Peritoneal malignant mesothelioma versus serous papillary adenocarcinoma. A histochemical and immunohistochemical comparison

Our plain-English summary of Peritoneal malignant mesothelioma versus serous papillary adenocarcinoma. A histochemical and immunohistochemical comparison, by D.J. Bollinger, M.R. Wick, L.P. Dehner, et al (The American Journal of Surgical Pathology, 1989).

The study

• Authors: D.J. Bollinger, M.R. Wick, L.P. Dehner, S.E. Mills, P.E. Swanson, R.E. Clarke
• Journal: The American Journal of Surgical Pathology
• Published: 1989;13(8):659-70
• Cited by: 109 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

In order to evaluate adjunctive histologic methods for separating mesothelioma (MM) and serous adenocarcinoma (SC), we studied 28 and 46 respective cases histochemically and immunohistochemically. Ten serous adenocarcinomas arose primarily in extraovarian sites within the abdomen. Diagnoses in each case were established retrospectively by a combination of electron microscopy and clinicopathologic correlation. A panel of antibodies to cytokeratin (CK), epithelial membrane antigen (EMA), B72.3, placental alkaline phosphatase (PLAP), S-100 protein, carcinoembryonic antigen (CEA), Leu M1, CA-125, and amylase (AM) was applied to paraffin sections of each case. Serous carcinoma was reactive for neutral mucins whereas mesothelioma was not; however, only 50% of adenocarcinoma cases stained in this manner. Peritoneal mesothelioma showed reactivity for CK (28 of 28 cases), EMA (24 of 28 cases), AM (five of 28 cases), CA-125 (four of 28 cases), and S-100 protein (three of 28 cases), but lacked B72.3, PLAP, and CEA. Three mesotheliomas expressed Leu M1, but in an extremely focal distribution. Serous carcinoma reacted for CK (46 of 46 cases), EMA (46 of 46 cases), CA-125 (42 of 46 cases), S-100 protein (40 of 46 cases), Leu M1 (34 of 46 cases; with diffuse staining), B72.3 (33 of 46 cases), PLAP (29 of 46 cases), AM (15 of 46 cases), and CEA (six of 46 cases). Two profiles (S-100 + B72.3; S-100 + PLAP) were seen in 41 of 46 serous adenocarcinoma cases but were absent in all mesotheliomas. Hence, these combinations of determinants are effective in separating such neoplasms diagnostically. Moreover, diffuse reactivity for Leu M1, B72.3, PLAP, or CEA in papillary peritoneal neoplasms appears to exclude the possibility of mesothelioma; however, focal Leu M1 reactivity may indeed be seen in mesothelioma. Although CA-125 is a sensitive marker for serous carcinoma, it is not effective in distinguishing it from mesothelioma.

In plain English

This was a laboratory study of tumor tissue stains. It did not examine asbestos exposure. The authors took 28 peritoneal malignant mesotheliomas, 36 ovarian serous adenocarcinomas and 10 serous carcinomas arising outside the ovary from pathology files at four US medical centers. They tested whether special stains and a panel of nine antibodies could tell the two tumor types apart. Mesothelioma diagnoses were confirmed by electron microscopy. No mesothelioma stained for B72.3, PLAP or CEA. Among the 46 serous carcinomas, 33 stained for B72.3, 29 for PLAP and 6 for CEA. Three mesotheliomas showed only tiny spots of Leu M1 staining, while 34 of 46 carcinomas stained diffusely. The pairings S-100 plus B72.3 or S-100 plus PLAP appeared in 41 of 46 carcinomas and in no mesothelioma. CA-125 stained 42 of 46 carcinomas and 4 of 28 mesotheliomas. The authors concluded that diffuse staining for Leu M1, B72.3, PLAP or CEA appears to exclude mesothelioma, and that CA-125 does not separate the two tumors.

