D2-40 were as follows: MM (0/20), (0/20), (17/20), (18/20), (19/20), (17/20), for PA (8/10), (0/10), (3/10), (0/10), (0/10), (0/10), and for PSCC (1/10), (10/10), (6/10), (10/10), (0/15), (0/10). The staining pattern for D2-40 was characterized by thick membranous staining. Diffuse cytoplasmic staining by D2-40 was seen in 2 cases of pulmonary carcinoma, counted as negative. Our study showed that in differentiating MM from PA, CK5/6, WT-1, and D2-40 have high specificity and sensitivity for MM. Although calretinin is a sensitive IHC marker for MM, it is not specific since it stained 30% of PA. Conversely, to differentiate between MM and PSCC, p63 and WT-1 are the best available markers. We recommend a panel of CK5/6, p63, D2-40, and WT-1 to differentiate MM from pulmonary carcinomas in effusion cytology specimens.
Collapse
Affiliation(s)
- Reda S Saad
- Department of Pathology, Drexel University College of Medicine, Allegheny General Hospital, 320 East North Avenue, Pittsburgh, PA 15212, USA.
| | | | | | | | | |
Collapse
|
35
|
Ordóñez NG. Value of estrogen and progesterone receptor immunostaining in distinguishing between peritoneal mesotheliomas and serous carcinomas. Hum Pathol 2005; 36:1163-7. [PMID: 16260268 DOI: 10.1016/j.humpath.2005.08.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Revised: 08/15/2005] [Accepted: 08/17/2005] [Indexed: 11/17/2022]
Abstract
The differential diagnosis between peritoneal mesotheliomas and serous carcinomas involving the peritoneum may be difficult, but it can be facilitated by the use of immunohistochemistry. To determine whether estrogen receptors (ER) or progesterone receptors (PR) may have any value as immunohistochemical markers for discriminating between these malignancies, 40 serous carcinomas of the ovary metastatic to the peritoneum, 7 primary peritoneal serous carcinomas, 30 epithelioid peritoneal malignant mesotheliomas, 5 well-differentiated papillary mesotheliomas, and 4 adenomatoid tumors were immunostained for ER and PR. Reactivity for ER was obtained in 35 (88%) of the metastatic serous carcinomas of the ovary and 6 (86%) of the primary peritoneal serous carcinomas, whereas positivity for PR was observed in 24 (60%) of the metastatic serous carcinomas and 4 (56%) of the primary peritoneal serous carcinomas. None of the mesotheliomas or adenomatoid tumors expressed ER or PR. It is concluded that, because of its high sensitivity for serous carcinomas, ER immunostaining could be very useful in distinguishing between serous carcinomas and peritoneal mesotheliomas. Immunostaining for PR, however, has little practical utility.
Collapse
Affiliation(s)
- Nelson G Ordóñez
- Department of Pathology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA.
| |
Collapse
|
36
|
Hoekstra AV, Riben MW, Frumovitz M, Liu J, Ramirez PT. Well-differentiated papillary mesothelioma of the peritoneum: A pathological analysis and review of the literature. Gynecol Oncol 2005; 98:161-7. [PMID: 15894368 DOI: 10.1016/j.ygyno.2005.03.031] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2004] [Revised: 03/08/2005] [Accepted: 03/14/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Well-differentiated papillary mesothelioma (WDPM) of the peritoneum is a rare subtype of peritoneal epithelioid mesothelioma which typically has low malignant potential. It most commonly occurs in young women lacking a history of asbestos exposure. Only 38 female patients with peritoneal WPDM have been reported in the literature, and no uniform treatment recommendation has been established. CASE REPORT A 74-year-old asymptomatic woman without significant past medical history underwent workup and subsequent surgery for an adnexal mass with a normal serum CA-125 level. Exploratory laparotomy identified an ovarian serous cystadenoma and an incidental multifocal peritoneal neoplasm with extensive calcifications. Histology and cytology confirmed WDPM with extensive, intimately associated mesothelial cystic inclusions and zonal calcifications with osseous metaplasia. Our patient did not receive adjuvant therapy and was without clinical or radiologic evidence of disease 12 months after diagnosis. CONCLUSION WDPM of the peritoneum in women is frequently asymptomatic and associated with an indolent course. Patient outcomes are usually favorable after tumor-debulking surgery without adjuvant therapy.
