Value of mesothelial and epithelial antibodies in distinguishing diffuse peritoneal mesothelioma in females from serous papillary carcinoma of the ovary and peritoneum

Our plain-English summary of Value of mesothelial and epithelial antibodies in distinguishing diffuse peritoneal mesothelioma in females from serous papillary carcinoma of the ovary and peritoneum, by R.L. Attanoos, R. Webb, S.D. Dojcinov, et al (Histopathology, 2002).

The study

• Authors: R.L. Attanoos, R. Webb, S.D. Dojcinov, A.R. Gibbs
• Journal: Histopathology
• Published: 2002;40(3):237-44
• Cited by: 108 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Aims: To evaluate the role of mesothelial markers (calretinin, thrombomodulin, cytokeratin 5/6, and CD44H) and carcinoma markers (polyclonal and monoclonal carcinoembryonic antigen, Leu-M1, CA-125 and Ber-EP4) in distinguishing diffuse peritoneal malignant mesothelioma from primary serous papillary adenocarcinoma of the ovary and peritoneum.

Methods And Results: Paraffin-embedded formalin-fixed blocks from 32 diffuse peritoneal mesotheliomas of epithelial subtype (all females), 20 serous papillary ovarian carcinomas and three primary peritoneal serous papillary carcinomas were studied. Calretinin and Ber-EP4 appeared to be the best positive mesothelial and carcinoma marker, respectively. Nuclear calretinin expression was identified in 28 of 32 malignant mesotheliomas with no nuclear immunoreactivity in the cohorts of serous papillary ovarian and peritoneal carcinomas, thus yielding 88% sensitivity and 100% specificity. Ber-EP4 showed 95% sensitivity and 91% specificity for serous papillary ovarian carcinoma. Thrombomodulin, cytokeratin 5/6 and CD44H immunoreactivities were seen in 18 (56%), 17 (53%) and 15 (47%) of peritoneal mesotheliomas, respectively, and in six (30%), five (25%) and five (25%) of the ovarian tumours, respectively. None of the three primary peritoneal serous papillary carcinomas expressed calretinin, thrombomodulin, cytokeratin 5/6 or CD44H. Polyclonal and monoclonal CEA, and Leu-M1 were expressed by two (10%), one (5%) and seven (35%) serous papillary ovarian carcinomas, respectively. None of the serous papillary peritoneal carcinomas expressed polyclonal CEA, monoclonal CEA or Leu-M1. CA-125 was positive in 19 (95%) and two (67%) ovarian and peritoneal carcinomas, respectively, and in eight (25%) peritoneal mesotheliomas.

Conclusions: Calretinin and Ber-EP4 are useful discriminant markers in distinguishing peritoneal mesothelioma in women from serous papillary ovarian and peritoneal carcinoma. The other mesothelial markers (thrombomodulin, cytokeratin 5/6, and CD44H) and carcinoma markers (polyclonal and monoclonal CEA, and Leu-M1) yielded a too low sensitivity for practical use.

In plain English

This study tested whether antibody stains could help pathologists tell diffuse peritoneal mesothelioma (epithelial subtype) in women from serous papillary carcinoma of the ovary or peritoneum. These cancers can look alike under the microscope. The authors stained tissue from 32 such mesotheliomas, from the UK Health and Safety Executive Mesothelioma Register, and from 20 ovarian and 3 peritoneal carcinomas, with nine markers. The study did not report the patients' asbestos exposure. Nuclear calretinin staining was seen in 28 of 32 mesotheliomas (88%) and in none of the carcinomas. Ber-EP4 stained 95% of ovarian carcinomas but only 9% of mesotheliomas, focally. Thrombomodulin, cytokeratin 5/6 and CD44H stained 56%, 53% and 47% of mesotheliomas, and 30%, 25% and 25% of ovarian carcinomas. CA-125 stained 95% of ovarian carcinomas but also 25% of mesotheliomas. The authors concluded that calretinin and Ber-EP4 were useful markers. They judged thrombomodulin, cytokeratin 5/6, CD44H, CEA and Leu-M1 too insensitive to be primary markers, though they had a supporting role. They judged CA-125 unsuitable because it stained mesotheliomas. They noted that the peritoneal carcinoma group was very small.

