Differentiation of carcinoma from mesothelial cells in effusions
Immunohistochemistry on cell blocks prepared from effusion specimens:
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carcinoma
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mesothelioma
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reactive mesothelial cells
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Desmin
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2/98: both positive cases were serous ovarian carcinomas1,
1/22: staining weak and focal in all 22, but with suitable cut-of could be differentiated from mesothelial cells (scored 0-3 for intensity and 0-5 for distribution; a sum of the score of 4 or greater is definite staining.)2, 0/565
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1/121, 0/145
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47/561,
25/25(scored 0-3 for intensity and 0-5 for distribution; the sum of the scores of at least 4 for definite positivity)2, 19/203,
22/24: strong cytoplasmic5
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Calretinin
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3/98(polyclonal): breast; 1/16,
3/67(ovarian carcinomas)6
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11/121
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52/561, 37/526
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CEA
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40/981
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0/121
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0/561
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Ber-EP4
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94/981
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4/121
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4/561
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p53
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66/981
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10/121
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8/561
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N-cadherin
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47/98: primary peritoneal; 3/3, serous ovarian; 34/48, breast; 3/16, endometrial; 1/61
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12/121
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48/561
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E-cadherin
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90/981
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10/121
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28/561
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CA 125
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70/981
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12/121
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47/561
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vimentin
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32/981
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9/121
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50/561
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EMA
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94/981
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12/121
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39/561, 4/124
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Desmin and calretinin appear to be useful mesothelial markers. CEA has a high specificity for carcinoma but a low sensitivity. Ber-EP4 also appears useful, but stains some mesotheliomas as well as carcinomas. p53 has potential in the differentiation of malignant (carcinoma or mesothelioma) from benign mesothelial cells.
References
1Davidson, B., Nielsen, S., Christensen, J., Asschenfeldt, P., Berner, A., Risberg, B., Johansen, P. The role of desmin and N-cadherin in effusion cytology: a comparative study using established markers of mesothelial and epithelial cells. Am J Surg Pathol 2001;25:1405-1412.
2Gill, S. A., Meier, P. A., Kendall, B. S. Use of desmin immunohistochemistry to distinguish between mesothelial cells and carcinoma in serous fluid cell block preparations. Acta Cytol 2000;44:976-80.
3Hurlimann, J. Desmin and neural marker expression in mesothelial cells and mesotheliomas. Hum Pathol 1994;25:753-7.
4Walts, A. E., Said, J. W., Shintaku, I. P. Epithelial membrane antigen in the cytodiagnosis of effusions and aspirates: immunocytochemical and ultrastructural localization in benign and malignant cells. Diagn Cytopathol 1987;3:41-9.
5Afify, A.M., Al-Khafaji, B.M., Paulino, A.F. and Davila, R.M. Diagnostic use of muscle markers in the cytologic evaluation of serous fluids. Appl Immunohistochem Mol Morphol 2002;10:178-82.
6B Davidson et al. E-cadherin and alpha-, beta-, and gamma-catenin protein expression is up-regulated in ovarian carcinoma cells in serous effusions. J Pathol 2000;192:46-469.
This page last revised 16.12.2002.
©SMUHT/PW Bishop