Histochemical demonstration of hyaluronic acid in pleural mesotheliomas

Our plain-English summary of Histochemical demonstration of hyaluronic acid in pleural mesotheliomas, by J.C. Wagner, D.E. Munday, J.S. Harington (The Journal of Pathology and Bacteriology, 1962).

The study

• Authors: J.C. Wagner, D.E. Munday, J.S. Harington
• Journal: The Journal of Pathology and Bacteriology
• Published: 1962;84:73-8
• Cited by: 161 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 001587).

Abstract

Diffuse pleural mesotheliomas secrete material that stains as an acid mucopolysaccharide and can be removed by prior digestion with either testicular or streptococcal hyaluronidase. Chemically, this material can be quantitatively precipitated by acetic acid, and its presence confirmed by prior treatment of pleural fluid with hyaluronidase. These methods have been used to differentiate between diffuse pleural mesothelioma and peripheral pulmonary adenocarcinoma, especially in asbestosis.

PubMed has no abstract for this study. This is the authors' abstract, copied from the article.

In plain English

This laboratory study tested staining methods meant to help pathologists tell diffuse pleural mesothelioma apart from adenocarcinoma, which it can resemble. The authors stained tissue from 16 mesotheliomas and compared it with control tumours, including peripheral pulmonary adenocarcinomas. In all 16 mesotheliomas the secreted material was metachromatic and stained with Hale's method and alcian blue. Only 2 of the 16 were positive with the periodic acid-Schiff (P.A.S.) stain. The adenocarcinomas stained strongly with P.A.S., Hale's method and alcian blue. In none of the adenocarcinomas with metachromatic or Hale-positive secretion was that staining reversed by either hyaluronidase enzyme. Streptococcal hyaluronidase removed the metachromatic staining in 13 of the 16 mesotheliomas and markedly reduced it in the other 3. Hyaluronic acid was isolated from the pleural fluid of 5 confirmed pleural mesothelioma cases. The authors concluded that these methods had been used to separate the two tumour types, especially in asbestosis. They noted that most specimens arrive in formol-saline, a fixative that limits the tests. They also noted that the pleural fluid test was negative in some proven cases.

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 histochemical study developing staining methods for diagnosing mesothelioma, with chemical isolation of hyaluronic acid from pleural fluid in some cases
• Who was studied: Tumour tissue from 16 diffuse mesotheliomas: 14 fixed in formol-alcohol-acetic and 2 fixed in 10 per cent formol-saline that still held stainable secretion. Controls were 4 peripheral pulmonary adenocarcinomas, 4 colloid carcinomas of the gastro-intestinal tract, healthy umbilical cord and 2 metastatic adenocarcinomas from the omentum. The work was done at the Pneumoconiosis Research Unit in Johannesburg. A further 20 formol-saline-fixed mesotheliomas were tested with P.A.S. only.
• Exposure: Asbestos exposure was not measured in this study, and no fiber type is named. The study grew out of an investigation of pleural mesothelioma and its possible association with asbestos exposure. One specimen came from a man who had worked on an asbestos mine for many years and whose lung biopsy showed asbestosis.
• Main results:
  • Mesotheliomas: in all 16, the secretion was metachromatic and stained with Hale's method and alcian blue
  • Mesotheliomas: only 2 of the 16 were P.A.S.-positive
  • Adenocarcinomas: strongly positive with P.A.S., Hale's method and alcian blue
  • Adenocarcinomas: in none with metachromatic or Hale-positive secretion was the staining reversed by either hyaluronidase
  • Mesotheliomas: streptococcal hyaluronidase removed the metachromasia in 13 of 16 and markedly reduced it in the remaining 3
  • pH test (7 mesotheliomas, 3 pulmonary adenocarcinomas): 6 of the 7 mesotheliomas showed no metachromasia below pH 4; one was metachromatic at pH 3.5
  • Pleural fluid: hyaluronic acid was isolated from 5 confirmed pleural mesothelioma cases at concentrations from 0.02 to 1.25 per cent
  • Pleural fluid: in 3 of these 5 cases the yield of hyaluronic acid increased as the disease progressed
  • Pleural fluid: no false positives were obtained from a large number of other pleural fluids, including idiopathic effusions, tuberculous infections and other malignancies
  • A further 20 formol-saline-fixed mesotheliomas: only 5 contained P.A.S.-positive secretion, and in every case it was removed by diastase
• The authors' conclusion: The authors concluded that diffuse pleural mesotheliomas secrete material that stains as an acid mucopolysaccharide and is removed by testicular or streptococcal hyaluronidase. They stated that these methods have been used to differentiate diffuse pleural mesothelioma from peripheral pulmonary adenocarcinoma, especially in asbestosis.
• Limitations the authors state:
  • Most specimens are received fixed in formol-saline, which limits use of the histochemical tests
  • Differentiation by pH testing was not as clear as expected
  • It is not yet known whether the methods can distinguish peritoneal mesothelioma from metastatic carcinoma
  • The pleural fluid test was negative in some cases later proved to be mesothelioma, so only positive results are useful

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: Hyaluronic Acid, Pleural Mesothelioma, Adenocarcinoma.

Related studies

• Mesothelioma of the peritoneum; a case report in which the ascitic fluid contained hyaluronic acid — S. Dvoskin (1954)
• Clinical significance of the immunometric measurements of hyaluronic acid — E.H. Cooper, B.J. Rathbone (1990)
• Pleural effusion hyaluronic acid as a prognostic marker in pleural malignant mesothelioma — J. Creaney, I.M. Dick, et al. (2013)
• Hyaluronic acid in the pleural fluid of patients with malignant pleural mesothelioma — N. Fujimoto, K. Gemba, et al. (2013)
• Serum mesothelin has a higher diagnostic utility than hyaluronic acid in malignant mesothelioma — B. Grigoriu, B. Chahine, et al. (2009)
• Biochemical characterization of hyaluronic acid from a case of benign, localized, pleural mesothelioma — M. Motomiya, M. Endo, et al. (1975)

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