Reactive and neoplastic serosal tissue. A light-microscopic, ultrastructural, and immunocytochemical study

Our plain-English summary of Reactive and neoplastic serosal tissue. A light-microscopic, ultrastructural, and immunocytochemical study, by J.W. Bolen, S.P. Hammar, M.A. McNutt (The American Journal of Surgical Pathology, 1986).

The study

• Authors: J.W. Bolen, S.P. Hammar, M.A. McNutt
• Journal: The American Journal of Surgical Pathology
• Published: 1986;10(1):34-47
• Cited by: 253 articles, as counted by NIH iCite
• Read it: PubMed · Publisher
• In J-M's library: Johns-Manville's company medical library held a copy (J-M no. 003158).

Abstract

Normal and reactive non-neoplastic serosal tissues and a spectrum of serosal neoplasms were studied using light-microscopic, ultrastructural, immunocytochemical, gel electrophoretic, and immunoblot techniques. Normal surface mesothelium expressed both low- and high-molecular-weight cytokeratins, whereas the scattered submesothelial cells were decorated only with antibodies to vimentin. Reactive non-neoplastic subserosal cells, however, coexpressed both low-molecular-weight cytokeratin and vimentin and demonstrated the ability for surface differentiation during which higher-molecular-weight cytokeratins were acquired and vimentin was lost. The authors suggest the term "multipotential subserosal cells," recognizing the unique intermediate filament expression of reactive subserosal cells and the ability for surface differentiation. The intermediate filament expression of the sarcomatoid/desmoplastic mesotheliomas resembled the MSC, whereas epithelial mesotheliomas resembled surface mesothelium. These findings have potential usefulness for diagnostic pathology.

In plain English

This laboratory pathology study examined tissue from 25 cases using light and electron microscopy, antibody staining and protein gel methods. Eight cases had non-cancerous reactive serosal tissue, the lining of body cavities. One had chronic peritonitis and seven had other cancers that had spread to the lining. Seventeen had diffuse malignant mesothelioma: seven sarcomatoid or desmoplastic, one mixed and nine epithelial. The authors stated that most were associated with heavy asbestos exposure. Normal surface lining cells carried cytokeratin proteins, while resting cells beneath them carried only vimentin. Reactive cells beneath the surface carried both low-molecular-weight cytokeratin and vimentin, and lost vimentin as they took on surface features. The authors called these "multipotential subserosal cells." Sarcomatoid and desmoplastic mesotheliomas, and pleural plaques included with one case, showed this mixed pattern. Epithelial mesotheliomas resembled the surface lining. No mesothelioma showed significant CEA staining. The authors suggested that these patterns could help diagnosis. They cautioned that cancer spreading to the lining can make reactive cells carry cytokeratin. Benign localized mesotheliomas were not studied.

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 pathology study of surgical and autopsy tissue (light microscopy, electron microscopy, immunocytochemistry, gel electrophoresis and immunoblot)
• Who was studied: 25 cases from Seattle pathology departments (Mason Clinic; University of Washington). Cases 1 to 8 were non-neoplastic reactive serosal tissue: case 1 chronic active peritonitis with scarring, cases 2 to 8 carcinoma metastatic to serosal tissue. Cases 9 to 25 were diffuse malignant mesotheliomas: cases 9 to 15 sarcomatoid or desmoplastic, case 16 mixed, cases 17 to 25 epithelial. All specimens were surgical except case 16 (autopsy). Dates are not given.
• Exposure: Asbestos exposure was not measured or analysed. The authors stated only that most mesothelioma cases were associated with heavy asbestos exposure; no fiber types, jobs or doses are given for these patients.
• Main results:
  • In all eight reactive cases, normal surface mesothelium stained with all four cytokeratin antibodies.
  • In all eight reactive cases, subserosal cells in uninjured areas contained only vimentin.
  • Reactive subserosal cells (cases 1 to 8) coexpressed low-molecular-weight cytokeratin and vimentin. Vimentin was lost as the cells acquired higher-molecular-weight cytokeratin.
  • Under the electron microscope, the reactive subserosal cells looked like myofibroblasts.
  • The sarcomatoid and desmoplastic mesotheliomas (cases 9 to 15) resembled reactive subserosal cells, coexpressing low-molecular-weight cytokeratin and vimentin. Cases 9 to 14 were negative with the higher-molecular-weight cytokeratin antibody 34BE12; case 15 showed focal staining.
  • Hyalinized pleural plaques, included with case 11, also coexpressed low-molecular-weight cytokeratin and vimentin.
  • The epithelial mesotheliomas (cases 17 to 25) resembled surface mesothelium. They stained with all four cytokeratin antibodies, with vimentin only in scattered weakly positive cells in some tumors.
  • No significant CEA staining was found in any of the mesotheliomas in the study.
  • All 7 of 7 epithelial mesotheliomas tested were positive for both EMA and MFG-2.
  • The sarcomatoid and desmoplastic mesotheliomas were negative for both EMA and MFG-2.
  • Gel electrophoresis confirmed the antibody findings in two cases: case 25 (epithelial) and case 13 (desmoplastic).
• The authors' conclusion: The authors proposed the term "multipotential subserosal cells" and suggested that these cells serve as the replicating population that can differentiate into surface mesothelium. They concluded that their findings have potential usefulness for diagnostic pathology, for example that coexpression of vimentin and cytokeratin distinguishes sarcomatoid mesothelioma from other soft-tissue sarcomas.
• Limitations the authors state:
  • No benign localized spindle cell mesotheliomas were examined.
  • The transition zones of the mixed mesothelioma (case 16) were not available for electron microscopy.
  • The authors cautioned that carcinoma spreading to serosal tissue can make reactive subserosal cells express cytokeratin, and that this should not be misread as mesothelioma.
  • The authors noted that sarcomatoid renal cell carcinoma spreading to serosal tissue may mimic sarcomatoid mesothelioma, both in appearance and in staining.

Topics

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

Medical terms in this study, explained in our Lexicon: Neoplasm, Mesothelium, Sarcomatoid, Desmoplastic Mesothelioma, Mesothelioma, Pathology.

Related studies

• Use of antimesothelial cell antibody and computer assisted quantitative analysis for distinguishing between reactive and neoplastic serosal tissues — A. Donna, P.G. Betta, et al. (1987)
• Immunolocalization of nestin, mesothelin and epithelial membrane antigen (EMA) in developing and adult serous membranes and mesotheliomas — J. Petricevic, H. Punda, et al. (2012)
• Cytokeratin 7 and cytokeratin 20 expression in epithelial neoplasms: a survey of 435 cases — P. Chu, E. Wu, et al. (2000)
• Immunocytochemical panel for the identification of malignant cells in serous effusions — K.V. Nance, J.F. Silverman (1991)
• The relation between connective tissue cells and intercellular substances, including basement membranes — P. Davies, A.C. Allison, et al. (1975)
• Localized fibrous tumor of the serosal cavities. Immunohistochemical, electron-microscopic, and flow-cytometric DNA study — A.K. el-Naggar, J.Y. Ro, et al. (1989)

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