The diagnostic utility of D2-40, calretinin, CK5/6, desmin and MOC-31 in the differentiation of mesothelioma from adenocarcinoma in pleural effusion cytology

Our plain-English summary of The diagnostic utility of D2-40, calretinin, CK5/6, desmin and MOC-31 in the differentiation of mesothelioma from adenocarcinoma in pleural effusion cytology, by T.S. Hyun, M. Barnes, Z.L. Tabatabai (Acta Cytologica, 2012).

The study

• Authors: T.S. Hyun, M. Barnes, Z.L. Tabatabai
• Journal: Acta Cytologica
• Published: 2012;56(5):527-32
• Cited by: 41 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Objective: To evaluate the utility of the lymphatic endothelial marker D2-40, along with calretinin, CK5/6, desmin and MOC-31, in differentiating mesothelioma and adenocarcinoma in pleural effusion cytology.

Study Design: Forty-five pleural effusion cases representing confirmed reactive effusions (13), mesotheliomas (11) and metastatic adenocarcinomas (21) were immunostained with antibodies against D2-40, calretinin, CK5/6, desmin and MOC-31.

Results: D2-40 showed membranous staining in 82% of mesotheliomas and 77% of reactive effusions. Calretinin and CK5/6 were positive in 100 and 64% of mesotheliomas, and 92 and 31% of reactive effusions, respectively. All adenocarcinomas showed lack of staining with these markers. Desmin was negative in all malignant cases and positive in 85% of reactive effusions. All adenocarcinomas were positive for MOC-31 and negative for the remaining markers.

Conclusion: Calretinin was the most sensitive in detecting mesothelial differentiation, followed by D2-40. Although useful, D2-40 necessitated cautious interpretation due to occasional focal/weak positivity, particularly in limited cellularity samples. The muscle marker desmin was useful in differentiating benign from malignant effusions but not in distinguishing mesotheliomas from adenocarcinomas. MOC-31 was both highly sensitive and specific for detecting adenocarcinoma and was useful as part of a panel of stains in differentiating cells of mesothelial origin from adenocarcinoma.

Copyright © 2012 S. Karger AG, Basel.

In plain English

This study tested whether five laboratory stains could tell apart three kinds of fluid collected from around the lungs (pleural effusions). The authors stained 45 archived cell samples: 13 benign reactive effusions, 11 mesotheliomas and 21 adenocarcinomas that had spread from elsewhere. All patients were male, aged 53 to 91. Five of the mesothelioma cases and 3 of the reactive cases had known asbestos exposure. Calretinin stained all of the mesotheliomas and 92% of the reactive samples. D2-40 stained 82% of mesotheliomas and 77% of reactive samples. CK5/6 stained 64% of mesotheliomas. None of these three stains marked any adenocarcinoma. MOC-31 stained every adenocarcinoma and none of the other samples. Desmin stained 85% of reactive samples, often patchily or focally, and none of the mesotheliomas or adenocarcinomas. Used together, calretinin and D2-40 detected every sample of mesothelial origin. The authors concluded that D2-40 can serve as a useful addition to a panel of stains, but that its staining must be interpreted cautiously.

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: Diagnostic study of archived pleural effusion cell blocks stained with five immunohistochemical markers. Two of the authors reviewed the results blinded, and a stain counted as positive if at least 10% staining was present.
• Who was studied: 45 pleural effusion cell blocks: 13 reactive (benign) effusions, 11 mesotheliomas (9 epithelioid, 2 mixed epithelioid and desmoplastic, called biphasic) and 21 metastatic adenocarcinomas (lung 11, pancreatic 3, gastric 1, colonic 1, unknown origin 5). All patients were male, aged 53 to 91. The cases came from the Department of Pathology archives; the affiliations are the University of California and Veterans Affairs Medical Centers, San Francisco. Collection dates were not given.
• Exposure: The study tested diagnostic stains (D2-40, calretinin, CK5/6, desmin, MOC-31), not an exposure. Known asbestos exposure was reported for 5 of the 11 mesothelioma cases and 3 of the 13 reactive effusion cases. No fiber types or doses were reported.
• Main results:
  • D2-40 stained 82% of mesotheliomas (9 of 11), 77% of benign reactive effusions (10 of 13) and none of the 21 adenocarcinomas. For separating mesothelial cells from adenocarcinoma it was 79% sensitive and 100% specific. Staining was patchy or weak in some benign and mesothelioma cases.
  • Calretinin stained all 11 mesotheliomas (100%), 12 of 13 benign reactive effusions (92%) and no adenocarcinomas. For separating mesothelial cells from adenocarcinoma it was 96% sensitive and 100% specific.
  • CK5/6 stained 64% of mesotheliomas (7 of 11), 31% of benign reactive effusions (4 of 13) and no adenocarcinomas. For separating mesothelial cells from adenocarcinoma it was 46% sensitive and 100% specific.
  • Combining calretinin and D2-40 detected 100% of mesothelial-origin samples (mesothelioma and benign reactive). D2-40 stained the one benign reactive case that was negative for calretinin.
  • MOC-31 stained all 21 adenocarcinomas and none of the benign reactive or mesothelioma samples. It was 100% sensitive and 100% specific in this test group.
  • Desmin stained 85% of benign reactive effusions (11 of 13), often patchily or focally, and none of the mesotheliomas or adenocarcinomas. It was 85% sensitive and 100% specific for separating benign from malignant effusions.
• The authors' conclusion: The authors concluded that calretinin was the most sensitive marker of mesothelial origin. They saw D2-40 as a useful second-line addition to a panel of stains, but said its interpretation must be cautious because of occasional patchy or weak staining, particularly in samples with few cells. In their view, desmin may help separate benign from malignant effusions, and MOC-31 was a very useful marker for 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: Podoplanin (D2-40), Calretinin, Desmin, MOC-31, Mesothelioma, Adenocarcinoma, Pleural Effusion, Cytology.

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