Reactive mesothelium versus
malignant mesothelioma
This
differential may be extremely difficult, especially on small biopsies.
Immunohistochemistry
|
|
reactive mesothelium |
malignant mesothelioma |
comment |
|
Desmin |
80% (8/10
staining generally strong and diffuse2,
8/103) |
23% (10/45
biphasic: 10/19, epithelioid 0/13, sarcomatoid; 0/131,
9/16
epithelioid; 8/13, biphasic; 1/3. Staining was only focal.2,
4/38 27
predominantly epithelioid, 4 predominantly spindle, 7 biphasic.
Desmin positive in epithelioid component in 4/38 and in spindle cell
component in 12/383 ), 18/40
(12/26 epithelioid, 4/10 sarcomatoid, 2/4 biphasic)16,
21/43
(14/34 epithelioid, 5/7 sarcomatoid, 0/1 mixed and 1/1
lymphohistiocytoid mesotheliomas)17 |
examine epithelial component
: desmin is less useful in distinguishing reactive from neoplastic
spindle cell mesothelial proliferations |
|
EMA |
14% (3/734, 5/205, 2/126 6/117) |
74% (103/1414, 30/31
diffuse linear membrane, stronger in epithelioid areas5,
10/126, 76/1127) |
|
|
p53 |
14% (0/208, 0/209, 0/4010, 0/1311,
0/2012, 0/136, 13/20
occasional nuclei positive5, 9/117) |
62% (14/208, 21/47
epithelioid; 10/16, biphasic; 9/19, sarcomatoid; 2/12. Some small
biopsies shows very intense staining.9, 9/3610,
19/4011, 30/3512, 5/126, 30/315,
78/1127) |
|
|
bcl-2 |
0/4413, 0/205 |
5/6213, 0/315 |
does not appear to be useful |
|
p-glycoprotein |
4%( 0/3514, 2/117) |
49% (31/3314, 37/1067) |
background staining may make interpretation difficult |
|
PDGF receptor b |
4% (0/3515, 2/117) |
32% (15/3315, 31/1127) |
probably not useful |
|
Telomerase reverse transcriptase |
0/318 |
67/6818 |
needs the study of more cases of reactive proliferation |
| |
See
also the use of Immunohistochemistry in effusion
cytology.
References
1Mayall,
F. G., Goddard, H., Gibbs, A. R. Intermediate filament expression in
mesotheliomas: leiomyoid mesotheliomas are not uncommon.
Histopathology 1992;21:453-7.
2Hurlimann,
J. Desmin and neural marker expression in mesothelial cells and
mesotheliomas. Hum Pathol 1994;25:753-7.
3Scoones DJ, Richman PI. Expression of desmin and smooth
msucle actin in mesothelial hyperplasia and mesothelioma. J Pathol
1993;169SL188A (abstract).
4Wolanski,
K. D., Whitaker, D., Shilkin, K. B., Henderson, D. W. The use of
epithelial membrane antigen and silver-stained nucleolar organizer
regions testing in the differential diagnosis of mesothelioma from
benign reactive mesothelioses. Cancer 1998;82:583-90.
5Cury,
P. M., Butcher, D. N., Corrin, B., Nicholson, A. G. The use of
histological and immunohistochemical markers to distinguish pleural
malignant mesothelioma and in situ mesothelioma from reactive
mesothelial hyperplasia and reactive pleural fibrosis. J Pathol 1999;189:251-7.
6Casalots J, Tarroch X, Forcada P et al. Utility of
epithelial membrane antigen adn p53 in the differential diagnosis of
benign reactive processes from malingnacy in pelural biopsy
specimens. Virchows Archives 1999;435:286 (abstract).
7Roberts,
F., Harper, C. M., Downie, I., Burnett, R. A. Immunohistochemical
analysis still has a limited role in the diagnosis of malignant
mesothelioma. A study of thirteen antibodies. Am J Clin Pathol 2001;116253-62.
8Kafiri,
G., Thomas, D. M., Shepherd, N. A., Krausz, T., Lane, D. P., Hall,
P. A. p53 expression is common in malignant mesothelioma.
Histopathology 1992;21:331-4.
9Mayall,
F. G., Goddard, H., Gibbs, A. R. p53 immunostaining in the
distinction between benign and malignant mesothelial proliferations
using formalin-fixed paraffin sections. J Pathol 1992;168:377-81.
10Ramael,
M., Lemmens, G., Eerdekens, C., Buysse, C., Deblier, I., Jacobs, W.,
van Marck, E. Immunoreactivity for p53 protein in malignant
mesothelioma and non- neoplastic mesothelium. J Pathol 1992;168:371-5.
11Cagle,
P.T., Brown, R.W. and Lebovitz, R.M. p53 immunostaining in the
differentiation of reactive processes from malignancy in pleural
biopsy specimens. Hum Pathol 1994;25:443-8.
12Esposito,
V., Baldi, A., De Luca, A., Claudio, P.P., Signoriello, G.,
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13Segers,
K., Ramael, M., Singh, S.K., Weyler, J., Van Meerbeeck, J.,
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malignant mesothelioma and non- neoplastic mesothelium. Virchows Arch 1994;424:631-4.
14Ramael,
M., van den Bossche, J., Buysse, C., van Meerbeeck, J., Segers, K.,
Vermeire, P. and van Marck, E. Immunoreactivity for P-170
glycoprotein in malignant mesothelioma and in non-neoplastic
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J Pathol 1992;167:5-8.
15Ramael,
M., Buysse, C., van den Bossche, J., Segers, K. and van Marck, E.
Immunoreactivity for the beta chain of the platelet-derived growth
factor receptor in malignant mesothelioma and non-neoplastic
mesothelium. J Pathol 1992;167:1-4.
16Garcia-Prats,
M. D., C. Ballestin, et al. (1998). "A comparative evaluation
of immunohistochemical markers for the differential diagnosis of
malignant pleural tumours." Histopathology 32(5): 462-72.
17Gonzalez-Lois,
C., Ballestin, C., Sotelo, M. T., Lopez-Rios, F., Garcia-Prats, M.
D., Villena, V. Combined use of novel epithelial (MOC-31) and
mesothelial (HBME-1) immunohistochemical markers for optimal first
line diagnostic distinction between mesothelioma and metastatic
carcinoma in pleura. Histopathology 2001;38:528-34.
18Kumaki,
F., Kawai, T., Churg, A., Galateau-Salle, F. B., Hasleton, P.,
Henderson, D., Roggli, V., Travis, W. D., Cagle, P. T., Ferrans, V.
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This page last
revised 16.12.2002.
©SMUHT/PW Bishop