title: Pleural mesothelioma: diagnostic problems and evaluation of prognostic factors.
abstract: BACKGROUND
  Malignant pleural mesothelioma (MPM) in Egypt is mainly attributed to an environmental origin i.e exposure to asbestos, with a high incidence in women and young adults. Immunohistochemistry and ultrastructural features aid in the diagnosis. The p27Kip1 is a kinase inhibitor protein acting as a cell cycle regulator and a putative tumor suppressor gene playing a critical role in the pathogenesis of several human neoplasms.
  
  
  OBJECTIVE
  A clinicopathologic, immunohistochemical and ultrastructural study of mesothelioma in Egyptian patients, with identification of different prognostic factors.
  
  
  METHODS
  Sixty-one cases of MPM were collected from the department of pathology at the NCI, Cairo. Cases were stained by monoclonal antibodies against CK5/6, calretinin, vimentin, CD15, CEA and p27.
  
  
  RESULTS
  More than half (57.4%) of the patients were residents in endemic areas; 50.8% were of epithelioid type. CK5/6 was positive in 45 (73.8%) cases, 39 (63.9%) cases were positive for vimentin, 49 (80.3%) cases were positive for calretinin. One case showed a focal weak positive reaction to CD15. None of the cases stained for CEA. There was a statistically significant relation between p27 expression and the histopathologic type (p=0.02) between overall survival and age (p=0.01), histopathologic type (p=0.02) and stage (p=0.006).
  
  
  CONCLUSIONS
  MPM is an increasing disaster in Egypt which is underestimated and neglected. A panel of immunohistochemical markers should be used for proper evaluation. p27 has proven to be a potential biologic prognostic marker for mesothelioma and more studies as regard its significance are recommended on a larger number.
authors.affiliation: The Department of Pathology, National Cancer Institute, Cairo University. hodanci@hotmail.com
authors.forename: Hoda M
authors.initials: HM
authors.lastname: Ismail
authors.forename: Mohamed A Akram A
authors.initials: MA
authors.lastname: Nouh
authors.forename: Iman L
authors.initials: IL
authors.lastname: Abulkheir
authors.forename: Abd El-Rahman M
authors.initials: Ael-R
authors.lastname: Abd El-Rahman
authors.forename: Hassan N
authors.initials: HN
authors.lastname: Tawfik
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis* / Q000378:metabolism; D064032:Calbindin 2; D002272:Carcinoembryonic Antigen / Q000378:metabolism; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053555:Keratin-5 / Q000378:metabolism; D053553:Keratin-6 / Q000378:metabolism; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality; D008875:Middle Aged; D010997:Pleural Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000401:mortality; D011379:Prognosis; D018809:Proliferating Cell Nuclear Antigen / Q000378:metabolism; D064030:S100 Calcium Binding Protein G / Q000378:metabolism; D016019:Survival Analysis
chemical_list: D014408:Biomarkers, Tumor; C576764:CALB2 protein, human; D064032:Calbindin 2; D002272:Carcinoembryonic Antigen; D053555:Keratin-5; D053553:Keratin-6; D018809:Proliferating Cell Nuclear Antigen; D064030:S100 Calcium Binding Protein G; C413374:p27 antigen