A case of malignant mesothelioma pleural effusion with MOC-31, BerEP4, and calretinin expression

Our plain-English summary of A case of malignant mesothelioma pleural effusion with MOC-31, BerEP4, and calretinin expression, by P. Zhao (Diagnostic Cytopathology, 2019).

The study

• Author: P. Zhao
• Journal: Diagnostic Cytopathology
• Published: 2019;47(12):1321-1323
• Type of article: Case report, Letter
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Publisher

In plain English

This letter to the editor described one patient, an 80-year-old man with cough, left-sided chest pain and shortness of breath. His chest scan showed a large left pleural effusion, a build-up of fluid around the lung. The letter did not mention asbestos exposure. Cells in the drained fluid stained positive for MOC-31, BerEP4, calretinin and CK7, and a diagnosis of metastatic adenocarcinoma was first made based on the MOC-31 and BerEP4 results. Later scans were most consistent with mesothelioma. A needle biopsy showed sarcomatoid tumor cells, which were first diagnosed as poorly differentiated carcinoma with sarcomatoid features. A national academic institution then found the cells focally positive for D2-40 and diagnosed sarcomatoid mesothelioma. The author suggested the tumor may have had both epithelioid and sarcomatoid parts. The author concluded that knowing a small subset of malignant mesotheliomas express MOC-31 and BerEP4 can prevent misdiagnosis as adenocarcinoma. The author recommended using panels of markers together with clinical and imaging findings. Claudin-4 staining, which the author said might have helped, was not available in the author's laboratory.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (letter to the editor)
• Who was studied: One 80-year-old man with gastroesophageal reflux disease and hypertension who had a persistent cough for a month, left-sided chest pain and shortness of breath; the author is from the Department of Pathology, Washington Adventist Hospital, Takoma Park, Maryland
• Main results:
  • Malignant cells in the pleural fluid cell block were positive for MOC-31, BerEP4, calretinin (mostly nuclear staining) and CK7
  • A diagnosis of metastatic adenocarcinoma was first made based on the MOC-31 and BerEP4 results
  • Later CT and PET imaging showed left pleural thickening and masses, with no lymph node or other metastasis, and these findings were most consistent with mesothelioma
  • A CT-guided needle biopsy showed sarcomatoid malignant cells; because all mesothelial markers tested were negative, a diagnosis of poorly differentiated carcinoma with sarcomatoid features was made
  • At a national academic institution, tumor cells were positive for AE1/AE3 and focally for D2-40, negative for calretinin, WT1, CK5/6 and mesothelin, with retained BAP1 expression; sarcomatoid mesothelioma was diagnosed
  • The author suggested the tumor may have had both an epithelioid component (seen in the pleural fluid) and a sarcomatoid component (seen in the needle biopsy)
• The authors' conclusion: The author concluded that awareness that a small subset of malignant mesotheliomas express MOC-31 and BerEP4 can prevent misdiagnosis as adenocarcinoma, that no marker definitively excludes malignant mesothelioma, and that panels of markers along with clinical and radiologic correlation should be used
• Limitations the authors state:
  • Claudin-4 antibodies, which the author said may have helped exclude adenocarcinoma, were not available in the author's laboratory

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Pleural Effusion, MOC-31, Calretinin.

Related studies

• The diagnostic utility of D2-40, calretinin, CK5/6, desmin and MOC-31 in the differentiation of mesothelioma from adenocarcinoma in pleural effusion cytology — T.S. Hyun, M. Barnes, et al. (2012)
• The importance of EZH2 and MOC-31 expression in the differential diagnosis of benign and malignant effusions — C. Sadullahoglu, D. Nart, et al. (2017)
• IMP3/L523S, a novel immunocytochemical marker that distinguishes benign and malignant cells: the expression profiles of IMP3/L523S in effusion cytology — K. Ikeda, G. Tate, et al. (2010)
• Calretinin. A selective marker of normal and neoplastic mesothelial cells in serous effusions — M.C. Barberis, M. Faleri, et al. (1997)
• Calretinin and other mesothelioma markers in synovial sarcoma: analysis of antigenic similarities and differences with malignant mesothelioma — M. Miettinen, J. Limon, et al. (2001)
• Immunocytochemical utility of claudin-4 versus those of Ber-EP4 and MOC-31 in effusion cytology — T. Oda, S. Ogata, et al. (2016)

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