title: Value of the mesothelium-associated antibodies thrombomodulin, cytokeratin 5/6, calretinin, and CD44H in distinguishing epithelioid pleural mesothelioma from adenocarcinoma metastatic to the pleura.
abstract: 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.
authors.affiliation: Department of Histopathology, Heart Institute, University of Sao Paulo, Brazil.
authors.forename: P M
authors.initials: PM
authors.lastname: Cury
authors.forename: D N
authors.initials: DN
authors.lastname: Butcher
authors.forename: C
authors.initials: C
authors.lastname: Fisher
authors.forename: B
authors.initials: B
authors.lastname: Corrin
authors.forename: A G
authors.initials: AG
authors.lastname: Nicholson
mesh_terms: 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
chemical_list: 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