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 described^10,11.

Immunohistochemistry

		mesothelioma	renal cell carcinoma	all other adenocarcinomas
	Calretinin	86% (158/184: 36/371, 38/382, 12/315, 44/446, 47/517, 20/20 (three cases stained only weakly)9)	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, 1/20 (weak staining in one case)9)
	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	6/37 (membrane staining, always focal and generally weak)1,	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