CD24 is highly useful in differentiating high-grade serous carcinoma from benign and malignant mesothelial cells

Our plain-English summary of CD24 is highly useful in differentiating high-grade serous carcinoma from benign and malignant mesothelial cells, by B. Davidson (Human Pathology, 2016).

The study

• Author: B. Davidson
• Journal: Human Pathology
• Published: 2016;58:123-127
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

CD24 was previously shown to be overexpressed in high-grade serous carcinoma (HGSC) effusions compared to malignant mesothelioma (MM) in gene expression array analysis. The present study validated this observation in a large series consisting of both effusions and surgical specimens. Effusions (n = 206; 100 HGSC, 16 ovarian carcinomas of other histological types, 54 breast carcinomas, 36 MM) and surgical specimens (n = 182; 117 ovarian carcinomas, 65 MM) were analyzed for CD24 expression using immunohistochemistry. CD24 was expressed in 105/116 (91%) ovarian carcinoma and 16/54 (30%) breast carcinoma effusions, while it was uniformly absent in MM (0/36; 0%; P < .001). Reactive mesothelial cells were CD24-negative in all carcinoma specimens. Comparative analysis of 117 solid primary (n = 43) and metastatic (n = 74) ovarian carcinomas and 65 solid MM specimens showed CD24 expression in 46% (54/117) of the former compared to 3% (2/65) of the latter (P < .001). Comparative analysis of ovarian carcinomas at different anatomic sites showed significantly higher CD24 expression in effusions compared to solid ovarian and metastatic lesions (P < .001), with similar results when analysis was limited to HGSC (P < .001). In conclusion, CD24 is a highly sensitive and specific marker of ovarian carcinoma in the differential diagnosis from MM and reactive mesothelium in effusions. CD24 is similarly a specific marker in surgical specimens, though with lower sensitivity. The overexpression of CD24 in ovarian carcinoma effusions compared to solid lesions may be due to the acquisition of cancer stem cell characteristics.

Copyright © 2016 Elsevier Inc. All rights reserved.

In plain English

This laboratory study, by a single author at Oslo University Hospital in Norway, tested whether staining for a protein called CD24 helps pathologists tell ovarian carcinoma, mainly high-grade serous carcinoma, apart from malignant mesothelioma and from reactive (non-cancerous) mesothelial cells. It did not study asbestos exposure. The author stained 206 fluid samples (effusions) and 182 tissue samples. In effusions, CD24 was found in 105 of 116 ovarian carcinomas (91%), 16 of 54 breast carcinomas (30%) and none of 36 mesotheliomas. Reactive mesothelial cells were negative in all carcinoma specimens. In tissue samples, CD24 was found in 54 of 117 ovarian carcinomas (46%) and 2 of 65 mesotheliomas (3%), and both of those mesotheliomas stained only in small areas. Ovarian carcinoma effusions showed more CD24 than ovarian tissue samples. The author concluded that CD24 is a highly specific marker for ovarian carcinoma against benign and malignant mesothelial cells, and that it is also highly sensitive in effusions. The author noted that few ovarian carcinomas of types other than high-grade serous were included.

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: Diagnostic laboratory study (immunohistochemistry) on stored effusion and surgical specimens, by a single author
• Who was studied: Effusions submitted to the Department of Pathology at the Norwegian Radium Hospital from 1998 to 2008, plus 8 mesothelioma specimens from Aalborg, Denmark. There were 206 effusions in all: 116 ovarian carcinoma (100 high-grade serous, 12 clear cell, 4 endometrioid), 54 breast carcinoma and 36 malignant mesothelioma. There were also 117 solid ovarian carcinoma tissue samples (43 ovarian, 74 extra-ovarian, from 56 patients) and 65 solid malignant mesotheliomas (47 pleural, 18 peritoneal).
• Exposure: No asbestos or other exposure was studied. The study measured CD24 protein staining in tumor and mesothelial cells.
• Main results:
  • In effusions, CD24 was expressed in 105/116 (91%) ovarian carcinomas and 16/54 (30%) breast carcinomas, and in none of 36 malignant mesotheliomas. Differences were statistically significant (p less than 0.001).
  • Reactive mesothelial cells were CD24-negative in all carcinoma specimens.
  • In solid tissue samples, CD24 was expressed in 54/117 (46%) ovarian carcinomas and 2/65 (3%) malignant mesotheliomas (p less than 0.001). Both positive mesotheliomas stained focally (under 5% of cells); one was biphasic and one sarcomatoid.
  • Ovarian carcinoma effusions showed significantly higher CD24 expression than solid ovarian and metastatic tissue samples (p less than 0.001), including when only high-grade serous carcinoma was analyzed.
  • The author wrote that the data do not support using CD24 to tell ovarian carcinoma from breast carcinoma.
• The authors' conclusion: The author concluded that CD24 is a highly specific marker for ovarian carcinoma in distinguishing it from benign and malignant mesothelial cells, and that it is also highly sensitive in effusion specimens. The author suggested that higher CD24 in effusions may be a marker of a cancer stem cell phenotype.
• Limitations the authors state:
  • Only a small number of ovarian carcinomas of types other than high-grade serous were included. The author stated that a larger series is needed to validate CD24 staining in these other types.

Topics

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

Medical terms in this study, explained in our Lexicon: Carcinoma, Mesothelial Cells, Malignant Mesothelioma, Immunohistochemistry, Reactive Mesothelial Cells, Differential Diagnosis, Mesothelium, STEM.

Related studies

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• PAX8 Expression in a Subset of Malignant Peritoneal Mesotheliomas and Benign Mesothelium has Diagnostic Implications in the Differential Diagnosis of Ovarian Serous Carcinoma — D.B. Chapel, A.N. Husain, et al. (2017)
• Nongynecologic metastases to fallopian tube mucosa: a potential mimic of tubal high-grade serous carcinoma and benign tubal mucinous metaplasia or nonmucinous hyperplasia — J.T. Rabban, P. Vohra, et al. (2015)
• MMP-7 is a highly specific negative marker for benign and malignant mesothelial cells in serous effusions — B. Davidson, H.T. Stavnes, et al. (2016)
• Improving the cytological diagnosis of high-grade serous carcinoma in ascites with a panel of complementary biomarkers in cell blocks — X. Zhang, L. Chen, et al. (2018)
• The diagnostic and molecular characteristics of malignant mesothelioma and ovarian/peritoneal serous carcinoma — B. Davidson (2011)

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