Value of immunocytochemistry in the study of malignant effusions

Our plain-English summary of Value of immunocytochemistry in the study of malignant effusions, by M.R. Mason, C.W. Bedrossian, C.A. Fahey (Diagnostic Cytopathology, 1987).

The study

• Authors: M.R. Mason, C.W. Bedrossian, C.A. Fahey
• Journal: Diagnostic Cytopathology
• Published: 1987;3(3):215-21
• Cited by: 52 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Recognition of malignant effusion relies heavily on cytologic examination despite the difficulty of distinguishing atypical mesothelial hyperplasia from metastatic carcinoma. The combination of CEA, EMA, vimentin, keratin, high-molecular-weight cytokeratin (HMWK), low-molecular-weight cytokeratin (LMWK), and Alcian blue was tested in 51 cytologic specimens of pleural, peritoneal, and pericardial effusions. These showed metastatic carcinoma in 38 cases (ovary, 14; lung, 8; breast, 7; GI, 4; endometrium, 4; bladder, 1) and mesothelial processes in 13 (hyperplasia, 9; mesothelioma, 4). Strong positivity for EMA (92%), CEA (90%), and Alcian blue (71%) was noted in metastatic carcinoma but not in the mesothelial processes. Keratin was positive in all cases of mesothelioma but occurred also in mesothelial hyperplasias (44%) and metastatic carcinomas (47%). In mesothelial cells, HMWK was consistently stronger than LMWK, whereas in adenocarcinoma the reverse was true. There was no difference in the degree or distribution of positivity of any of the markers among the various primary sites of the neoplasms. Our findings are consistent with the view that immunocytochemistry with a battery of antibodies is useful in the recognition of malignant effusions but cannot, as yet, determine the site of origin of metastatic neoplasms.

In plain English

This laboratory study tested whether a panel of stains could help pathologists tell cancer cells from reactive (non-cancerous) mesothelial cells in fluid from the chest, abdomen or around the heart. Of 208 effusions submitted to a St. Louis hospital laboratory between July 1, 1985 and June 30, 1986, 51 specimens from 46 patients were suitable. Thirty-eight showed metastatic carcinoma. The other 13 came from five lymphomas, four cases of congestive heart failure and four mesotheliomas. The stains were read without knowing the patient's diagnosis. CEA was positive in 34 of 38 carcinomas (89%) and Alcian blue in 27 of 38 (71%); neither stained mesothelial cells. EMA showed strong positivity in 92% of carcinomas and stained reactive mesothelial cells in 1 of 9 cases. Keratin was positive in all four mesotheliomas, but also in 4 of 9 reactive cases and in 47% of carcinomas. No marker revealed where a carcinoma had started. The authors concluded that the stains help recognize metastatic carcinoma but cannot yet identify its site of origin. The article does not discuss asbestos.

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 of consecutive body-fluid (effusion) specimens stained with a panel of antibodies and a mucin stain, with blinded interpretation
• Who was studied: 51 specimens of pleural, pericardial and peritoneal fluid from 46 patients, selected from 208 effusions submitted to the Cytopathology Immunocytochemistry Laboratory of Firmin Desloge Hospital, St. Louis, between July 1, 1985 and June 30, 1986
• Exposure: No asbestos or other environmental or occupational exposure was studied. What was tested was a panel of laboratory stains: CEA, EMA, keratin, high- and low-molecular-weight cytokeratin, vimentin and Alcian blue.
• Main results:
  • Of the 51 specimens, 38 showed malignant epithelial cells (metastatic carcinoma). The remaining 13 came from five lymphomas, four cases of congestive heart failure and four mesotheliomas. Mesothelial cells appeared reactive in nine of these and neoplastic in the four mesotheliomas.
  • CEA was positive in 34 of 38 adenocarcinomas (89%) and Alcian blue in 27 of 38 (71%). Neither marker was positive in mesothelial cells (Table IV: 0 of 9 reactive, 0 of 4 mesothelioma).
  • Strong EMA positivity was seen in 92% of metastatic carcinomas. Reactive mesothelial cells were EMA-positive in 1 of 9 cases (11%), a lymphoma case. EMA was negative in the mesotheliomas (0 of 4 in Table V).
  • Keratin was positive in all four mesotheliomas and in four of nine reactive mesothelial cases (44%). Keratin was also positive in 47% of metastatic carcinomas.
  • In six keratin-positive carcinoma cases, the two cytokeratin types behaved differently in the two cell types. In mesothelial cells, high-molecular-weight cytokeratin (HMWK) stained as strongly as or more strongly than polyclonal keratin. In the adenocarcinoma cells, HMWK was virtually negative while low-molecular-weight cytokeratin (LMWK) was strongly positive.
  • Neither the intensity nor the pattern of EMA staining distinguished the primary site of the carcinomas.
  • Staining was generally stronger and easier to see in smears than in cell blocks (compared in 34 cases).
  • In ten cases where the primary tumor was removed near the time of fluid sampling, tissue staining closely agreed with the fluid staining.
• The authors' conclusion: The authors concluded that immunocytochemistry is of value in distinguishing metastatic epithelial malignancy from atypical mesothelial hyperplasia. They found that difficulty remains in identifying the primary site of the carcinomas.
• Limitations the authors state:
  • The authors stated that their results apply only to the fixation methods they used: alcohol-fixed smears, and cell blocks fixed in B5 and postfixed in alcohol.

Topics

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

Medical terms in this study, explained in our Lexicon: Atypical Mesothelial Proliferation, Carcinoma, Pericardial Effusion, Mesothelioma, Reactive Mesothelial Hyperplasia, Mesothelial Cells, Adenocarcinoma, Neoplasm.

Related studies

• Utility of HBME-1 immunostaining in serous effusions — V. Ascoli, C. Carnovale-Scalzo, et al. (1997)
• Cytological differential diagnosis among adenocarcinoma, epithelial mesothelioma, and reactive mesothelial cells in serous effusions by immunocytochemistry — X.Y. Su, G.D. Li, et al. (2011)
• Diagnostic problems in serous effusions — C.W. Bedrossian (1998)
• Usefulness of Claudin 4 in the cytological diagnosis of serosal effusions — S. Lonardi, C. Manera, et al. (2011)
• Cytomorphological profile of neoplastic effusions: an audit of 10 years with emphasis on uncommonly encountered malignancies — S. Gupta, P. Sodhani, et al. (2012)
• Use of antisera to epithelial membrane antigen for the cytodiagnosis of malignancy in serous effusions — A. To, D.V. Coleman, et al. (1981)

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