Renal cell carcinoma vs mesothelioma
Renal cell carcinoma may present with pleural metastases, even in the absence of urological symptoms. Differentiation on morphological grounds may not be possible: a clear cell variant of mesothelioma has been described10,11.
Immunohistochemistry
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mesothelioma
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renal cell carcinoma
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all other adenocarcinomas
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|
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Calretinin
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86% (158/184: 36/371, 38/382, 12/315, 44/446, 47/517,
20/20(three cases stained only weakly)9)
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7% (4/58: 4/401, 0/82, 0/15, 0/46, 0/47, 0/19)
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9% (43/501: 14/1472, 0/35, 28/2766, 1/557,
1/20(weak staining in one case)9)
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CK5/6
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79% (134/169: 29/371, 40/403, 9/315, 56/617)
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5% (3/55: 2/401, 0/103, 0/15, 1/47)
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13% (22/175: 14/1133, 0/35, 8/597)
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Thrombomodulin
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76% (156/206: 32/371, 11/204, 9/315, 55/617, 49/578)
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20% (17/85: 13/401, 1/204, 0/15, 2/47, 1/208)
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16% (17/105: 0/35, 10/597, 7/438)
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CEA
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0/371,
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0/401,
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|
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BerEP4
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6/37(membrane staining, always focal and generally weak)1,
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20/401,
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CD10
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578/145(staining was seen in both epithelioid and sarcomatoid components) 12
|
20/2012
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|
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Erythropoietin
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100/100(staining was equally strong in epithelioid and sarcomatoid components)12
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20/2012
|
|
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Renal cell carcinoma marker
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38/145(staining was largely restricted to the epithelioid coponent)12
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11/2012
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|
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BCA225
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30/361,
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35/401,
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Conclusion
While calretinin and CK5/6 are diagnostically useful, thrombomodulin shows variable specificity for mesothelioma. CEA and BCA225 are uninformative in this context. The sensitivity of BerEP4 for renal cell carcinoma is poor.
References
1 Osborn, M., N. Pelling, et al. (2002). "The value of 'mesothelium-associated' antibodies in distinguishing between metastatic renal cell carcinomas and mesotheliomas." Histopathology 41(4): 301-7.
2 Ordonez, N. G. (1998). "Value of calretinin immunostaining in differentiating epithelial mesothelioma from lung adenocarcinoma." Mod Pathol 11(10): 929-33.
3 Ordonez, N. G. (1998). "Value of cytokeratin 5/6 immunostaining in distinguishing epithelial mesothelioma of the pleura from lung adenocarcinoma." Am J Surg Pathol 22(10): 1215-21.
4 Attanoos, R. L., H. Goddard, et al. (1995). "A comparative immunohistochemical study of malignant mesothelioma and renal cell carcinoma: the diagnostic utility of Leu-M1, Ber EP4, Tamm- Horsfall protein and thrombomodulin." Histopathology 27(4): 361-6.
5 Attanoos, R. L., S. D. Dojcinov, et al. (2000). "Anti-mesothelial markers in sarcomatoid mesothelioma and other spindle cell neoplasms." Histopathology 37(3): 224-31.
6 Doglioni, C., A. P. Tos, et al. (1996). "Calretinin: a novel immunocytochemical marker for mesothelioma." Am J Surg Pathol 20(9): 1037-46.
7 Cury, P. M., D. N. Butcher, et al. (2000). "Value of the mesothelium-associated antibodies thrombomodulin, cytokeratin 5/6, calretinin, and CD44H in distinguishing epithelioid pleural mesothelioma from adenocarcinoma metastatic to the pleura." Mod Pathol 13(2): 107-12.
8 Kennedy, A. D., G. King, et al. (1997). "HBME-1 and antithrombomodulin in the differential diagnosis of malignant mesothelioma of pleura." J Clin Pathol 50(10): 859-62.
9 Leers, M. P., M. M. Aarts, et al. (1998). "E-cadherin and calretinin: a useful combination of immunochemical markers for differentiation between mesothelioma and metastatic adenocarcinoma." Histopathology 32(3): 209-16.
10 Ordonez, N. G., M. Myhre, et al. (1996). "Clear cell mesothelioma." Ultrastruct Pathol 20(4): 331-6.
11 Dessy, E., M. Falleni, et al. (2001). "Unusual clear cell variant of epithelioid mesothelioma." Arch Pathol Lab Med 125(12): 1588-90.
12 Butnor KJ, Nicholson AG, Allred DC, et al. Expression of renal cell carcinoma-associated markers erythropoietin, CD10, and renal cell carcinoma marker in diffuse malignant mesothelioma and metastatic renal cell carcinoma. Arch Pathol Lab Med 2006; 130:823-7 FULL TEXT
This page last revised 12.7.2008.
©SMUHT/PW Bishop