Mesothelioma versus adenocarcinoma: false-positive CEA and Leu-M1 staining due to hyaluronic acid

Our plain-English summary of Mesothelioma versus adenocarcinoma: false-positive CEA and Leu-M1 staining due to hyaluronic acid, by J.A. Robb (Human Pathology, 1989).

The study

• Author: J.A. Robb
• Journal: Human Pathology
• Published: 1989;20(4):400
• Type of article: Letter
• Cited by: 26 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This letter to the editor responded to an earlier observation by Triol et al that mucicarmine-positive cytoplasmic vacuoles in malignant epithelial mesotheliomas are due to hyaluronic acid. The author noted that such vacuoles may lead to an incorrect diagnosis of adenocarcinoma if hyaluronidase predigestion is not used, and that positive CEA or Leu-M1 staining is also thought to favor adenocarcinoma. He described his 43rd case of malignant mesothelioma, which was clinically, morphologically and histochemically typical of epithelial malignant mesothelioma. It had a tubulopapillary pattern and contained a marked amount of hyaluronic acid, with colloidal iron- and mucicarmine-positive cytoplasmic vacuoles that became negative after hyaluronidase predigestion. The B72.3 stain was negative. Adsorbed CEA weakly stained some cytoplasmic vacuoles, and Leu-M1 stained some epithelial cell cytoplasms. Both stains became negative after hyaluronidase predigestion, while a lung adenocarcinoma control remained positive for all three antigens. The author concluded that when unexpected CEA or Leu-M1 staining is seen in an otherwise typical epithelial mesothelioma, hyaluronidase predigestion should be used before issuing a diagnosis favoring adenocarcinoma. He also suggested that mesotheliomas reported in the literature as CEA-positive may be false-positive cases due to high hyaluronic acid content. In a printed reply, Triol and Chandler stated that his results appeared to agree with theirs.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This letter to the editor described a single case. It built on an earlier report by Triol and colleagues that mucicarmine-stained vacuoles in epithelial malignant mesothelioma are due to hyaluronic acid. The author's 43rd case of malignant mesothelioma was typical of an epithelial malignant mesothelioma, with a tubulopapillary pattern and a marked amount of hyaluronic acid. Its stained vacuoles became negative after pretreatment with the enzyme hyaluronidase. The B72.3 stain was negative. However, CEA weakly stained some vacuoles, and Leu-M1 stained the cytoplasm of some epithelial cells. Both of these stains became negative after hyaluronidase pretreatment. A lung adenocarcinoma control sample stayed positive for all three markers. The author concluded that unexpected CEA or Leu-M1 staining in an otherwise typical epithelial mesothelioma should prompt hyaluronidase pretreatment before issuing a diagnosis favoring adenocarcinoma. The letter did not mention asbestos, the patient's exposure history, or where in the body the tumor arose.

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: letter to the editor describing a single case, commenting on an earlier letter by Triol et al
• Who was studied: one patient, the author's 43rd case of malignant mesothelioma, described as a typical epithelial malignant mesothelioma; no age, sex, tumor site, place or date given
• Main results:
  • In this case, the tumor had a tubulopapillary pattern and a marked amount of hyaluronic acid. Its colloidal iron- and mucicarmine-positive cytoplasmic vacuoles became negative after predigestion with hyaluronidase.
  • In this case, the B72.3 stain was negative. The adsorbed CEA stain weakly stained some cytoplasmic vacuoles, and the Leu-M1 stain stained the cytoplasm of some epithelial cells.
  • Both the CEA and Leu-M1 stains became negative after hyaluronidase predigestion. A lung adenocarcinoma control remained positive for all three antigens.
• The authors' conclusion: The author concluded that when aberrant or unexpected CEA and/or Leu-M1 staining is seen in an otherwise typical epithelial mesothelioma, hyaluronidase predigestion should be used before issuing a diagnosis favoring adenocarcinoma.

Topics

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

Medical terms in this study, explained in our Lexicon: Mesothelioma, Adenocarcinoma, Hyaluronic Acid, Malignant Mesothelioma, Tubulopapillary, B72.3 (TAG-72), Lung Adenocarcinoma.

Related studies

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• Utility of hyaluronic acid in pleural fluid for differential diagnosis of pleural effusions: likelihood ratios for malignant mesothelioma — S. Atagi, M. Ogawara, et al. (1997)
• Malignant mesothelioma and CEA staining — K. Mukai (1985)
• Evidence against a role for SV40 infection in human mesotheliomas and high risk of false-positive PCR results owing to presence of SV40 sequences in common laboratory plasmids — F. López-Ríos, P.B. Illei, et al. (2004)
• Benign cystic mesothelioma: false-positive iodine accumulation in a patient with oncocytic follicular thyroid carcinoma — M. Meyer, Y. Godbert, et al. (2014)
• Distinct keratin patterns demonstrated by immunoperoxidase staining of adenocarcinomas, carcinoids, and mesotheliomas using polyclonal and monoclonal anti-keratin antibodies — H.J. Kahn, P.S. Thorner, et al. (1986)

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