Collapse
Affiliation(s)
- Anna V Hoekstra
- Department of Obstetrics and Gynecology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA
| | | | | | | | | |
Collapse
|
37
|
Dejmek A, Hjerpe A. The combination of CEA, EMA, and BerEp4 and hyaluronan analysis specifically identifies 79% of all histologically verified mesotheliomas causing an effusion. Diagn Cytopathol 2005; 32:160-6. [PMID: 15690331 DOI: 10.1002/dc.20202] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A previously tested antibody panel identified three criteria of major importance for distinguishing between mesothelioma and adenocarcinoma (ACA): carcinoembryonic antigen (CEA), BerEp4, and epithelial membrane antigen (EMA) accentuated at the cell membrane. An extended panel, consisting of CEA, BerEp4, EMA, vimentin, mesothelioma antibody (HBME-1), thrombomodulin, Ca125, and sialyl-Tn was applied to effusions from 86 ACAs and 21 mesotheliomas. The specificities and sensitivities of the previously identified reactivity patterns were tested on the new material and the effect of the added antibodies was evaluated. Further, hyaluronan analysis was added as a parameter. The previously selected criteria remained fully predictive for mesothelioma and ACA, respectively, also in the extended material (in all, 139 ACAs and 57 mesotheliomas). With the addition of the hyaluronan value, 79% of the cases was identified with 100% specificity. Among the new antibodies sialyl-Tn seemed the most promising because it specifically identified ACAs not expressing CEA.
Collapse
Affiliation(s)
- Annika Dejmek
- Department of Pathology and Cytology, Malmö University Hospital, Lund University, Sweden.
| | | |
Collapse
|
38
|
Reggeti F, Brisson B, Ruotsalo K, Southorn E, Bienzle D. Invasive epithelial mesothelioma in a dog. Vet Pathol 2005; 42:77-81. [PMID: 15657276 DOI: 10.1354/vp.42-1-77] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This report describes the gross, microscopic, and immunohistochemical features of an invasive epithelial mesothelioma in an 11-year-old neutered male Golden Retriever. The tumor involved the pericardium, pleura, mediastinum, and peritoneum and invaded into submesothelial tissues. Neoplastic cells in the thoracic fluid showed prominent features of malignancy in a background of mixed inflammatory cells and scattered erythrocytes. Histologically, the tumor consisted of nests of epithelioid cells with frequent mitotic figures and multinucleation that infiltrated submesothelial tissues. Neoplastic cells strongly coexpressed vimentin and cytokeratin intermediate filaments, which assisted in the differentiation from other epithelial tumors of nonmesothelial origin.
Collapse
Affiliation(s)
- F Reggeti
- Department of Pathobiology, University of Guelph, Guelph, Ontario N1G 2W1, Canada.
| | | | | | | | | |
Collapse
|
39
|
Stewart DJ, Edwards JG, Smythe WR, Waller DA, O'Byrne KJ. Malignant pleural mesothelioma--an update. INTERNATIONAL JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HEALTH 2004; 10:26-39. [PMID: 15070023 DOI: 10.1179/oeh.2004.10.1.26] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Exposure to asbestos is the most frequent, but not exclusive, cause of malignant mesothelioma. Clinical features include dyspnea, cough, nonspecific chest pain, weight loss and night sweats. Diagnosis may be complicated by histologic difficulties. Thoracoscopic techniques are proving beneficial, but no one method of imaging has proven superior, and disease staging is inconsistent. Conventional treatments such as chemotherapy, surgery, and radiotherapy have had variable impacts, although chemotherapy is useful in palliation and can improve both survival and quality of life. There is hope for new antimetabolite agents. The role of radical surgery is yet to be evaluated in a large trial. New radiotherapeutic techniques to improve local control are promising. Multimodality treatments appear to be the most successful for management of potentially resectable disease. It is likely that biological markers will improve accuracy in staging and prognosis. With new treatments based on better understanding of the biology of the disease, there is cautious optimism for the future for patients with malignant pleural mesothelioma.
