Immunohistochemistry in Peritoneal Mesothelioma: A Single-Center Experience of 244 Cases

Our plain-English summary of Immunohistochemistry in Peritoneal Mesothelioma: A Single-Center Experience of 244 Cases, by R.T. Tandon, Y. Jimenez-Cortez, R. Taub, et al (Archives of Pathology & Laboratory Medicine, 2018).

The study

• Authors: R.T. Tandon, Y. Jimenez-Cortez, R. Taub, A.C. Borczuk
• Journal: Archives of Pathology & Laboratory Medicine
• Published: 2018;142(2):236-242
• Cited by: 57 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Context: - Diagnosis of malignant mesothelioma is more common in the chest than it is in the abdomen. Most published immunohistochemistry data are more applicable to pleural than to peritoneal mesothelioma.

Objective: - To clarify the practical utility of 17 immunohistochemistry markers in the differential diagnosis of peritoneal mesothelioma with an emphasis on stains for which there is either contradictory information or a paucity of literature.

Design: - Consultation files of peritoneal mesothelioma diagnoses rendered from 1999 to 2014 were reviewed; 244 cases were identified. The results of immunohistochemistry markers performed were tabulated.

Results: - Immunohistochemistry markers positive in peritoneal mesothelioma in order of sensitivity were calretinin (244 of 244; 100%), WT1 (205 of 218; 94%), CK5/6 (173 of 194; 89%), mesothelin (132 of 150; 88%), and D2-40 (78 of 97; 80%). Markers used to differentiate carcinoma from mesothelioma showed immunoreactivity in peritoneal mesothelioma: estrogen receptor (2 of 84; 2%), B72.3 (6 of 196; 3%), CK20 (5 of 116; 4%), CD15 (7 of 192; 4%), p63 (3 of 62; 5%), carcinoembryonic antigen (9 of 199; 5%), PAX8 (12 of 191; 6%), progesterone receptor (5 of 71; 7%), Ber-EP4 (17 of 209; 8%), and CD138 (9 of 91; 10%). BAP1 loss, increasingly used in the differential diagnosis of benign versus malignant mesothelial proliferation, occured in 55% (99 of 181) of peritoneal mesothelioma cases.

Conclusions: - The results support the experience that there is no definitive marker to rule out malignant mesothelioma, including PAX8, estrogen receptor, progesterone receptor, and p63 immunoreactivity. The high rate of immunoreactivity for mesothelin may have a role as a predictive marker for immune targeting. BAP1 loss of 55% in this cohort of peritoneal mesothelioma confirms published observations, and BAP1 retention is seen in a significant proportion of neoplastic cases.

In plain English

This was a retrospective review of pathology records at Columbia University Medical Center in New York from 1999 to 2014. The authors identified 244 peritoneal (abdominal) mesotheliomas: 177 epithelioid, 50 biphasic and 17 well-differentiated papillary. Pleural cases, mesothelioma of the tunica vaginalis and multicystic mesothelioma were excluded. They tabulated the results of 17 immunohistochemistry stains, laboratory tests used to tell mesothelioma apart from other cancers such as carcinomas. The study did not examine asbestos exposure. All 244 tumors stained for calretinin, 205 of 218 (94%) for WT1, 173 of 194 (89%) for CK5/6, 132 of 150 (88%) for mesothelin and 78 of 97 (80%) for D2-40. Stains usually linked with carcinoma were positive in a small share of these mesotheliomas, such as PAX8 in 12 of 191 (6%) and estrogen receptor in 2 of 84 (2%). The BAP1 protein was lost in 99 of 181 tumors (55%). The authors concluded that no single marker can rule out peritoneal mesothelioma. They also concluded that mesothelin may have a role in guiding immune-targeted treatment, and that BAP1 retention in 45% of cases limits that marker's value.

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 review of pathology records (case series of tumor stain results)
• Who was studied: 244 peritoneal (abdominal) mesothelioma tumors diagnosed at or sent in consultation to Columbia University Medical Center, New York, 1999 to 2014. Per the results table, 177 were epithelioid, 50 were biphasic and 17 were well-differentiated papillary mesotheliomas. Pleural, tunica vaginalis and multicystic mesotheliomas were excluded.
• Exposure: Not studied. The article reports tumor stain (immunohistochemistry) results, not asbestos or other exposures of the patients.
• Main results:
  • Calretinin was positive in all 244 peritoneal mesotheliomas (100%).
  • WT1 was positive in 205 of 218 peritoneal mesotheliomas tested (94%).
  • CK5/6 was positive in 173 of 194 cases (89%).
  • D2-40 was positive in 78 of 97 tumors (80%).
  • Mesothelin was positive in 132 of 150 tumors (88%).
  • Some markers generally used to identify carcinoma were positive in a small share of the peritoneal mesotheliomas: B72.3 in 6 of 196 (3%), CK20 in 5 of 116 (4%) and CD15 in 7 of 192 (4%).
  • Ber-EP4 was positive in 17 of 209 peritoneal mesotheliomas (8%) and CD138 in 9 of 91 (10%).
  • PAX8 was positive in 12 of 191 peritoneal mesotheliomas (6%).
  • Estrogen receptor was positive in 2 of 84 patients (2%), both women.
  • Progesterone receptor was positive in 5 of 71 patients (7%).
  • p63 was positive in 3 of 62 peritoneal mesotheliomas (5%).
  • CK7 was positive in 123 of 132 (93%), so it did not help separate mesothelioma from carcinoma.
  • BAP1 was retained (expressed) in 82 of 181 cases (45%) and lost in 99 of 181 cases (55%).
• The authors' conclusion: The authors concluded that no definitive marker rules out malignant mesothelioma. PAX8, estrogen receptor, progesterone receptor and p63 cannot exclude peritoneal mesothelioma as single markers. Mesothelin may have a role as a predictive marker for immune targeting.
• Limitations the authors state:
  • For some consultation cases, the specific staining method used was not available.
  • Stains were scored only as positive or negative, not graded by amount.

Topics

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

Medical terms in this study, explained in our Lexicon: Immunohistochemistry, Peritoneal Mesothelioma, Malignant Mesothelioma, Differential Diagnosis, Calretinin, Mesothelin, Podoplanin (D2-40), Carcinoma.

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