D2-40, oncofetal M2A antigen

D2-40 was initially considered to be directed against the M2A antigen, a 40 kDa O-linked sialoglycoprotein found on the cell surface of testicular gonocytes, germ cell tumours lymphatic endothelium and mesothelial cells. Using a human podoplanin-Fc fusion protein, it has been shown that the commercially available mouse monoclonal antibody D2-40 specifically recognized human podoplanin, as assessed by enzyme-linked immunosorbent assay and Western blot analyses8.

D2-40 is immunoreactive with formalin-fixed paraffin embedded tissue.

Immunohistochemical expression

The lymphatic staining is in a thin linear pattern: unlike CD31 and CD34, blood vessel endothelium is negative.

The basal layer of sebaceous glands and outer root sheath of hair follicles stain.

Kaposi sarcoma stains, suggesting derivation from lymphatics.

   

D2-40

CD31

 
 

Lymphangioma

10/106, 10/107

5/106, 5/107

 

Haemangioma

0/106 0/227

10/106, 27/277

Spindle cell haemangioma

1/57

 

Glomus tumour

0/36, 0/57

0/36, 0/57

Angiolipoma

0/26

2/26

Pyogenic granuloma

0/26

2/26

Vascular malformation

0/26

2/26

Reactive angioendotheliomatosis

1/1

1/17

Vascular transformation of lymph node

1/17

1/17

Dabska tumour

3/37

3/37

Haemangiopericytoma

0/16

1/16

Epithelioid haemangioendothelioma

0/16, 1/107

1/16, 10/107

Retiform haemangioendothelioma

0/17

1/17

Kaposiform haemangioendothelioma

0/17

1/17

Cutaneous Kaposi sarcoma

24/246, 9/107

24/246, 9/107

Angiosarcoma

3/76, 7/157

7/76, 15/157

Neurofibroma

0/66

 

Dermatofibroma

2/66

 

Dermatofibrosarcoma protuberans

0/46

 

Leiomyosarcoma

3/106

 

Malignant fibrous histiocytoma

1/26

 

     

 

Mesothelial immunoreactivity is membranous and, to a lesser extent, cytoplasmic. Other antibodies are shown for comparison.

   

D2-40

Calretinin

WT1

CK5/6

 
 

rate of positivity

mean percentage of cells staining in positive cases

 

 
Mesothelioma

epithelioid

33/331, 32/455,  84/11211

92%1

33/331,  104/11211

19/331

29/321

biphasic

15/161,  96/16211,  39/12011

epithelioid cells: 90%, sarcomatous cells: 26%1

16/161,  148/16411,  70/12111

10/161

13/161

sarcomatous

3/41,  11/4611

52%1

2/41,  25/4611

0/41

1/41

Reactive pleura

27/281

71%1

 

 

 

Pulmonary adenocarcinoma

2/311

13%1

7/311

2/311

12/311

Ovarian serous carcinoma

17/261

33%1

8/261

23/261

9/261

 
Renal cell carcinoma

Conventional

0/161

 

2/161

0/161

5/161

Papillary

5/131

43%1

1/131

1/131

7/131

Chromophobe

0/51

 

1/51

1/51

1/51

Breast carcinoma

3/161

13%1

 

 

 

Prostatic adenocarcinoma

0/111

 

 

 

 

Urothelial carcinoma

0/71

 

 

 

 

             

 

Calretinin has a greater sensitivity than does D2-40 in both epithelioid and sarcomatoid mesotheliomas but it is useful to combine them in a panel:

 

 Sensitivities:

epithelioid

sarcomatoid

 

calretinin

0.91

0.57

D2-40

0.66

0.3

positivity for calretinin or D2-40

0.96

0.66

 

Another study evaluated podoplanin alongside D2-402:

 

 

   

D2-40

Podoplanin

 

Mesothelioma

epithelioid

25/29

25/29

biphasic

4/5

4/5

sarcomatoid

0/6

0/6

Adenocarcinoma

lung

0/24

0/24

ovary

0/17

0/17

endometrium

0/5

0/5

breast

0/10

0/10

pancreas

0/5

0/5

stomach

0/5

0/5

colon

0/10

0/10

kidney

0/10

0/10

prostate

0/5

0/5

thyroid

0/3

0/3

Adenomatoid tumour

2/2

2/2

Squamous carcinoma of lung

0/10

0/10

Angiosarcoma

2/5

2/5

Synovial sarcoma

biphasic

4/6

4/6

monophasic

0/6

0/6

       

 

This study was based on cell blocks prepared from serous effusions3. In cases where tumours stained, the pattern was membranous.

