The diagnostic utility of D2-40, calretinin, CK5/6, desmin and MOC-31 in the differentiation of mesothelioma from adenocarcinoma in pleural effusion cytology.
OBJECTIVE
To evaluate the utility of the lymphatic endothelial marker D2-40, along with calretinin, CK5/6, desmin and MOC-31, in differentiating mesothelioma and adenocarcinoma in pleural effusion cytology.


METHODS
Forty-five pleural effusion cases representing confirmed reactive effusions (13), mesotheliomas (11) and metastatic adenocarcinomas (21) were immunostained with antibodies against D2-40, calretinin, CK5/6, desmin and MOC-31.


RESULTS
D2-40 showed membranous staining in 82% of mesotheliomas and 77% of reactive effusions. Calretinin and CK5/6 were positive in 100 and 64% of mesotheliomas, and 92 and 31% of reactive effusions, respectively. All adenocarcinomas showed lack of staining with these markers. Desmin was negative in all malignant cases and positive in 85% of reactive effusions. All adenocarcinomas were positive for MOC-31 and negative for the remaining markers.


CONCLUSIONS
Calretinin was the most sensitive in detecting mesothelial differentiation, followed by D2-40. Although useful, D2-40 necessitated cautious interpretation due to occasional focal/weak positivity, particularly in limited cellularity samples. The muscle marker desmin was useful in differentiating benign from malignant effusions but not in distinguishing mesotheliomas from adenocarcinomas. MOC-31 was both highly sensitive and specific for detecting adenocarcinoma and was useful as part of a panel of stains in differentiating cells of mesothelial origin from adenocarcinoma.
Department of Pathology, University of California, San Francisco, CA 94121, USA.
Teresa S
TS
Hyun
Michael
M
Barnes
Z Laura
ZL
Tabatabai
D000230:Adenocarcinoma / Q000175:diagnosis* / Q000378:metabolism; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000032:analysis; D058846:Antibodies, Monoclonal, Murine-Derived / Q000032:analysis; D014408:Biomarkers, Tumor / Q000032:analysis*; D064032:Calbindin 2; D003581:Cytodiagnosis / Q000379:methods; D003893:Desmin / Q000032:analysis; D003937:Diagnosis, Differential; D006801:Humans; D007150:Immunohistochemistry; D053555:Keratin-5 / Q000032:analysis; D053553:Keratin-6 / Q000032:analysis; D008297:Male; D008654:Mesothelioma / Q000175:diagnosis* / Q000378:metabolism; D008875:Middle Aged; D016066:Pleural Effusion, Malignant / Q000175:diagnosis* / Q000378:metabolism; D015203:Reproducibility of Results; D064030:S100 Calcium Binding Protein G / Q000032:analysis; D012680:Sensitivity and Specificity
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D014408:Biomarkers, Tumor; C576764:CALB2 protein, human; D064032:Calbindin 2; D003893:Desmin; D053555:Keratin-5; D053553:Keratin-6; C546130:MOC-31 monoclonal antibody, human; D064030:S100 Calcium Binding Protein G; C500987:monoclonal antibody D2-40