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 (immunohistochemical) comparison of archived tumour tissue samples, stained with a panel of antibodies and scored by two observers
• Who was studied: Tumour tissue from 32 women with diffuse peritoneal mesothelioma of epithelial subtype, identified from the UK Health and Safety Executive Mesothelioma Register. Comparison tissue came from 20 serous papillary ovarian carcinomas and 3 serous papillary peritoneal carcinomas from the files of the University Hospital of Wales. Dates of the cases were not given.
• Exposure: No asbestos exposure was measured or reported. What was tested was a panel of antibody stains. The mesothelial markers were calretinin, thrombomodulin, cytokeratin 5/6 and CD44H. The carcinoma markers were polyclonal and monoclonal CEA, Leu-M1, CA-125 and Ber-EP4.
• Main results:
  • Calretinin stained 28 of 32 (88%) peritoneal mesotheliomas. No nuclear calretinin staining was seen in any of the 20 serous papillary ovarian carcinomas or the 3 peritoneal carcinomas. Two ovarian carcinomas showed focal cytoplasmic staining, which the authors did not count as positive.
  • The authors described calretinin as the most sensitive (88%) and specific (100%) mesothelial marker in this comparison.
  • Ber-EP4 stained 9% (3 of 32) of peritoneal mesotheliomas, focally, compared with 95% (19 of 20) of serous papillary ovarian carcinomas and 1 of 3 (33%) serous papillary peritoneal carcinomas.
  • Thrombomodulin stained 18 of 32 (56%) mesotheliomas and 6 of 20 (30%) ovarian carcinomas.
  • Cytokeratin 5/6 stained 17 of 32 (53%) mesotheliomas and 5 of 20 (25%) ovarian carcinomas.
  • CD44H stained 15 of 32 (47%) mesotheliomas and 5 of 20 (25%) ovarian carcinomas.
  • The serous papillary peritoneal carcinomas did not stain with any of the four mesothelial markers.
  • Leu-M1 stained 7 of 20 (35%) ovarian carcinomas, 2 of 32 (6%) mesotheliomas, and none of the 3 peritoneal carcinomas.
  • Polyclonal CEA stained 2 of 20 (10%) ovarian carcinomas and 3 of 32 (9%) mesotheliomas. Monoclonal CEA stained 1 of 20 (5%) ovarian carcinomas and no mesotheliomas.
  • CA-125 stained 19 of 20 (95%) ovarian carcinomas, 2 of 3 (67%) peritoneal carcinomas and 8 of 32 (25%) mesotheliomas. The authors described it as having high sensitivity (95%) but moderate specificity (75%). Because it stained a quarter of the mesotheliomas, they considered it unsuitable for surgical practice.
  • Serous papillary ovarian carcinoma and serous papillary peritoneal carcinoma had similar staining patterns. Immunohistochemistry did not appear useful for telling these two cancers apart.
• The authors' conclusion: The authors concluded that calretinin and Ber-EP4 are useful markers for distinguishing diffuse peritoneal mesothelioma in women from serous papillary ovarian and peritoneal carcinoma. They concluded that thrombomodulin, cytokeratin 5/6, CD44H, polyclonal and monoclonal CEA, and Leu-M1 had too low sensitivity to be primary markers, but have a role alongside calretinin and Ber-EP4. They said CA-125 had low specificity, staining 25% of the mesotheliomas.
• Limitations the authors state:
  • Only three serous papillary peritoneal carcinomas were studied. The authors said the meaning of the low Ber-EP4 staining rate in this group is therefore uncertain.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma, Ovarian cancer, Peritoneal mesothelioma.

Medical terms in this study, explained in our Lexicon: Peritoneal Mesothelioma, Serous Papillary Carcinoma, Peritoneum, Calretinin, Cytokeratin 5/6, Carcinoma, Monoclonal, Carcinoembryonic Antigen (CEA).

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