Collapse
Affiliation(s)
- Duncan J Stewart
- University Department of Oncology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | | | | | | | | |
Collapse
|
40
|
Soto Parra H, Zucali PA, Colombo P, Balzarini L, Santoro A. Uncommon Manifestations of Common Malignancies. J Clin Oncol 2004; 22:3191-2. [PMID: 15284272 DOI: 10.1200/jco.2004.09.130] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hector Soto Parra
- Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Rozzano-Milan, Italy
| | | | | | | | | |
Collapse
|
41
|
Asioli S, Dal Piaz G, Damiani S. Localised pleural malignant mesothelioma. Report of two cases simulating pulmonary carcinoma and review of the literature. Virchows Arch 2004; 445:206-9. [PMID: 15232743 DOI: 10.1007/s00428-004-1062-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIMS To describe two cases of localised malignant mesothelioma with a predominantly intrapulmonary growth which led to a pre-operative diagnosis of pulmonary carcinoma. MATERIALS AND METHODS Both cases presented as intrapulmonary masses, while at computed tomography scan the pleura appeared not significantly thickened. In one patient, the main bronchus was diffusely infiltrated by the tumour. In both cases, a preoperative biopsy showed a proliferation of large cells leading to a diagnosis of non-small-cell lung carcinoma. Histological examination of the surgical specimens revealed features consistent with epithelioid mesothelioma with deciduoid features in one case and with biphasic mesothelioma in the other. Both cases were diffusely positive with anti-calretinin antibody, while anti-TTF1, anti-surfactant and anti-CEA antisera were negative. CONCLUSIONS Localised malignant mesotheliomas are unusual and predominantly intrapulmonary growth is rare. Pathologists should be aware of this possibility to avoid misdiagnosis, particularly in small biopsies.
Collapse
Affiliation(s)
- Sofia Asioli
- Section of Anatomic Pathology M. Malpighi Department of Oncologic Sciences, University of Bologna, Bellaria Hospital, Via Altura 3, 40139 Bologna, Italy
| | | | | |
Collapse
|
42
|
Abstract
BACKGROUND Cutaneous involvement by mesothelioma represents a rare occurrence from an uncommon neoplasm. Most cases have resulted from local extension of an underlying body cavity mesothelioma or from surgical site contamination. We could only find six previously reported cases of distant cutaneous metastases of mesothelioma. METHODS We describe a case of metastatic mesothelioma involving multiple skin sites and the lip in a 64-year-old man with an underlying primary pleural mesothelioma. RESULTS A 64-year-old man presented with a lip lesion clinically diagnosed as keratoacanthoma vs. squamous cell carcinoma. Evaluation of the lip biopsy revealed tubulo-glandular and acinar-like arrangements of plump epithelioid cells with a hobnailed appearance, vesicular nuclei, and prominent nucleoli. The initial impression of metastatic carcinoma was revised to probable mesothelioma upon discovery of a previous history of pleural mesothelioma. Positive immunohistochemical stains for anti-cytokeratin, anti-calretinin, and HBME-1 and negative stains for anti-CEA, Leu-M1, B72.3, and Ber-Ep4 confirmed the diagnosis. CONCLUSION We report a rare example of multiple cutaneous metastases of mesothelioma. We also demonstrate the usefulness of relatively new and specific immunomarkers for mesothelioma vs. adenocarcinoma. Metastatic mesothelioma to the skin or lip is a very rare occurrence but should be considered in the differential diagnosis of malignant epithelioid neoplasms.
Collapse
Affiliation(s)
- David S Cassarino
- Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
| | | | | |
Collapse
|
43
|
Ordóñez NG. The diagnostic utility of immunohistochemistry in distinguishing between mesothelioma and renal cell carcinoma: A comparative study. Hum Pathol 2004; 35:697-710. [PMID: 15188136 DOI: 10.1016/j.humpath.2003.11.013] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Both mesotheliomas and renal cell carcinomas can present a wide variety of morphological patterns. Because of this, renal cell carcinomas that metastasize to the pleura and lung may be confused with mesotheliomas. The aim of the present study was to compare the value of the various immunohistochemical markers currently available for the diagnosis of mesothelioma and renal cell carcinoma. A total of 48 mesotheliomas (40 epithelioid, 8 sarcomatoid), and 48 renal cell carcinomas (24 conventional, 12 chromophobe, 8 papillary, 4 sarcomatoid) were investigated for the expression of the following markers: calretinin, mesothelin, cytokeratin 5/6, WT1, thrombomodulin (TM), N-cadherin, CD15 (leu-M1), MOC-31, Ber-EP4, BG-8 (Lewis(y)), CD10, renal cell carcinoma marker (RCC Ma), carcinoembryonic antigen (CEA), and B72.3. All (100%) of the epithelioid mesotheliomas reacted for calretinin, mesothelin, and cytokeratin 5/6; 93% for WT1; 78% for TM; 75% for N-cadherin, 48% for CD10, 15% for Ber-EP4, 8% for MOC-31, 8% for RCC Ma, 5% for BG-8, and none for CEA, B72.3, or CD15. Of the sarcomatoid mesotheliomas, 88% expressed calretinin, 75% N-cadherin, 38% CD10, and 13% each expressed cytokeratin 5/6, WT1, and TM. All of the remaining markers were negative. Among the RCCs, 81% expressed CD10, 75% N-cadherin, 63% CD15, 50% RCC Ma, 50% MOC-31, 42% Ber-EP4, 8% BG-8, and 2% TM. The remaining markers were negative. The results indicate that calretinin, mesothelin, and cytokeratin 5/6 are the best positive mesothelioma markers for differentiating epithelioid mesotheliomas from renal cell carcinomas. The best discriminators among the antibodies considered negative markers for mesothelioma are CD15, MOC-31, and RCC Ma. An accurate differential diagnosis can be reached with the use of any 2 of the 3 recommended positive markers, which should be selected based on availability and on which ones yield the best staining results in a given laboratory. One of the recommended negative markers may be added to the panel if deemed necessary. If confirmation of renal origin is needed, RCC Ma could be useful. Calretinin is the only marker that appears to have any utility in distinguishing between sarcomatoid mesotheliomas and sarcomatoid renal cell carcinomas.
