HBME-1 and antithrombomodulin in the differential diagnosis of malignant mesothelioma of pleura

Our plain-English summary of HBME-1 and antithrombomodulin in the differential diagnosis of malignant mesothelioma of pleura, by A.D. Kennedy, G. King, K.M. Kerr (Journal of Clinical Pathology, 1997).

The study

• Authors: A.D. Kennedy, G. King, K.M. Kerr
• Journal: Journal of Clinical Pathology
• Published: 1997;50(10):859-62
• Cited by: 42 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Aims: To determine the usefulness of antibodies HBME-1 and antithrombomodulin in the differential diagnosis of malignant mesothelioma of the pleura.

Methods: Using microwave antigen retrieval and streptavidin-biotin complex horseradish peroxidase immunohistochemistry the above antibodies were used to stain sections of 57 malignant mesotheliomas, 17 reactive pleural hyperplasias, 23 cases of carcinoma metastatic in pleura, 20 primary ovarian cell carcinomas, and 20 primary renal cell carcinomas.

Results: Eighty six per cent of mesotheliomas and 82% of reactive mesothelial hyperplasias stained strongly with HBME-1. However, 48% of carcinomas metastatic to pleura also stained, as did all serous ovarian carcinomas. Seventy two per cent of mesotheliomas and 24% of reactive mesothelial hyperplasias stained strongly with the antithrombomodulin antibody; 86% and 88%, respectively, of these cases showed staining of any type. While 26% of metastatic carcinomas showed some staining with antithrombomodulin, only one third of these (9%) showed strong, yet focal, staining. Of 40 ovarian and renal carcinomas only two (5%) showed any staining with antithrombomodulin.

Conclusions: HBME-1, although a sensitive mesothelial marker, is not sufficiently specific to be useful diagnostically, as almost half of carcinomas metastatic to pleura also stained positive. Antithrombomodulin is also a sensitive mesothelial marker and is sufficiently specific to be a useful discriminator, positively identifying, in appropriate circumstances, the mesothelial nature of a cell population.

In plain English

This laboratory study from Aberdeen Royal Infirmary in the UK tested whether two antibody stains, HBME-1 and antithrombomodulin, help pathologists tell malignant mesothelioma of the pleura apart from carcinoma. The authors stained stored tissue from 57 malignant mesotheliomas, 17 cases of reactive (non-cancerous) mesothelial hyperplasia, 23 carcinomas that had spread to the pleura, 20 ovarian carcinomas and 20 renal carcinomas. The study did not look at asbestos exposure. HBME-1 stained 53 of 57 mesotheliomas (93%), 49 (86%) of them strongly. It also stained 11 of 23 spread carcinomas (48%) and all 10 serous ovarian carcinomas. Antithrombomodulin stained 49 of 57 mesotheliomas (86%), 41 (72%) of them strongly, and 15 of 17 reactive hyperplasias (88%). Only six of 23 spread carcinomas (26%) stained, and only in small areas. The authors concluded that HBME-1 has little use for this purpose, while antithrombomodulin is a useful marker for distinguishing mesothelioma from carcinoma. They noted that antithrombomodulin cannot separate benign from malignant mesothelial cells, and that its focal or weak staining can be hard to see.

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 immunohistochemistry study of archived surgical tissue samples, comparing staining by two antibodies across tumour and non-tumour groups
• Who was studied: Tissue from the surgical histopathology files of the department of pathology, Aberdeen Royal Infirmary, UK. The samples were 57 malignant mesotheliomas (47 purely epithelioid; 10 with a sarcomatous appearance, three of which were biphasic), 17 reactive mesothelial hyperplasias, 23 carcinomas metastatic to the pleura (13 from lung), 20 ovarian cystadenocarcinomas (10 serous, 10 mucinous) and 20 renal cell carcinomas. Dates are not given.
• Exposure: No asbestos or other exposure was studied. The study tested two diagnostic antibody stains: HBME-1 (Dako M3505, dilution 1/80) and antithrombomodulin (Dako M0617, dilution 1/10).
• Main results:
  • Malignant mesotheliomas: 53 of 57 (93%) stained with HBME-1, and 49 (86%) stained strongly
  • Reactive mesothelial hyperplasia: 14 of 17 (82%) showed strong HBME-1 staining
  • Carcinomas metastatic to the pleura: 11 of 23 (48%) stained with HBME-1
  • Serous ovarian carcinomas: all 10 stained strongly and widely with HBME-1
  • Malignant mesotheliomas: 49 of 57 (86%) stained with antithrombomodulin, and 41 of 57 (72%) were strongly positive
  • Reactive mesothelial hyperplasia: 15 of 17 (88%) stained with antithrombomodulin
  • Carcinomas metastatic to the pleura: 6 of 23 (26%) stained with antithrombomodulin, all only focally
  • Ovarian carcinomas and antithrombomodulin: all 10 serous ovarian carcinomas and 9 of 10 mucinous ovarian carcinomas were negative
  • Sarcomatoid areas of mesotheliomas mostly did not stain with antithrombomodulin, as with HBME-1
  • Across all carcinomas in the study, 44% stained with HBME-1 and 13% stained with antithrombomodulin
• The authors' conclusion: The authors concluded that HBME-1 has little use as a marker for diagnosing malignancy in the pleura. They considered antithrombomodulin a useful marker for distinguishing malignant mesothelioma from carcinoma.
• Limitations the authors state:
  • The authors agreed that antithrombomodulin cannot distinguish benign from malignant mesothelial cells
  • Antithrombomodulin may stain only focally or weakly, which is hard to see; the authors said this could lead to false negative results on small tissue samples
  • Antithrombomodulin also stained blood vessel lining, which made tumours with many blood vessels, such as renal cell carcinoma, difficult to score

Topics

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

Medical terms in this study, explained in our Lexicon: HBME-1, Differential Diagnosis, Malignant Mesothelioma, Pleura, Immunohistochemistry, Carcinoma, Mesothelioma, Reactive Mesothelial Hyperplasia.

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