title: MUC4, a novel immunohistochemical marker identified by gene expression profiling, differentiates pleural sarcomatoid mesothelioma from lung sarcomatoid carcinoma.
abstract: Sarcomatoid mesothelioma, a histological subtype of malignant pleural mesothelioma, is a very aggressive tumor with a poor prognosis. Histological diagnosis of sarcomatoid mesothelioma largely depends on the histomorphological feature of spindled tumor cells with immunohistochemical reactivity to cytokeratins. Diagnosis also requires clinico-radiological and/or macroscopic evidence of an extrapulmonary location to differentiate it from lung sarcomatoid carcinoma. Although there are promising immunohistochemical antibody panels to differentiate mesothelioma from lung carcinoma, a consensus on the immunohistochemical markers that distinguish sarcomatoid mesothelioma from lung sarcomatoid carcinoma has not been reached and requires further study. We performed whole gene expression analysis of formalin-fixed paraffin-embedded tissue from sarcomatoid mesothelioma and lung sarcomatoid carcinoma and observed significant differences in the expression of MUC4 and other genes between sarcomatoid mesothelioma and lung sarcomatoid carcinoma. Immunohistochemistry demonstrated that MUC4 was expressed in the spindled tumor cells of lung sarcomatoid carcinoma (21/29, 72%) but was not expressed in any sarcomatoid mesothelioma (0/31, 0%). To differentiate sarcomatoid mesothelioma from lung sarcomatoid carcinoma, negative MUC4 expression showed 100% sensitivity and 72% specificity and accuracy rate of 87%, which is higher than immunohistochemical markers such as calretinin, D2-40 and Claudin-4. Therefore, we recommend to include MUC4 as a novel and useful negative immunohistochemical marker for differentiating sarcomatoid mesothelioma from lung sarcomatoid carcinoma.
authors.affiliation: Department of Pathology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
authors.forename: Vishwa Jeet
authors.initials: VJ
authors.lastname: Amatya
authors.affiliation: Department of Pathology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Kushitani
authors.affiliation: Department of Pathology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.|Department of Pathology and Clinical Pathology, South Valley University, Qena, Egypt.
authors.forename: Amany Sayed
authors.initials: AS
authors.lastname: Mawas
authors.affiliation: Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Miyata
authors.affiliation: Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Hiroshima, Japan.
authors.forename: Morihito
authors.initials: M
authors.lastname: Okada
authors.affiliation: Department of Internal Medicine, Okayama Rosai Hospital, Okayama, Japan.
authors.forename: Takumi
authors.initials: T
authors.lastname: Kishimoto
authors.affiliation: Department of Pathology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.|Pathologic Diagnostic Center, Inc., Hiroshima, Japan.
authors.forename: Kouki
authors.initials: K
authors.lastname: Inai
authors.affiliation: Department of Pathology, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Takeshima
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis; D002277:Carcinoma / Q000175:diagnosis*; D003937:Diagnosis, Differential; D020869:Gene Expression Profiling / Q000379:methods; D006801:Humans; D007150:Immunohistochemistry; D008175:Lung Neoplasms / Q000175:diagnosis*; D008654:Mesothelioma / Q000175:diagnosis*; D000086002:Mesothelioma, Malignant; D055264:Mucin-4 / Q000032:analysis / Q000096:biosynthesis*; D010997:Pleural Neoplasms / Q000175:diagnosis*; D012680:Sensitivity and Specificity
chemical_list: D014408:Biomarkers, Tumor; C524658:MUC4 protein, human; D055264:Mucin-4