Collapse
Affiliation(s)
- Nelson G Ordóñez
- The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
| |
Collapse
|
44
|
Abstract
Malignant mesothelioma (MM) is a very aggressive tumor that is caused by environmental, biologic, and genetic factors. Among these factors, asbestos plays a major role. The link between asbestos and MM has been firmly established through numerous epidemiologic studies conducted during the past 40 years. However, the causal role of chrysotile asbestos compared with crocidolite asbestos in MM, the method of correctly establishing asbestos exposure, the amount of asbestos necessary to cause MM, and the mechanisms of asbestos tumorigenicity are still being debated. Along with asbestos, Simian virus 40 (SV40), a DNA monkey virus, has recently been implicated in the etiology of MM. Simian virus 40 large T antigen (Tag) and small t antigen (tag) are largely responsible for the carcinogenicity of the virus, and it is possible that SV40 and asbestos are cocarcinogens. Finally, a genetic factor identified in 3 villages in Cappadocia, Turkey, where 50% of individuals die of MM, appears to be the cause of a high incidence of the disease. In these villages, genetic predisposition for MM works together with erionite, a nonasbestos fiber found in the stones used in construction of houses. The diagnosis of MM is made histologically and confirmed through electron microscopy and immunohistochemistry. Currently available therapies for MM prolong survival by a few months at most. An SV40 vaccine is being developed for human use and it is hoped that it may reduce the incidence of MM in asbestos workers.
Collapse
Affiliation(s)
- Michele Carbone
- Cancer Immunology Program, Department of Pathology, Cardinal Bernardin Cancer Center, Loyola University Chicago, Maywood, IL 60153, USA.
| | | |
Collapse
|
45
|
Abstract
Distinguishing between epithelioid mesothelioma and pulmonary adenocarcinoma involving the pleura can be difficult on routine histological preparations. This differential diagnosis can be greatly facilitated by using immunohistochemical markers. E-cadherin and N-cadherin are among the newly described markers that have been proposed as potentially useful in the diagnosis of mesothelioma. E-cadherin and N-cadherin are members of the cadherin family of calcium-dependent cell adhesion molecules that play an important role in the embryogenic development and maintenance of normal tissue. Although several investigations have indicated that immunostaining for these markers can be useful in discriminating between mesotheliomas and adenocarcinomas, others have not confirmed this observation. In an attempt to resolve this controversy, the present study investigated 31 epithelioid mesotheliomas and 29 pulmonary adenocarcinomas for E-cadherin and N-cadherin expression using the 5H9, HECD-1, and clone 36 anti-E-cadherin antibodies, and the 3B9 and clone 32 anti-N-cadherin antibodies. Among the mesotheliomas, 68% reacted with the clone 36, 52% reacted with the HECD-1, and 19% reacted with the 5H9 anti-E-cadherin antibodies, and 74% reacted with the 3B9 and 71% reacted with the clone 32 anti-N-cadherin antibodies. Of the adenocarcinomas, 93% stained with the clone 36, 90% reacted with the HECD-1, and 90% reacted with the 5H9 anti-E-cadherin antibodies, 45% reacted with the clone 32 and 34% reacted with the 3B9 anti-N-cadherin antibodies. Based on the frequent strong reactivity with adenocarcinomas but not with mesotheliomas, it is concluded that only the 5H9 anti-E-cadherin antibody may have some utility in discriminating between epithelioid pleural mesotheliomas and pulmonary adenocarcinomas. The causes of the disparate results reported in the literature on the value of E-cadherin and N-cadherin immunostaining in distinguishing between mesotheliomas and pulmonary adenocarcinomas are unclear, but a significant factor appears to be differences in the reactivity of the antibodies used.
