Comparison of tumour markers in malignant mesothelioma and pulmonary adenocarcinoma

Our plain-English summary of Comparison of tumour markers in malignant mesothelioma and pulmonary adenocarcinoma, by A.R. Gibbs, R. Harach, J.C. Wagner, et al (Thorax, 1985).

The study

• Authors: A.R. Gibbs, R. Harach, J.C. Wagner, B. Jasani
• Journal: Thorax
• Published: 1985;40(2):91-5
• Cited by: 54 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Immunohistological methods were used to investigate the presence of carcinoembryonic antigen, beta 1 pregnancy specific glycoprotein, beta subunit of human chorionic gonadotrophin, human placental lactogen, calcitonin, and keratin in formalin fixed tissue from 29 malignant mesotheliomas and 27 pulmonary adenocarcinomas. Malignant mesotheliomas were negative for tumour markers except for the beta subunit of human chorionic gonadotrophin and keratin, one and 13 cases respectively being positive for these. Pulmonary adenocarcinomas, however, were frequently positive for tumour markers--namely, carcinoembryonic antigen, beta 1 pregnancy specific glycoprotein, beta subunit of human chorionic gonadotrophin, human placental lactogen, calcitonin, and keratin. The presence of carcinoembryonic antigen and beta 1 pregnancy specific glycoprotein within an intrathoracic tumour is strong evidence against its being of mesothelial origin.

In plain English

This laboratory study compared tissue staining in two chest tumours that can look alike under the microscope: malignant mesothelioma and pulmonary (lung) adenocarcinoma. The authors noted that telling them apart matters for patient care and for industrial compensation. They tested preserved tissue from 29 malignant mesotheliomas, all from necropsy (post-mortem) cases, and 27 pulmonary adenocarcinomas for six markers; three markers were tested in only 27 mesotheliomas and 25 adenocarcinomas. Carcinoembryonic antigen was found in 24 of 27 adenocarcinomas and beta-1 pregnancy specific glycoprotein in 23 of 27. Neither was found in any of the 29 mesotheliomas. Every adenocarcinoma was positive for one or both. Keratin was found about as often in each tumour: 12 of 27 adenocarcinomas and 13 of 29 mesotheliomas. The other three markers appeared in a minority of adenocarcinomas and in no mesotheliomas, except for weak staining for one marker in one mesothelioma. The authors concluded that a positive result for either of the first two markers is strong evidence against mesothelioma. The study did not assess 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: Laboratory (immunohistological) comparison of tumour tissue samples
• Who was studied: Tissue from 29 malignant mesotheliomas, all from necropsy cases (12 purely epithelial, 14 mixed epithelial and sarcomatous, 3 purely sarcomatous), and 27 pulmonary adenocarcinomas (13 surgical, 14 necropsy cases). For the beta subunit of human chorionic gonadotrophin, human placental lactogen and calcitonin, only 27 mesotheliomas and 25 adenocarcinomas were tested. No dates of collection are given.
• Exposure: Not applicable: the study did not examine asbestos or any other exposure. It tested tumour tissue for six markers: carcinoembryonic antigen, beta-1 pregnancy specific glycoprotein, beta subunit of human chorionic gonadotrophin, human placental lactogen, calcitonin, and keratin.
• Main results:
  • Carcinoembryonic antigen was present in 24 of 27 adenocarcinomas and absent in all 29 malignant mesotheliomas
  • Beta-1 pregnancy specific glycoprotein was positive in 23 of 27 adenocarcinomas and negative in all malignant mesotheliomas tested
  • Every adenocarcinoma was positive for carcinoembryonic antigen, beta-1 pregnancy specific glycoprotein, or both; every malignant mesothelioma was negative for both
  • Weak staining for the beta subunit of human chorionic gonadotrophin was seen in 8 of 25 adenocarcinomas and 1 of 27 malignant mesotheliomas
  • Human placental lactogen was weakly positive in 2 of 25 adenocarcinomas and negative in all 27 malignant mesotheliomas
  • Calcitonin was weakly positive in 3 of 25 adenocarcinomas and negative in all 27 malignant mesotheliomas
  • Keratin was positive in 12 of 27 adenocarcinomas and 13 of 29 malignant mesotheliomas, so it did not separate the two tumours
  • There appeared to be no significant differences in staining between necropsy and surgical tissues for any marker
• The authors' conclusion: The authors concluded that carcinoembryonic antigen and beta-1 pregnancy specific glycoprotein were the most helpful of the six markers. A positive result for either in a tumour is strong evidence against malignant mesothelioma, and a negative result for both is highly suggestive of mesothelioma if the microscopic appearance is compatible.
• Limitations the authors state:
  • Keratin positivity in these mesotheliomas was lower than in most other series. The authors suggested this may be because keratin is lost after death, since all mesotheliomas were post-mortem samples.
  • Keratin results may depend on the fixative used; other workers reported better keratin staining with other fixatives
  • Keratin results could vary with the antibody used, and the authors said more work with monoclonal antibodies is needed

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Adenocarcinoma, Carcinoembryonic Antigen (CEA), Glycoprotein, Intrathoracic.

Related studies

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• Value of Glut-1 and Koc markers in the differential diagnosis of reactive mesothelial hyperplasia, malignant mesothelioma and pulmonary adenocarcinoma — Ö. Üçer, A.F. Dağli, et al. (2013)
• CD24: a potential new marker in differentiating malignant mesothelioma from pulmonary adenocarcinoma — D.J. Pinato, P. Nya, et al. (2013)
• Ber-EP4 for differentiating adenocarcinoma from reactive and neoplastic mesothelial cells in serous effusions. Comparison with carcinoembryonic antigen, B72.3 and Leu-M1 — M.E. Bailey, R.W. Brown, et al. (1996)
• Immunohistochemical distinction of malignant mesothelioma from pulmonary adenocarcinoma with anti-surfactant apoprotein, anti-Lewisa, and anti-Tn antibodies — M. Noguchi, T. Nakajima, et al. (1989)

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