Value of D2-40 in the differential diagnosis of pleural neoplasms with emphasis on its positivity in solitary fibrous tumor

Our plain-English summary of Value of D2-40 in the differential diagnosis of pleural neoplasms with emphasis on its positivity in solitary fibrous tumor, by Y. Hu, Q. Yang, L.A. McMahon, et al (Applied Immunohistochemistry & Molecular Morphology, 2010).

The study

• Authors: Y. Hu, Q. Yang, L.A. McMahon, H.L. Wang, H. Xu
• Journal: Applied Immunohistochemistry & Molecular Morphology
• Published: 2010;18(5):411-3
• Cited by: 5 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

D2-40 is a new monoclonal antibody recognizing podoplanin and it is selective for lymphatic endothelium. Several studies have confirmed the reliability of D2-40 in the diagnosis of pleural malignant mesothelioma, but the evaluation of this antibody in other pleural neoplasms is limited. The aim of this study was to determine the diagnostic value of D2-40 in segregation of malignant mesothelioma from other pleural or lung neoplasms. Sixty-seven cases, including 36 pleural malignant mesotheliomas, 15 solitary fibrous tumors, 13 pleomorphic carcinomas, and 3 synovial sarcomas, were immunohistochemically studied using a D2-40 monoclonal antibody. Twenty-five (21 epithelioid and 4 biphasic) of 36 (69%) malignant mesotheliomas and 2 of 15 (13%) solitary fibrous tumors were positive for D2-40. The difference of D2-40 positivity between these 2 types of tumor was significant (P<0.001). No D2-40 positivity was detected in pleomorphic carcinomas (n=13) or synovial sarcomas (n=3). These findings showed that D2-40 was frequently positive in malignant mesothelioma, but could also be positive in a small portion of solitary fibrous tumor. These results indicate that D2-40 is a valuable marker for malignant mesothelioma, but caution should be taken when evaluating D2-40-positive pleural spindle cell neoplasms in limited small biopsy specimens, especially when the differential diagnosis includes solitary fibrous tumor and malignant mesothelioma.

In plain English

This laboratory study tested whether staining with the antibody D2-40 helps pathologists tell pleural malignant mesothelioma apart from other chest tumors. The authors examined 67 archived surgical and biopsy samples from the University of Rochester and Cedars-Sinai Medical Center, dated 2000 to 2008. The samples were 36 pleural malignant mesotheliomas (28 epithelioid, 5 biphasic, 3 sarcomatoid), 15 solitary fibrous tumors, 13 pleomorphic carcinomas and 3 synovial sarcomas. A tumor counted as positive if more than 10% of its cells stained. Of the 36 mesotheliomas, 25 (69%) were positive: 21 of 28 epithelioid and 4 of 5 biphasic, but none of the 3 sarcomatoid. Two of 15 solitary fibrous tumors (13%) were also positive, and the difference from mesothelioma was statistically significant (P less than 0.001). No pleomorphic carcinoma or synovial sarcoma stained. The authors concluded that D2-40 is a valuable marker for mesothelioma, but that caution is needed with D2-40-positive spindle-cell tumors in small biopsies, especially when solitary fibrous tumor is possible. The study did not examine 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 (immunohistochemistry) study of archived pathology cases from surgical resection or biopsy
• Who was studied: 67 tumor cases from the University of Rochester and Cedars-Sinai Medical Center, 2000 to 2008: 36 pleural malignant mesotheliomas (28 epithelioid, 5 biphasic, 3 sarcomatoid), 15 solitary fibrous tumors, 13 pleomorphic carcinomas and 3 synovial sarcomas
• Main results:
  • In malignant mesothelioma, 25 of 36 (69%) were positive for D2-40, with more than 10% of tumor cells moderately to strongly stained: 21 epithelioid and 4 biphasic tumors.
  • Of the 4 D2-40-positive biphasic mesotheliomas, 2 stained only in the epithelioid component and 2 stained in both the epithelioid and sarcomatoid components.
  • In solitary fibrous tumor, 2 of 15 (13%) were positive for D2-40.
  • The difference in D2-40 positivity between mesothelioma and solitary fibrous tumor was statistically significant (P less than 0.001).
  • No D2-40 positivity was found in sarcomatoid mesothelioma (n = 3), pleomorphic carcinoma (n = 13) or synovial sarcoma (n = 3).
• The authors' conclusion: The authors concluded that D2-40 is a valuable marker for malignant mesothelioma. They also concluded that caution is needed when evaluating D2-40-positive pleural spindle cell tumors, especially in small biopsy specimens and when the choice is between biphasic or sarcomatoid mesothelioma and solitary fibrous tumor.

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), Differential Diagnosis, Neoplasm, Solitary Fibrous Tumor, Monoclonal Antibody, Mesothelioma, Pleomorphic, Carcinoma.

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• NY-ESO-1 expression in synovial sarcoma and other mesenchymal tumors: significance for NY-ESO-1-based targeted therapy and differential diagnosis — J.P. Lai, P.F. Robbins, et al. (2012)
• Somatic and visceral solitary fibrous tumors in the abdomen and pelvis: cross-sectional imaging spectrum — A.K. Shanbhogue, S.R. Prasad, et al. (2011)
• The value of anti-calretinin antibody in the differential diagnosis of normal and reactive mesothelia versus metastatic tumors in effusion cytology — H. Nagel, B. Hemmerlein, et al. (1998)
• Value of p63 and cytokeratin 5/6 as immunohistochemical markers for the differential diagnosis of poorly differentiated and undifferentiated carcinomas — O. Kaufmann, E. Fietze, et al. (2001)

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