Application of markers in the diagnosis of soft tissue tumours

Our plain-English summary of Application of markers in the diagnosis of soft tissue tumours, by P.J. Roholl, A.S. De Jong, F.C. Ramaekers (Histopathology, 1985).

The study

• Authors: P.J. Roholl, A.S. De Jong, F.C. Ramaekers
• Journal: Histopathology
• Published: 1985;9(10):1019-35
• Cited by: 102 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

In this review we describe the application of markers which are useful for the diagnosis of soft tissue tumours in paraffin sections. Detection of intermediate filament proteins appears to be most useful for first screening of these neoplasms because all, except neuroblastomas, express vimentin; cytokeratin is expressed in synovial sarcomas, epithelioid sarcomas and mesotheliomas; desmin in myogenic tumours and glial fibrillary acidic protein in astrocytomas and gliomas. Tissue-specific markers are: factor VIII--related antigen-endothelial cells; myoglobulin and skeletal muscle myosin--skeletal muscle cells; neuron specific enolase--neurons and cells of the APUD systems; and leukocyte-associated antigen--leukocytes. Markers which are present in a variety of cell types and therefore do not serve as tissue-specific markers are; S-100 proteins, alpha-1-antichymotrypsin, creatine kinase M and actin. The S-100 antigens have been detected in melanomas, granular cell tumours, chondrosarcomas and in some schwannomas and liposarcomas. Alpha-1-antichymotrypsin has been found in fibrohistiocytic and 'true' histiocytic tumours and creatine kinase M and actin in myogenic tumours. No specific markers have, as yet, been described for fibrosarcomas, Ewing's sarcomas and hemangiopericytomas.

In plain English

This 1985 article was a review, not a new study of patients. The authors described laboratory staining markers (immunohistochemistry) that help pathologists tell different kinds of soft tissue tumours apart, mainly in routinely processed paraffin sections. They also set out a step-by-step scheme for using these markers. The article did not study asbestos or any other exposure. Drawing on published studies and their own experience, the authors reported that most sarcomas examined so far had stained for vimentin. Malignant mesotheliomas stained for cytokeratin, which the authors described as helpful in separating sarcomatoid mesotheliomas from fibrosarcomas. They noted that the spindle cell part of mesotheliomas may show both cytokeratin and vimentin, a combination also reported in other tumours. Other markers were described for muscle, blood vessel, nerve and white blood cell tumours. The authors concluded that not all of the markers described so far are of value in diagnosis. They cautioned that absence of staining can result from fixation artefacts, and that no specific markers had yet been recognised for malignant fibrous histiocytomas and liposarcomas.

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: Review of published work on immunohistochemical markers for diagnosing soft tissue tumours, including the authors' own experience and a proposed stepwise scheme (flow diagram) for using the markers
• Who was studied: No new patient group. The review covered published findings on soft tissue tumours of many types (sarcomas, mesotheliomas, lymphomas, neuroblastomas, nerve sheath and vascular tumours, and others).
• Exposure: No exposure was studied. The article concerns diagnostic staining markers and does not discuss asbestos.
• Main results:
  • The authors reported that most sarcomas examined so far had been positive for vimentin in paraffin sections.
  • Malignant mesotheliomas showed a positive reaction for cytokeratin, as reported in the cited studies.
  • The authors stated that telling sarcomatoid mesotheliomas from fibrosarcomas is difficult, and that detecting cytokeratin helps.
  • The spindle cell component of mesotheliomas may show both cytokeratin and vimentin.
  • The authors cautioned that the combination of cytokeratin and vimentin occurs in certain tumours and should be kept in mind when interpreting stains of tumours of unknown origin.
  • A cited study reported that mesothelial cells produce collagen types I and III in a different ratio from fibroblasts. The authors suggested this might be an additional aid in diagnosis.
  • Lymphomas can be distinguished from other mesenchymal tumours by the presence of common leukocyte antigen.
  • In the authors' opinion, a negative reaction with all intermediate filament antibodies, at least in frozen sections, strongly indicates neuroblastoma.
  • Only myoglobin, skeletal muscle myosin and skeletal muscle actin were found to be specific markers of cross-striated muscle differentiation in tumours.
  • No specific markers had been described for leiomyosarcoma.
  • No specific markers had yet been described for fibrosarcomas, Ewing's sarcomas and hemangiopericytomas.
• The authors' conclusion: The authors concluded that not all markers described so far are of value in diagnosis. They added that specific markers or a characteristic pattern of markers had not yet been recognised for malignant fibrous histiocytomas and liposarcomas, and that more sophisticated markers are needed.
• Limitations the authors state:
  • Absence of staining can be caused by fixation artefacts or by reduced expression of the marker, so a negative result does not rule out a tumour type.
  • In the authors' opinion, the distribution patterns of some markers (such as S-100) in soft tissue tumours had not yet been completely investigated.
  • Large numbers of macrophages within tumours may themselves express some of the markers, so these non-malignant cells must be excluded from evaluation.

Topics

Medical terms in this study, explained in our Lexicon: Neoplasm, Synovial Sarcoma, Epithelioid, Sarcoma, Mesothelioma, Desmin, S-100.

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