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

 

 

mesothelioma

renal cell carcinoma

all other adenocarcinomas

 

Calretinin

86% (158/184: 36/371, 38/382, 12/315, 44/446, 47/517, 20/209)

7% (4/58: 4/401, 0/82, 0/15, 0/46, 0/47, 0/19)

9% (43/501: 14/1472, 0/35, 28/2766, 1/557, 1/209)

CK5/6

79% (134/169: 29/371, 40/403, 9/315, 56/617)

5% (3/55: 2/401, 0/103, 0/15, 1/47)

13% (22/175: 14/1133, 0/35, 8/597)

Thrombomodulin

76% (156/206: 32/371, 11/204, 9/315, 55/617, 49/578)

20% (17/85: 13/401, 1/204, 0/15, 2/47, 1/208)

16% (17/105: 0/35, 10/597, 7/438)

CEA

0/371,

0/401,

 

BerEP4

6/371,

20/401,

 

BCA225

30/361,

35/401,

 

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

1Osborn, 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.

2Ordonez, N. G. (1998). "Value of calretinin immunostaining in differentiating epithelial mesothelioma from lung adenocarcinoma." Mod Pathol 11(10): 929-33.

3Ordonez, 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.

4Attanoos, 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.

5Attanoos, R. L., S. D. Dojcinov, et al. (2000). "Anti-mesothelial markers in sarcomatoid mesothelioma and other spindle cell neoplasms." Histopathology 37(3): 224-31.

6Doglioni, C., A. P. Tos, et al. (1996). "Calretinin: a novel immunocytochemical marker for mesothelioma." Am J Surg Pathol 20(9): 1037-46.

7Cury, 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.

8Kennedy, 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.

9Leers, 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.

10Ordonez, N. G., M. Myhre, et al. (1996). "Clear cell mesothelioma." Ultrastruct Pathol 20(4): 331-6.

11Dessy, E., M. Falleni, et al. (2001). "Unusual clear cell variant of epithelioid mesothelioma." Arch Pathol Lab Med 125(12): 1588-90.

 

This page last revised 7.1.2004.

©SMUHT/PW Bishop