Differentiation of carcinoma from mesothelial cells in effusions

Immunohistochemistry on cell blocks prepared from effusion specimens:

carcinoma

mesothelioma

reactive mesothelial cells

Desmin

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

1/12¹, 0/14⁵

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

Calretinin

3/98 (polyclonal): breast; 1/16, 3/67 (ovarian carcinomas)⁶

11/12¹

52/56¹, 37/52⁶

CEA

40/98¹

0/12¹

0/56¹

Ber-EP4

94/98¹

4/12¹

4/56¹

p53

66/98¹

10/12¹

8/56¹

N-cadherin

47/98: primary peritoneal; 3/3, serous ovarian; 34/48, breast; 3/16, endometrial; 1/6¹

12/12¹

48/56¹

E-cadherin

90/98¹

10/12¹

28/56¹

CA 125

70/98¹

12/12¹

47/56¹

vimentin

32/98¹

9/12¹

50/56¹

EMA

94/98¹

12/12¹

39/56¹, 4/12⁴

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.

See also the use of Immunohistochemistry in histological specimens.

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