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

Our plain-English summary of 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, by E.S. Cibas, J.M. Corson, G.S. Pinkus (Human Pathology, 1987).

The study

• Authors: E.S. Cibas, J.M. Corson, G.S. Pinkus
• Journal: Human Pathology
• Published: 1987;18(1):67-74
• Cited by: 119 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The immunohistochemical profile (i.e., carcinoembryonic antigen, keratin proteins, epithelial membrane antigen, human milk fat globule-derived antigen, and mucin) of paraffin-embedded cell blocks of 20 malignant effusions from patients with malignant mesothelioma was compared with that of 39 malignant effusions from patients with metastatic adenocarcinoma to determine whether these markers distinguished between these tumor types. Twenty-three adenocarcinomas (59 per cent) stained for mucin. Immunoreactivity for carcinoembryonic antigen (CEA) was observed in 28 adenocarcinomas (72 per cent). All were immunoreactive for keratin proteins, and 29 adenocarcinomas (74 per cent), including seven that were mucin and CEA negative and exhibited a "peripheral predominant" staining pattern for keratin proteins. By contrast, none of the mesotheliomas stained for mucin or for CEA, and, although all were immunoreactive for keratin proteins, none demonstrated a peripheral predominant pattern of staining. Epithelial membrane antigen and milk fat globule-derived antigen were identified in the majority of both mesotheliomas and adenocarcinomas. Neither staining intensity nor pattern of reactivity of these markers clearly distinguished the tumors. This study of cell blocks of serous effusions suggests that staining for mucin, immunoreactivity for carcinoembryonic antigen, and a peripheral predominant pattern of reactivity for keratin proteins represent highly characteristic markers of adenocarcinomas, which identify the majority of these tumors (38 of 39) and allow their distinction from malignant mesotheliomas.

In plain English

This laboratory study, done with samples from the pathology files of Brigham and Women's Hospital, asked whether certain stains could tell malignant mesothelioma apart from metastatic adenocarcinoma (cancer that has spread from another organ) in fluid collected from around the lungs or in the abdomen. The authors stained preserved cell samples from 20 fluid specimens from 19 patients with malignant mesothelioma and 39 specimens from 39 patients with adenocarcinoma. None of the mesothelioma samples stained for mucin or for carcinoembryonic antigen (CEA). Among the adenocarcinomas, 23 of 39 (59 per cent) stained for mucin and 28 (72 per cent) for CEA. All samples stained for keratin proteins. A "peripheral predominant" keratin pattern appeared in 29 of 39 adenocarcinomas and in none of the mesotheliomas. Two other markers, EMA and HMFG-2, did not separate the tumors. Together, mucin, CEA and the keratin pattern identified 38 of 39 adenocarcinomas. The authors concluded these features appear highly characteristic of adenocarcinomas. They noted that the keratin pattern could not be determined in eight of 59 samples, and that three adenocarcinomas showed the pattern typical of mesothelioma. The article does not address 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: Laboratory diagnostic study comparing staining of fluid cell blocks from two tumor types
• Who was studied: Paraffin-embedded cell blocks from the files of Brigham and Women's Hospital: 20 malignant effusions (14 pleural, 6 peritoneal) from 19 patients with malignant mesothelioma, accessioned 1977 to 1984; and 39 effusions (24 pleural, 15 peritoneal) from 39 patients with metastatic adenocarcinoma, from 1980 to 1984
• Exposure: Not applicable. The article does not discuss asbestos or any fiber exposure. It evaluated laboratory stains (mucin, CEA, keratin proteins, EMA, HMFG-2) on fluid samples.
• Main results:
  • None of the 20 mesothelioma fluids stained for mucin.
  • 23 of 39 adenocarcinoma fluids (59 per cent) showed mucin.
  • None of the 20 mesothelioma fluids reacted for CEA.
  • 28 of the 39 adenocarcinoma fluids (72 per cent) were CEA positive.
  • CEA and/or mucin positivity was seen in 31 of 39 adenocarcinomas (80 per cent).
  • All adenocarcinoma fluids (and all mesothelioma fluids) were immunoreactive for keratin proteins.
  • A peripheral-over-perinuclear keratin pattern was seen in 29 of 39 adenocarcinomas, including seven of the eight that were mucin and CEA negative.
  • In 15 of 20 mesotheliomas, a perinuclear keratin pattern predominated. A peripheral predominant pattern was not observed in any mesothelioma.
  • EMA and HMFG-2 staining did not discriminate between the tumors.
  • The combined markers identified 38 of 39 adenocarcinomas.
• The authors' conclusion: The authors concluded that mucin staining, CEA immunoreactivity and a peripheral-predominant keratin pattern appear highly characteristic of adenocarcinomas and help distinguish them from malignant mesotheliomas in fluid cell blocks.
• Limitations the authors state:
  • The keratin pattern was indeterminate in 8 of 59 cell blocks because of poor resolution, possibly due to delayed fixation.
  • Perinuclear predominance was not entirely specific to mesothelioma: three adenocarcinomas showed it.
  • After trypsin treatment, very intense staining sometimes hampered assessment of staining patterns.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Adenocarcinoma, Mesothelioma, Cell Block, Carcinoembryonic Antigen (CEA), Epithelial Membrane Antigen (EMA).

Related studies

• 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)
• Immunocytological staining reactions of anti-carcinoembryonic antigen, Ca, and anti-human milk fat globule monoclonal antibodies on benign and malignant exfoliated mesothelial cells — A.K. Ghosh, E.B. Butler (1987)
• Immunoperoxidase localization of keratin proteins, carcinoembryonic antigen, and factor VIII in adenomatoid tumors: evidence for a mesothelial derivation — J.W. Said, G. Nash, et al. (1982)
• Ber-EP4 for differentiating adenocarcinoma from reactive and neoplastic mesothelial cells in serous effusions. Comparison with carcinoembryonic antigen, B72.3 and Leu-M1 — M.E. Bailey, R.W. Brown, et al. (1996)
• Keratin proteins and carcinoembryonic antigen in lung carcinoma: an immunoperoxidase study of fifty-four cases, with ultrastructural correlations — J.W. Said, G. Nash, et al. (1983)
• Lung surfactant protein-A and carcinoembryonic antigen in pleural effusions due to lung adenocarcinoma and malignant mesothelioma — N. Shijubo, Y. Honda, et al. (1995)

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