Value of the mesothelium-associated antibodies thrombomodulin, cytokeratin 5/6, calretinin, and CD44H in distinguishing epithelioid pleural mesothelioma from adenocarcinoma metastatic to the pleura.
Until recently, the standard approach of most laboratories in distinguishing epithelioid pleural mesothelioma from metastatic adenocarcinoma has been a negative result from a panel of adenocarcinoma-associated antibodies. However, several "mesothelium-associated" antibodies have been proposed as useful in this situation, and we have applied four of these putative mesothelioma markers--thrombomodulin, cytokeratin 5/6, calretinin, and CD44H--to a series of 61 epithelioid pleural mesotheliomas and 63 metastatic adenocarcinomas with known primary sites (lung = 19; breast = 21; ovary = 6; colon = 10; kidney = 4; uterus, epididymis, pancreas = 1 case each). Of the mesotheliomas, 55 of 61 (90%) stained for thrombomodulin, 56 of 61 (92%) for cytokeratin 5/6, 47 of 51 cases (92%) were positive for calretinin, and 39 of 43 (91%) were positive for CD44H. Of the metastatic adenocarcinomas, 12 of 63 (19%) cases were positive for thrombomodulin, 9 of 63 (14%) were positive for CK5/6, and 27 of 60 (45%) were positive for CD44H. With calretinin, only 1 case of 59 (2%) showed positive nuclear staining. All four antibodies stained reactive mesothelium; thrombomodulin also stained endothelium; and CD44H variably stained lymphocytes, macrophages, and fibroblasts. We conclude that all four antibodies show high sensitivity for epithelioid mesothelioma, but only calretinin (98%), cytokeratin 5/6 (86%), and thrombomodulin (81%) show sufficient specificity for practical use in this situation.
Cury
P M
PM
Department of Histopathology, Heart Institute, University of Sao Paulo, Brazil.
Butcher
D N
DN
Fisher
C
C
Corrin
B
B
Nicholson
A G
AG
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000556:secondary; D000912:Antibodies, Neoplasm; D000951:Antigens, Neoplasm / Q000276:immunology*; D064032:Calbindin 2; D003937:Diagnosis, Differential; D006801:Humans; D018960:Hyaluronan Receptors / Q000276:immunology; D007124:Immunoenzyme Techniques; D007633:Keratins / Q000276:immunology; D008654:Mesothelioma / Q000175:diagnosis* / Q000473:pathology; D010997:Pleural Neoplasms / Q000175:diagnosis* / Q000556:secondary; D064030:S100 Calcium Binding Protein G / Q000276:immunology; D012680:Sensitivity and Specificity; D018180:Thrombomodulin / Q000276:immunology
D000912:Antibodies, Neoplasm; D000951:Antigens, Neoplasm; C576764:CALB2 protein, human; D064032:Calbindin 2; D018960:Hyaluronan Receptors; D064030:S100 Calcium Binding Protein G; D018180:Thrombomodulin; D007633:Keratins