Document Type : Original Research
Department of Pathology, Tabriz University of Medical Sciences, Tabriz, Iran
Department of Cardiothoracic Surgery, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
Background and Objective: Early diagnosis of malignant pleural mesothelioma (MPM) is the key point of its treatment. The main problem is the precise diagnosis of mesothelioma and its differentiation from metastatic lung adenocarcinoma. Mesothelioma exhibits complex immunohistochemical characteristics. The aim of this study was to study hybrid immunohistochemistry in the differential diagnosis of primary malignant pleural effusion from metastatic pulmonary cancers.
Material and Methods: Twenty tissue samples in paraffin blocks from the pathology department of Imam Reza Hospital in Tabriz whose pathology reports cited mesothelioma or metastatic lung adenocarcinomas, were included in the studies. These tissues were deemed appropriate for IHC in terms of tissue quality and quantity. They were studied and evaluated for pathological markers.
Results: In patients with adenocarcinoma CK7 in 100% of patients (13 patients), TTF1 in 61.5% of patients (8 patients) and CEA in 53.8% of patients (7 patients) were positive, but HBME1 and Calretinin were negative for all patients. In patients with mesothelioma, HBME1 and Calretinin were positive in 100% of patients (7 patients) and TTF1, CEA and CK7 were negative.
Conclusion: The results of this study showed that CEA, CK7, TTF1, Calretinin and HBME1 are suitable criteria for differentiating between metastatic lung adenocarcinoma and mesothelioma, and can differentiate the mesothelioma and adenocarcinoma with high accuracy.
- Lopes C,Teixera E, Mayor R, Almeida A. Malignant mesothelioma: A ten years experience. Rev Port Pneumol 2005;11(1):16-18.
- Bagheri R, Haghi SZ, Rahim MB, Attaran D, Toosi M S . Malignant pleural mesothelioma: clinicopathologic and survival characteristic in a consecutive series of 40 patients. Ann Thorac Cardiovasc Surg 2011;17(2):130-6.
- Elkiran ET, Kaplan MA, Sevinc A, Aksoy S, Demirci U, Seker M et al. Multicentric study on malignant pleural mesothelioma in Turkey: clinicopathologic and survival characteristics of 282 patients. Medical oncology 2012;29(5):3147-54.
- Zalcman G, Mazieres J, Margery J, Greillier L., Audigier-Valette C, Moro-Sibilot D et al. Bevacizumab for newly diagnosed pleural mesothelioma in the Mesothelioma Avastin Cisplatin Pemetrexed Study (MAPS): a randomised, controlled, open-label, phase 3 trial. The Lancet 2016;387(10026):1405-14.
- Ordóñez NG. Immunohistochemical diagnosis of epithelioid mesothelioma: an update. Arch Pathol Lab Med 2005;129(11):1407-14 .
- Nitadori JI, Ishii G, Tsuta K, Yokose T, Murata Y, Kodama T et al. Immunohistochemical differential diagnosis between large cell neuroendocrine carcinoma and small cell carcinoma by tissue microarray analysis with a large antibody panel. Am J Clin Pathol 2006;125:682-692 .
- Ordóñez NG, Sahin AA. Diagnostic utility of immunohistochemistry in distinguishing between epithelioid pleural mesotheliomas and breast carcinomas: a comparative study. Human pathology 2014;45(7):1529-40.
- William M, Alan BP. Determination of primary site by examination of cancer cells in body fluids. Am J Clin Pathol 1972;58(5):479-488.
- Dardick I, Jabi M, Elliott Mccaughey WT, Deodhare S, Peter Van Nostrand A W, Srigley J R. Diffuse epithelial mesothelioma: a review of the ultrastructural spectrum. Ultrastructural pathology 1987;11(5-6): 503-33.
- Fetsch PA, Abati A. Immunocytochemistry in effusion cytology: a contemporary review. Cancer 2001;93(5):293-308.
- Khoor A, Whitsett JA, Stahlman MT, Olson SJ, Cagle PT. Utility of surfactant protein B precursor and thyroid transcription factor 1 in differentiating adenocarcinoma of the lung from malignant mesothelioma. Hum pathol 1999;30(6): 695-700.
- Su XY, Li GD, Liu WP, Xie B, Jiang YH. Cytological differential diagnosis among adenocarcinoma, epithelial mesothelioma, and reactive mesothelial cells in serous effusions by immunocytochemistry. Diagnostic cytopathology 2011;39(12):900-8.
- Carella R, Deleonardi G, D'errico A, Salerno A, Egarter–Vigl E, Seebacher C, Grigioni W F. Immunohistochemical panels for differentiating epithelial malignant mesothelioma from lung adenocarcinoma: a study with logistic regression analysis. Am j surg pathol 2001;25(1):43-50.
- Dinu M , Ciurea RN, Stefan M,Georgescu AC. The role of immunohistochemistry in the diagnosis of neoplastic pleural effusions. Rom J Morphol Embryol 2012;53(3 Suppl):817-20.
- Ordóñez NG. The immunohistochemical diagnosis of mesothelioma: a comparative study of epithelioid mesothelioma and lung adenocarcinoma. Am j surg patho 2003;27(8):1031-51.
- Comin CE, Novelli L, Boddi V, Paglierani M, Dini S. Calretinin, thrombomodulin, CEA, and CD15: a useful combination of immunohistochemical markers for differentiating pleural epithelial mesothelioma from peripheral pulmonary adenocarcinoma. Hum pathol 2001;32(5):529-36.
- Hyun TS, Barnes M, Tabatabai ZL.The diagnostic utility of D2-40, calretinin, CK5/6, desmin and MOC-31 in the differentiation of mesothelioma from adenocarcinoma in pleural effusion cytology. Acta cytol 2012;56(5):527-32.
- Lucian R Chirieac, Geraldine S Pinkus, Jack L Pinkus,John Godleski,david j Sugarbaker.The immunohistochemical characterization of sarcomatoid malignant mesothelioma of the pleura. Am j cancer res 2011;1(1):14-24.
- Woo JS, Reddy OL, Koo M, Xiong Y, Li F, Xu H. Application of Immunohistochemistry in the Diagnosis of Pulmonary and Pleural Neoplasms. ArchPathl Lab Med 2017;141(9):1195-1213. .
- Ordóñez NG. Value of claudin-4 immunostaining in the diagnosis of mesothelioma. Am j clin patho 2013;139(5):611-9.
- Tot T. The value of cytokeratins 20 and 7 in discriminating metastatic adenocarcinomas from pleural mesotheliomas. Cancer 2001;92(10):2727-32.