C-myc expression in exfoliated cells in serous effusions

Markers for metastatic adenocarcinoma in serous effusion specimens

A variety of stains have been proposed as useful adjuncts to the morphologic diagnosis of serous effusion specimens. This study evaluates the sensitivity and specificity of nine stains for the detection of metastatic adenocarcinoma in effusions. Mucin cytochemistry with the Periodic acid-Schiff reaction after diastase digestion (PASd) and the mucicarmine method, as well as immunochemical staining for five glycoprotein antigens, was undertaken on 153 effusion specimens with histological and/or clinically confirmed diagnoses. Immunochemical stains included three antibodies to CEA (Dako polyclonal, 4E7 and A5B7) and antibodies to HEA (Ber-EP4), TAG 72 (B72.3), CD15 (LeuM1) and Epithelial membrane antigen (EMA) were evaluated. The sensitivity of the stains for adenocarcinoma (102 cases) was: PASd 37%; mucicarmine 24%; polyclonal anti-CEA 69%; 4E7 52%; A5B7 21%; EMA 91%; B72.3 44%; Ber-EP4 32%; LeuM1 24%. With the exception of EMA, none of the stains reacted with any cases of benign mesothelial cells (11 cases), reactive mesothelial cells (34 cases), or with six cases of mesothelioma. However, EMA staining was present in two cases (6%) of reactive mesothelial cells and all cases of mesothelioma. The optimal combination of stains for use in a panel was polyclonal anti-CEA/B72.3/PASd. Combined results from these three stains yielded a sensitivity of 83% for adenocarcinoma with no false positive results. It is concluded that special staining may provide valuable information to assist in the classification of difficult effusion cases.

C-erbB-2 oncoprotein immunostaining in serous effusions

The product of c-erbB-2 gene is detected in a proportion of carcinomas from various sites and is generally associated with a high degree of malignancy. A series of 58 effusions containing malignant cells and 16 cytologically negative serous effusions was assessed by immunocytochemical methods for c-erbB-2 expression using the monoclonal antibody NCL-B11, which recognizes the internal domain of the c-erbB-2 oncoprotein. Both alcohol-fixed smears and cell blocks from formalin-fixed specimens were used. A crisp, clear cut membrane-associated positive staining was evident in 51% (30/58) malignant effusions and was restricted to metastatic adenocarcinomas. Breast and ovarian cancers showed the highest incidence of positivity. Mesotheliomas as well as non-neoplastic effusions were consistently negative. Paraffin blocks from formalin-fixed cells displayed a weak immunoreactivity when compared with their alcohol-fixed counterparts. The study shows that the c-erbB-2 oncoprotein can be easily identified in standard cytological smears: it can be of assistance in differentiating adenocarcinomas from mesotheliomas, and in selected cases it can provide a further prognostic indicator, replacing tissue immunohistochemistry.