A comparative immunohistochemical study of malignant mesothelioma and renal cell carcinoma: the diagnostic utility of Leu-M1, Ber EP4, Tamm-Horsfall protein and thrombomodulin

Our plain-English summary of A comparative immunohistochemical study of malignant mesothelioma and renal cell carcinoma: the diagnostic utility of Leu-M1, Ber EP4, Tamm-Horsfall protein and thrombomodulin, by R.L. Attanoos, H. Goddard, N.D. Thomas, et al (Histopathology, 1995).

The study

• Authors: R.L. Attanoos, H. Goddard, N.D. Thomas, B. Jasani, A.R. Gibbs
• Journal: Histopathology
• Published: 1995;27(4):361-6
• Cited by: 26 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Metastatic renal cell carcinoma has occasionally been reported to mimic malignant pleural mesothelioma. Morphologically, histochemically and immunohistochemically, similarities in the two tumours exist making their differentiation difficult, particularly in biopsy specimens. The aim of this study was to make a comparative immunohistochemical analysis of the two tumours by use of a panel of four antibodies (Leu M1; Ber EP4; thrombomodulin and Tamm-Horsfall protein). Their suitability in differentiating between the two tumours was assessed. We examined 20 cases of renal cell carcinoma and 20 cases of malignant pleural mesothelioma. On immunostaining with Leu M1, 14 of 20 renal cell carcinomas were positive, yielding 70% sensitivity and 95% specificity and one of 20 mesothelioma. In comparison, Ber EP4 antibody stained only seven of 20 of the renal cell carcinomas. In addition, it was noted that four tubulo-papillary pattern renal cell carcinomas stained positively with both anti-Leu M1 antibody and Ber EP4 antibody. Thrombomodulin immunostaining was present in 11 of 20 mesotheliomas (55% sensitivity and demonstrated 95% specificity) and one of 20 renal cell carcinomas. For epithelial mesotheliomas only, thrombomodulin staining was identified in 10 of 14 cases. In the differentiation of renal cell carcinoma from epithelial mesothelioma we recommend the use of Leu M1 and thrombomodulin as diagnostically useful markers. None of the antibodies used in this study was effective in distinguishing sarcomatoid renal cell carcinoma from sarcomatous mesothelioma. Tamm-Horsfall protein showed little diagnostic utility in differentiating the two tumours.

In plain English

This laboratory study compared malignant pleural mesothelioma with renal cell carcinoma (kidney cancer), two tumours that can look alike under the microscope. The authors noted that telling them apart matters for prognosis and for asbestos-related compensation claims. They stained archived tissue from 20 renal cell carcinomas and 20 mesotheliomas, from hospitals in Cardiff and Penarth, UK, with four antibodies. Leu M1 stained 14 of 20 renal cell carcinomas and one of 20 mesotheliomas. Ber EP4 stained seven of 20 renal cell carcinomas. Thrombomodulin stained 11 of 20 mesotheliomas and one of 20 renal cell carcinomas. Tamm-Horsfall protein stained none of the renal cell carcinomas and 10% of the mesotheliomas. The authors concluded that, in the correct clinical setting, thrombomodulin staining together with negative Leu M1 and Ber EP4 strongly favours epithelial mesothelioma, but that negative thrombomodulin staining is unhelpful. They also concluded that none of the antibodies distinguished sarcomatous mesothelioma from sarcomatoid renal cell carcinoma. The study did not measure anyone's asbestos exposure.

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: Comparative immunohistochemical (tissue-staining) study of archived tumour samples, assessing diagnostic markers
• Who was studied: Paraffin-embedded tumour blocks from 20 cases of renal cell carcinoma (clear cell, tubulopapillary, oxyphilic, sarcomatoid) and 20 cases of mesothelioma (7 epithelial, 7 mixed, 6 sarcomatous), taken from the files of University Hospital of Wales, Cardiff and Llandough Hospital, Penarth, UK. Dates of the cases are not given.
• Exposure: No asbestos exposure was studied. The study tested staining with four antibodies: Leu M1, Ber EP4, thrombomodulin and Tamm-Horsfall protein.
• Main results:
  • Leu M1 was positive in 14 of 20 renal cell carcinomas and 1 of 20 mesotheliomas (70% sensitivity, 95% specificity for renal cell carcinoma)
  • Ber EP4 stained 7 of 20 renal cell carcinomas
  • All four tubulopapillary renal cell carcinomas stained strongly and diffusely with both Leu M1 and Ber EP4
  • Thrombomodulin was positive in 11 of 20 mesotheliomas (55% sensitivity, 95% specificity) and in 1 of 20 renal cell carcinomas
  • Among mesotheliomas, thrombomodulin stained the epithelial component strongly in 5 of 7 (71%) pure epithelial and 5 of 7 (71%) mixed mesotheliomas
  • The one thrombomodulin-positive renal cell carcinoma was of the sarcomatoid pattern
  • For sarcomatous mesothelioma compared with sarcomatoid renal cell carcinoma, thrombomodulin stained 1 of 6 (17%) in the former group and 1 of 5 (20%) in the latter group (as reported in the discussion)
  • Tamm-Horsfall protein was negative in all 20 renal cell carcinomas
  • Tamm-Horsfall protein staining was seen in 10% of the mesotheliomas
  • A microwave pre-treatment method did not increase thrombomodulin staining
• The authors' conclusion: The authors concluded that, in the correct clinical setting, thrombomodulin positivity combined with Leu M1 and Ber EP4 negativity strongly favours epithelial mesothelioma over metastatic renal cell carcinoma. They also concluded that negative thrombomodulin staining is unhelpful because of 45% false negative cases, that the panel did not help distinguish sarcomatous mesothelioma from sarcomatoid renal cell carcinoma, and that Tamm-Horsfall protein was of little utility.
• Limitations the authors state:
  • The authors noted a low case number, in relation to the finding in the four tubulopapillary renal cell carcinomas

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, Carcinoma, Pleural Mesothelioma, Biopsy, Mesothelioma, Tubulopapillary, Sarcomatoid.

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