 

 

up to 10% of tumour cells staining

more than 10% of tumour cells staining

 

reactive mesothelium

 

153/153

malignant mesothelioma

2/32

30/32

malignant mesothelioma biopsies

 

12/12

ovarian carcinoma

85/169

13/169

ovarian microarray of biopsies

5/72

9/72

breast carcinoma

11/44

2/44

adenocarcinoma of unknown origin

3/14

3/14

lung carcinoma

2/6

0/6

Other cancers

7/17

2/17

     

 

Primary cutaneous carcinomas are commonly positive while metastases to skin are negative:

 

primary skin tumours

Sebaceous carcinoma

10/109, 2/29

 

Squamous cell carcinoma

10/109

Porocarcinoma

4/49, 2/29

Trichilemmal carcinoma

4/49

Sweat gland adenocarcinoma

1/19

Adenoid cystic carcinoma

0/19

Skin adnexal carcinoma NOS

4/49, 0/19

Atypical adnexal tumour

1/19

Benign primary adnexal tumour

38/469, 6/69

     

Carcinoma metastatic to skin

0/159, 1/219

     

Diagnostic utility

References

1 Chu AY, Litzky LA, Pasha TL, Acs G,Zhang PJ Utility of D2-40, a novel mesothelial marker, in the diagnosis of malignant mesothelioma. Mod Pathol 2005; 18:105-10

2 Ordonez NG D2-40 and podoplanin are highly specific and sensitive immunohistochemical markers of epithelioid malignant mesothelioma. Hum Pathol 2005; 36:372-80

3 Bassarova AV, Nesland JM,Davidson B. D2-40 is Not a Specific Marker for Cells of Mesothelial Origin in Serous Effusions. Am J Surg Pathol 2006; 30:878-82

4 Ordonez NG. Immunohistochemical diagnosis of epithelioid mesothelioma: an update. Arch Pathol Lab Med 2005; 129:1407-14 FULL TEXT

5 SienkoA, Zander DS, Killen D et al. D2-40 is a novel new marker of malignant mesothelioma (MM): tissue microarray study of 45 MM versus 409 lung carcinomas and primary non-mesothelial neoplasm of the pleura and chest wall. Mod Pathol 2005;18(suppl1):318A.

6 Kahn HJ, Bailey D,Marks A. Monoclonal antibody D2-40, a new marker of lymphatic endothelium, reacts with Kaposi's sarcoma and a subset of angiosarcomas. Mod Pathol 2002; 15:434-40

7 Fukunaga M. Expression of D2-40 in lymphatic endothelium of normal tissues and in vascular tumours. Histopathology 2005; 46:396-402

8 Schacht V, Dadras SS, Johnson LA, et al. Up-regulation of the lymphatic marker podoplanin, a mucin-type transmembrane glycoprotein, in human squamous cell carcinomas and germ cell tumors. Am J Pathol 2005; 166:913-21 FULL TEXT

9 Liang H, Wu H, Giorgadze TA, et al. Podoplanin is a highly sensitive and specific marker to distinguish primary skin adnexal carcinomas from adenocarcinomas metastatic to skin. Am J Surg Pathol 2007; 31:304-10

10 Arnaout-Alkarain A, Kahn HJ, Narod SA, et al. Significance of lymph vessel invasion identified by the endothelial lymphatic marker D2-40 in node negative breast cancer. Mod Pathol 2007; 20:183-91

11 Hinterberger M, Reineke T, Storz M, et al. D2-40 and calretinin - a tissue microarray analysis of 341 malignant mesotheliomas with emphasis on sarcomatoid differentiation. Mod Pathol 2007; 20:248-55

12 Kuroda N, Toi M, Hiroi M, et al. Diagnostic pitfall of D2-40 in adenomatosid tumour. Histopathology 2007; 51:719-21

13  Barresi V, Reggiani Bonetti L, Vitarelli E, Di Gregorio C, Ponz de Leon M, Barresi G. Immunohistochemical assessment of lymphovascular invasion in stage I colorectal carcinoma: prognostic relevance and correlation with nodal micrometastases. Am J Surg Pathol. 2012 Jan;36(1):66-72.

This page last revised 6.3.2012.

©SMUHT/PW Bishop