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 diagnostic pathology study comparing special stains (histochemistry) and antibody stains (immunohistochemistry) on archived tumor tissue
• Who was studied: 74 tumors from the pathology files of the University of Minnesota Medical Center, University of Virginia Medical Center, Minneapolis Veterans' Medical Center and Akron City Hospital: 28 peritoneal malignant mesotheliomas, 36 ovarian serous adenocarcinomas and 10 extragonadal serous carcinomas. All serous tumors were from women. All but five mesotheliomas were from men. Dates are not given.
• Exposure: Not studied. No asbestos or other exposure data are reported. The 'exposures' tested were laboratory stains: cytokeratin, epithelial membrane antigen (EMA), B72.3, placental alkaline phosphatase (PLAP), S-100 protein, carcinoembryonic antigen (CEA), Leu M1, CA-125 and amylase, plus mucin stains.
• Main results:
  • All 28 mesotheliomas and all 46 serous carcinomas stained for cytokeratin.
  • Mesotheliomas: EMA in 23 of 28 (82%) according to the article body and table. The abstract says 24 of 28.
  • No peritoneal mesothelioma stained for B72.3, PLAP or CEA.
  • Mesotheliomas: amylase in five (18%), CA-125 in four (14%) and S-100 protein in three (11%).
  • Leu M1 staining was diffuse in the positive serous carcinomas. In three mesotheliomas it was present only in extremely small areas.
  • Serous carcinomas stained for CK in 46 of 46, EMA in 46 of 46 and CA-125 in 42 of 46.
  • Serous carcinomas stained for S-100 protein in 40 of 46, Leu M1 (diffuse) in 34 of 46, B72.3 in 33 of 46, PLAP in 29 of 46, amylase in 15 of 46 and CEA in 6 of 46.
  • The combinations S-100 plus B72.3 or S-100 plus PLAP were seen in 41 of 46 serous adenocarcinomas and in none of the mesotheliomas.
  • Mucin stain (PAS-D): 23 serous carcinomas were positive.
  • Serous carcinoma stained for neutral mucins and mesothelioma did not. Only 50% of the adenocarcinoma cases stained this way.
  • The authors stated that CA-125, although sensitive for serous carcinoma, was not effective in distinguishing it from mesothelioma.
• The authors' conclusion: The authors concluded that diffuse staining for Leu M1, B72.3, PLAP or CEA in a papillary peritoneal tumor appears to exclude mesothelioma, although focal Leu M1 staining can occur in mesothelioma. They also concluded that the S-100 plus B72.3 and S-100 plus PLAP combinations are effective in separating the two tumors.
• Limitations the authors state:
  • Leu M1 was scored as positive even when only a tiny portion of the tumor reacted. The authors say this is more liberal than would be used in actual diagnosis.
  • The choice of antibody reagents (for example monoclonal versus heteroantisera for S-100 protein and PLAP) could affect how the findings apply.

Topics

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

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Adenocarcinoma, Mesothelioma, Epithelial Membrane Antigen (EMA), B72.3 (TAG-72), Placental Alkaline Phosphatase (PLAP), S-100, Carcinoembryonic Antigen (CEA).

Related studies

• A comparative immunohistochemical study of peritoneal and ovarian serous tumors, and mesotheliomas — N. Khoury, U. Raju, et al. (1990)
• Value of mesothelial and epithelial antibodies in distinguishing diffuse peritoneal mesothelioma in females from serous papillary carcinoma of the ovary and peritoneum — R.L. Attanoos, R. Webb, et al. (2002)
• Malignant epithelioid pleural mesothelioma versus peripheral pulmonary adenocarcinoma: a histochemical, ultrastructural, and immunohistologic study of 103 cases — M.R. Wick, T. Loy, et al. (1990)
• Immunohistochemical profile of paratesticular serous papillary adenocarcinoma and tunica vaginalis facilitates distinction from malignant mesothelioma — P.R. Anchala, R. Dhir, et al. (2011)
• Loss of BAP1 expression is very rare in peritoneal and gynecologic serous adenocarcinomas and can be useful in the differential diagnosis with abdominal mesothelioma — J. Andrici, J. Jung, et al. (2016)
• An autopsy case of serous papillary carcinoma of peritoneum with distant metastases but no peritoneal dissemination — O. Miyaishi, K. Iida, et al. (1994)

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