Diagnostic histochemical and immunohistochemical studies in malignant mesothelioma

Our plain-English summary of Diagnostic histochemical and immunohistochemical studies in malignant mesothelioma, by J.G. Lucas, S.E. Tuttle (Journal of Surgical Oncology, 1987).

The study

• Authors: J.G. Lucas, S.E. Tuttle
• Journal: Journal of Surgical Oncology
• Published: 1987;35(1):30-4
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

This study was undertaken to evaluate the relative utility of histochemical and immunohistochemical stains in diagnosing malignant mesothelioma of the thorax. We performed a battery of histochemical stains, including periodic acid Schiff (PAS) with and without diastase, mucicarmine, colloidal iron (Coll Fe) with and without hyaluronidase, and immunohistochemical stains for keratin and carcinoembryonic antigen (CEA) on 12 pleural mesothelioma specimens obtained from 11 patients, five primary pulmonary adenocarcinomas, and one metastatic adenocarcinoma each to pleura and pericardium. All diagnoses were established by autopsy or thorough clinical and surgical evaluation. The diagnosis of mesothelioma was established following rigid anatomic criteria. All tissue was formalin fixed and paraffin embedded. Commercially available reagents and antisera were used in all cases. Results showed a high rate of positivity for keratin and hyaluronidase-sensitive Coll Fe in the mesotheliomas while adenocarcinomas were uniformly positive for CEA and keratin and generally positive for PAS-D (diastase) and mucicarmine. Mesotheliomas were negative for CEA, mucin, and PAS-D. Positive keratin staining was also seen in the spindle cell components of mesotheliomas. Immunohistochemical stains often added significantly to our ability to establish the diagnosis of mesothelioma with confidence, since they were more frequently and more clearly positive than histochemical stains.

In plain English

This was a laboratory study by two authors from the Department of Pathology at Ohio State University. It compared traditional chemical (histochemical) stains with antibody-based (immunohistochemical) stains for telling malignant pleural mesothelioma apart from adenocarcinoma, a different cancer. The authors examined 12 pleural mesothelioma specimens from 11 patients and 7 adenocarcinomas: five primary lung tumors, one pleural metastasis from breast cancer and one pericardial metastasis from a lung cancer. The cases were collected between 1969 and 1984. The article does not report asbestos exposure. In the mesotheliomas, 11 of 12 specimens stained for keratin and none stained for carcinoembryonic antigen (CEA). Nine showed colloidal iron staining that was sensitive to hyaluronidase digestion. Mucicarmine and PAS-D stains were negative. All 7 adenocarcinomas stained for both keratin and CEA, and 5 of 7 showed mucin. The authors reported that keratin staining was more easily interpreted than colloidal iron staining. They concluded that immunohistochemical stains can help establish a mesothelioma diagnosis in some cases with negative histochemical stains and support the diagnosis in others. The study did not evaluate electron microscopy.

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: Retrospective laboratory diagnostic study of archived tumor specimens, comparing histochemical and immunohistochemical stains
• Who was studied: 12 pleural mesothelioma specimens from 11 patients (aged 26 to 70, average 62; two females and nine males) and 7 adenocarcinomas (five primary pulmonary, one metastatic pleural lesion from breast carcinoma, one pericardial metastasis from a lung primary). Cases came from the Anatomic Pathology Division files of Ohio State University, accrued 1969 to 1984. Five mesotheliomas were excluded for not meeting the selection criteria.
• Exposure: Asbestos exposure was not studied or reported. The study compared stains on tumor tissue: periodic acid Schiff with and without diastase, mucicarmine, colloidal iron with and without hyaluronidase, and immunostains for keratin and CEA.
• Main results:
  • Mesotheliomas: 9 of 12 were epithelial type, two biphasic, one sarcomatous
  • Mesotheliomas: 11 of 12 specimens were positive for keratin and all were negative for CEA
  • Mesotheliomas: 9 showed colloidal iron positivity that was hyaluronidase sensitive
  • Mesotheliomas were consistently negative on PAS-D and mucicarmine stains, which were generally positive in adenocarcinomas
  • Mesotheliomas: in one-third of cases, keratin staining was more intense and widely distributed than colloidal iron staining
  • Adenocarcinomas: 5 of 7 showed mucin, and colloidal iron staining was generally resistant to hyaluronidase digestion (6 of 7)
  • Adenocarcinomas: keratin and CEA stains were positive in all 7 cases
• The authors' conclusion: The authors concluded that immunochemical methods can help establish a diagnosis of mesothelioma in some cases with negative histochemical reactions, and give supportive evidence in cases with positive or equivocal histochemical stains.
• Limitations the authors state:
  • The study did not evaluate electron microscopy

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, Thorax, Carcinoembryonic Antigen (CEA), Pleural Mesothelioma, Adenocarcinoma, Pleura, Pericardium, Autopsy.

Related studies

• Adenomatoid tumours: a mucin histochemical and immunohistochemical study — M.J. Goddard, J.W. Grant (1992)
• Peritoneal malignant mesothelioma versus serous papillary adenocarcinoma. A histochemical and immunohistochemical comparison — D.J. Bollinger, M.R. Wick, et al. (1989)
• Distinguishing malignant mesothelioma from pulmonary adenocarcinoma: an immuno-histochemical approach using a panel of monoclonal antibodies — S.E. Tuttle, J.G. Lucas, et al. (1990)
• Combined use of novel epithelial (MOC-31) and mesothelial (HBME-1) immunohistochemical markers for optimal first line diagnostic distinction between mesothelioma and metastatic carcinoma in pleura — C. González-Lois, C. Ballestín, et al. (2001)
• The distinction of adenocarcinoma from malignant mesothelioma in cell blocks of effusions: the role of routine mucin histochemistry and immunohistochemical assessment of carcinoembryonic antigen, keratin proteins, epithelial membrane antigen, and milk fat globule-derived antigen — E.S. Cibas, J.M. Corson, et al. (1987)
• Immunohistochemical panels for differentiating epithelial malignant mesothelioma from lung adenocarcinoma: a study with logistic regression analysis — R. Carella, G. Deleonardi, et al. (2001)

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