Immunohistological study of malignant diffuse mesotheliomas of the pleura

Our plain-English summary of Immunohistological study of malignant diffuse mesotheliomas of the pleura, by H. Loosli, J. Hurlimann (Histopathology, 1984).

The study

• Authors: H. Loosli, J. Hurlimann
• Journal: Histopathology
• Published: 1984;8(5):793-803
• Cited by: 62 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Paraffin sections from fifteen cases of malignant diffuse mesothelioma of the pleura and five cases of bronchial adenocarcinoma infiltrating the pleura were examined with an antiserum specific for factor VIII related antigen and with antisera against various epithelial markers: keratin, carcinoembryonic antigen (CEA), fat globule membrane antigen and secretory component. In all adenocarcinomas all the epithelial markers were present whereas the factor VIII related antigen was absent. The distribution of the fat globule membrane antigens, keratin, secretory component and factor VIII related antigen varied from one mesothelioma to another. The mesotheliomas were generally negative for CEA. The three mesotheliomas which were positive for CEA were also positive for alcian blue after hyaluronidase treatment. Amongst the markers used, CEA seems the most useful for the differential diagnosis between carcinoma and mesothelioma. However, the simultaneous detection of several markers allows the characterization of various phenotypes. Some of them are close to the phenotypes of true adenocarcinoma. A relation between a given phenotype and the biological behaviour of the tumour has still to be demonstrated.

In plain English

This laboratory study, by pathologists at the University of Lausanne in Switzerland, examined stored tissue from 15 cases of malignant diffuse mesothelioma of the pleura. These were chosen from 17 cases found among the department's surgical pathology cases from 1972 to 1981. They were compared with five cases of bronchial adenocarcinoma (a lung cancer) spreading into the pleura. The aim was to find stains that help tell the two tumours apart. Tissue was tested for keratin, carcinoembryonic antigen (CEA), fat globule membrane antigens, secretory component and factor VIII related antigen. All 15 mesotheliomas stained for keratin, nine for fat globule membrane antigens, eight for secretory component and five for factor VIII related antigen (the discussion says four). Only three stained for CEA. All five adenocarcinomas stained for every epithelial marker, including CEA, and none for factor VIII related antigen. The authors concluded that CEA seemed the most useful of these markers for the distinction, although a negative CEA does not exclude adenocarcinoma, and that mesotheliomas showed varied staining patterns. The article does not report 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: Immunohistochemical (immunoperoxidase) laboratory study of archived surgical pathology specimens, with a comparison group of lung adenocarcinomas
• Who was studied: 15 cases of malignant diffuse mesothelioma of the pleura (8 men, mean age 59; 7 women, mean age 48), retained from 17 cases found among 280,000 surgical pathology cases of the Department of Pathology, University of Lausanne, 1972 to 1981. 13 were epithelioid type and 2 mixed; 11 were in the right pleura and 4 in the left. For comparison, 5 cases of pleural infiltration by bronchial adenocarcinoma were included.
• Main results:
  • Among the 15 mesotheliomas, all were positive for keratin, nine for fat globule membrane antigens, eight for secretory component and five for factor VIII related antigen.
  • Only three of the 15 mesotheliomas were positive for CEA.
  • The cells of all five bronchial adenocarcinomas infiltrating the pleura were positive for all the epithelial markers and negative for factor VIII related antigen.
  • The three CEA-positive mesotheliomas were the cases in which histochemical staining favoured adenocarcinoma.
  • There was no clear difference in staining pattern between epithelioid and mixed mesotheliomas.
  • Secretory component staining differed: it was spread through the cytoplasm in mesothelioma cells but at the cell surface (apical) in most adenocarcinoma cells.
  • Because keratin was present in both tumour types, the authors judged it not useful for telling them apart.
• The authors' conclusion: The authors concluded that, of the markers used, CEA seemed the most useful for distinguishing carcinoma from mesothelioma. They also concluded that mesotheliomas show various staining patterns, and that whether a given pattern relates to tumour behaviour remains to be shown.
• Limitations the authors state:
  • The anti-keratin antiserum recognises several keratin polypeptides, so the polypeptides detected in mesotheliomas may not be the same as those detected in carcinomas. The authors say the same applies to the fat globule membrane antiserum.
  • A negative CEA result does not exclude adenocarcinoma, since not all bronchial adenocarcinomas contain CEA.
  • In three mesothelioma cases the histochemical staining was not typical of mesothelioma; the diagnosis rested on gross and microscopic appearance and absence of other tumour sites.
  • In three mesotheliomas, secretory component staining was only slightly stronger than the control stains.
  • Whether a particular staining pattern relates to tumour behaviour, prognosis or response to therapy was not demonstrated.

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: Mesothelioma, Pleura, Adenocarcinoma, Carcinoembryonic Antigen (CEA), Differential Diagnosis, Carcinoma.

Related studies

• Immunohistological staining of reactive mesothelium, mesothelioma, and lung carcinoma with a panel of monoclonal antibodies — A.K. Ghosh, K.C. Gatter, et al. (1987)
• Peritoneal cystic mesothelioma: an electron microscopic and immunohistochemical study of two male patients — I.K. Sienkowski, A.J. Russell, et al. (1986)
• 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)
• Value of the mesothelium-associated antibodies thrombomodulin, cytokeratin 5/6, calretinin, and CD44H in distinguishing epithelioid pleural mesothelioma from adenocarcinoma metastatic to the pleura — P.M. Cury, D.N. Butcher, et al. (2000)
• Immunohistochemical distinction of malignant mesothelioma from pulmonary adenocarcinoma with anti-surfactant apoprotein, anti-Lewisa, and anti-Tn antibodies — M. Noguchi, T. Nakajima, et al. (1989)
• Use of antibodies to carcinoembryonic antigen and human milk fat globule to distinguish carcinoma, mesothelioma, and reactive mesothelium — R.J. Marshall, A. Herbert, et al. (1984)

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