Collapse
Affiliation(s)
- Nelson G Ordóñez
- The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| |
Collapse
|
46
|
Geninet C, Bernex F, Rakotovao F, Crespeau FL, Parodi AL, Fontaine JJ. Sclerosing Peritoneal Mesothelioma in a Dog - A Case Report. ACTA ACUST UNITED AC 2003; 50:402-5. [PMID: 14633218 DOI: 10.1046/j.0931-184x.2003.00566.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A case of peritoneal sclerosing mesothelioma in a 3-year-old German shepherd dog is reported. The dog presented a severe abdominal distension. Cytological examination of the peritoneal fluid revealed anaplastic epithelioid cells. Necropsy findings revealed an irregular-shaped mass attached to the pancreas and stomach with numerous nodules covering the intestinal and urinary bladder serosa. The diagnosis was made by histology and immunohistochemistry, with cytokeratin, vimentin and calretinin antibodies. Differential diagnosis with chronic peritonitis and spreading of abdominal primary carcinoma is discussed.
Collapse
Affiliation(s)
- C Geninet
- UP d'Histologie et d'Anatomie Pathologique, Ecole Nationale Vétérinaire d'Alfort, 7 Avenue du Général de Gaulle, 94704 Maisons-Alfort Cedex, France.
| | | | | | | | | | | |
Collapse
|
47
|
Ordóñez NG. The immunohistochemical diagnosis of mesothelioma: a comparative study of epithelioid mesothelioma and lung adenocarcinoma. Am J Surg Pathol 2003; 27:1031-51. [PMID: 12883236 DOI: 10.1097/00000478-200308000-00001] [Citation(s) in RCA: 276] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A large number of immunohistochemical markers that can facilitate the distinction between epithelioid pleural mesotheliomas and pulmonary peripheral adenocarcinomas have recently become available. The aim of this study is to compare the value of these new markers with others that are already commonly used for this purpose and to determine which are, at present, the best for discriminating between these malignancies. Sixty epithelioid mesotheliomas and 50 lung adenocarcinomas were investigated for expression of the following markers: calretinin, cytokeratin 5/6, WT1, thrombomodulin, mesothelin, CD44S, HBME-1, N-cadherin, E-cadherin, MOC-31, thyroid transcription factor-1 (TTF-1), BG-8 (Lewisy), carcinoembryonic antigen (CEA), Ber-EP4, B72.3 (TAG-72), leu-M1 (CD15), CA19-9, epithelial membrane antigen (EMA), and vimentin. All (100%) of the mesotheliomas reacted for calretinin, cytokeratin 5/6, and mesothelin, 93% for WT1, 93% for EMA, 85% for HBME-1, 77% for thrombomodulin; 73% for CD44S, 73% for N-cadherin, 55% for vimentin, 40% for E-cadherin, 18% for Ber-EP4, 8% for MOC-31, 7% for BG-8, and none for CEA, B72.3, leu-M1, TTF-1, or CA19-9. Of the adenocarcinomas, 100% were positive for MOC-31, Ber-EP4, and EMA, 96% for BG-8, 88% for CEA, 88% for E-cadherin, 84% for B72.3, 74% for TTF-1, 72% for leu-M1, 68% for HBME-1, 48% for CD44S, 48% for CA19-9, 38% for mesothelin, 38% for vimentin, 30% for N-cadherin, 14% for thrombomodulin, 8% for calretinin, 2% for cytokeratin 5/6, and none for WT1. After analyzing the results, it is concluded that calretinin, cytokeratin 5/6, and WT1 are the best positive markers for differentiating epithelioid malignant mesothelioma from pulmonary adenocarcinoma. The best discriminators among the antibodies considered to be negative markers for mesothelioma are CEA, MOC-31, Ber-EP4, BG-8, and B72.3. A panel of four markers (two positive and two negative) selected based upon availability and which ones yield good staining results in a given laboratory is recommended. Because of their specificity and sensitivity for mesotheliomas, the best combination appears to be calretinin and cytokeratin 5/6 (or WT1) for the positive markers and CEA and MOC-31 (or B72.3, Ber-EP4, or BG-8) for the negative markers. An extensive and detailed review of the literature is also provided.
Collapse
|