A comparative evaluation of immunohistochemical markers for the differential diagnosis of malignant pleural tumours

Abstract

Aims To determine the value of immunocytochemistry in differentiation of malignant pleural mesothelioma from carcinoma in a pleural biopsy using commercially available monoclonal antibodies. Methods and results A panel of monoclonal antibodies against keratins, epithelial membrane antigen (EMA), epithelial antigen Ber‐EP4, carcinoembryonic antigen (CEA), tumour‐associated glycoprotein (B72.3), Leu‐M1, CD30 (Ber‐H2), vimentin and desmin, was applied to 40 cases of malignant pleural mesothelioma and 23 cases of carcinoma metastatic to the pleura (16 pulmonary and seven extrapulmonary). Positivities for Ber‐EP4, CEA, B72.3 and Leu‐M1 were found to have the highest nosologic sensitivities (87.0%, 65.2%, 52.5% and 43.5%, respectively) and specificities (97.5%, 97.5%, 100% and 95%, respectively) for carcinoma. Positive staining for vimentin had the highest sensitivity (87.5%) with 95.7% specificity for mesothelioma. Positive staining for desmin was found in 45% of mesotheliomas and 0% of carcinomas. Diagnostic sensitivity and diagnostic specificity (P‐values) were calculated for these markers. In respect to the diagnostic power defined by the clinically relevant predictive values of positive and negative tests, we found that a two‐marker panel of antibodies including vimentin and Ber‐EP4 is most useful for the histopathological distinction between carcinoma (pulmonary or extrapulmonary) and malignant pleural mesothelioma. Conclusions A combination of Ber‐EP4 and vimentin provides the most sensitive and specific pair of markers for distinguishing between malignant pleural mesothelioma and carcinoma metastatic to the pleura. The prevalence of the tested tumours should be taken into account when evaluating the clinical value of ancillary techniques in pathology.

Primary Papillary Serous Carcinoma of the Peritoneum

“…16,17 In the neoplasm in our case, the positive immunostaining of the tumor cells for CK AE1-AE3, vimentin, BerEP4, B72.3, MOC-31 and CA-125 and their negativity for CK5/6, desmin, CEA and CK20 (an immunohistochemical profile similar to that of PSCO [1][2][3]18 and PSCP [1][2][3] ) supported the diagnosis of papillary serous carcinoma.…”

Mesothelioma with rhabdoid features: an ultrastructural and immunohistochemical study of 10 cases

“…68 Desmin is another marker that is frequently used in the diagnosis of rhabdomyosarcomas and, although it has been reported to be present in mesotheliomas, controversy exists regarding the percentage of desmin positivity in the latter tumors. While some groups of investigators have reported expression of this protein in 41-88% of the epithelioid [69][70][71] and in 33-71% of the sarcomatoid 69,70,72 mesotheliomas, others have reported desmin positivity in 0-10% of the epithelioid 68,[73][74][75][76] and in none of the sarcomatoid. [74][75][76] Of the eight cases investigated for desmin expression in the present study, only one exhibited positivity in sparse groups of neoplastic cells in the nonrhabdoid component of the tumor, a finding which confirms previous observations indicating that desmin can be expressed in mesotheliomas but it is a relatively uncommon phenomenon.…”

Deciduoid Pleural Mesothelioma Affecting a Young Female without Prior Asbestos Exposure

“…Histologically, it is not easy to differentiate adenocarcinoma from mesothelioma [3]. A panel of antibodies has to be used to diagnose a mesothelioma [7]. Recently, a new antibody, calretinin, was developed that is specific for mesothelial cells and therefore makes the diagnosis of mesothelioma more reliable [8].…”