Immunohistochemical staining in malignant mesotheliomas

Our plain-English summary of Immunohistochemical staining in malignant mesotheliomas, by J.G. Strickler, B.G. Herndier, R.V. Rouse (American Journal of Clinical Pathology, 1987).

The study

• Authors: J.G. Strickler, B.G. Herndier, R.V. Rouse
• Journal: American Journal of Clinical Pathology
• Published: 1987;88(5):610-4
• Cited by: 44 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The immunoreactivity of five antibodies was evaluated on six routinely processed mesotheliomas to evaluate their ability to distinguish mesothelioma from metastatic adenocarcinoma. The diagnosis in all cases was confirmed by electron microscopic examination and histochemical stains for neutral mucin (periodic acid-Schiff-diastase) and acid mucin (alcian blue with and without hyaluronidase). AE1, a monoclonal antikeratin antibody that stains most carcinomas, reacted with all six cases of mesothelioma. HMFG-2 and anti-epithelial membrane antigen (antibodies reactive with human milk fat globule proteins), two other closely related antibodies reactive with most carcinomas, also reacted with all of the mesotheliomas in the authors' series. A polyclonal antibody to carcinoembryonic antigen (anti-CEA) did not stain any of the mesotheliomas in their series. Anti-Leu-M1 did not react with the mesotheliomas. The authors conclude that none of these antibodies, when used alone on routinely fixed paraffin-embedded material, is both sensitive and specific in the distinction of mesothelioma from adenocarcinoma. However, immunoperoxidase studies using anti-CEA and anti-Leu-M1 may occasionally be helpful when used in conjunction with other histochemical stains and electron microscopic examination in distinguishing mesothelioma from metastatic adenocarcinoma.

In plain English

This laboratory study from Stanford University Medical Center tested whether five antibody stains could help pathologists tell malignant mesothelioma apart from adenocarcinoma that has spread from elsewhere. The authors stained tissue from six mesotheliomas seen there between 1971 and 1985. All six were mainly epithelial in pattern and met the authors' diagnostic criteria: no neutral mucin, acid mucin present, and long, thin microvilli under the electron microscope. The keratin antibody AE1 reacted with all six cases. HMFG-2 and anti-epithelial membrane antigen (anti-EMA), antibodies that react with milk fat globule proteins, stained the tumor cells in each case, according to the text. Stains for carcinoembryonic antigen (anti-CEA) and Leu-M1 did not stain any of the tumors above control levels. No adenocarcinomas were stained for comparison. The authors relied on their laboratory's earlier work showing these antibodies react with many carcinomas. The authors concluded that keratin and HMFG staining did not help with this distinction. They said anti-CEA and anti-Leu-M1 may help in some cases, and that tissue appearance and chemical stains remain essential. The article does not discuss 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 (immunohistochemical) case series evaluating five antibodies on stored tumor tissue
• Who was studied: six cases of mesothelioma (predominantly epithelial pattern) seen in the Laboratory of Surgical Pathology at Stanford University Medical Center, California, between 1971 and 1985
• Main results:
  • The antikeratin antibody AE1 reacted with all six mesotheliomas.
  • HMFG-2 and anti-EMA stained the tumor cells in each case, especially in epithelial areas.
  • With HMFG-2 and anti-EMA, cytoplasmic staining was present focally in three cases and extensively in two cases. One case showed membrane staining without definite cytoplasmic staining.
  • Anti-CEA and anti-Leu-M1 did not stain the tumor cells of any of the six cases above the negative-control level.
  • Only mesotheliomas were stained. That the antibodies react with carcinomas was based on the laboratory's prior experience, not on adenocarcinomas tested in this study.
• The authors' conclusion: The authors concluded that keratin and HMFG expression (detected by HMFG-2 and anti-EMA) are not helpful in distinguishing mesothelioma from adenocarcinoma. In their view, anti-CEA and anti-Leu-M1 may be useful in some cases, but morphologic and histochemical features remain essential to the diagnosis.
• Limitations the authors state:
  • The authors noted that because mesothelioma has no absolutely diagnostic histologic criteria, it is difficult to set a standard against which the stains can be compared.
  • Follow-up beyond one year was not possible for three of the six patients. Autopsy confirmation was available in only one case.

Topics

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

Medical terms in this study, explained in our Lexicon: Immunohistochemistry, Malignant Mesothelioma, Mesothelioma, Adenocarcinoma, Monoclonal, Carcinoma, Epithelial Membrane Antigen (EMA), Carcinoembryonic Antigen (CEA).

Related studies

• Comparative immunohistochemical staining for desmin and muscle-specific actin. A study of 576 cases — S. Rangdaeng, L.D. Truong (1991)
• Immunohistochemical staining for vimentin and keratin in malignant mesothelioma — A. Churg (1985)
• Immunohistochemical staining of ras oncogene product in neoplastic and non-neoplastic mesothelial tissues: immunoreactivity for N-ras and lack of immunohistochemical staining for Ha-ras and K-ras — M. Ramael, I. Deblier, et al. (1993)
• Immunohistochemical study of 158 lung carcinomas — L. Johansson, C. Andersson, et al. (1992)
• Calretinin, thrombomodulin, CEA, and CD15: a useful combination of immunohistochemical markers for differentiating pleural epithelial mesothelioma from peripheral pulmonary adenocarcinoma — C.E. Comin, L. Novelli, et al. (2001)
• Immunohistological staining of reactive mesothelium, mesothelioma, and lung carcinoma with a panel of monoclonal antibodies — A.K. Ghosh, K.C. Gatter, et al. (1987)

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