Cytologic diagnosis of malignant mesothelioma in serous effusions using an antimesothelial‐cell antibody

Abstract

Differentiating mesothelioma, reactive mesothelium, and adenocarcinoma in serous effusions is often difficult, despite the application of ancillary techniques in support of the traditional cytomorphologic criteria. A polyclonal antimesothelial-cell antibody recently developed by our group was evaluated as a histogenetic marker on a series of primary (n = 12) and metastatic (n = 12) malignant effusions. Immunostaining was performed on paraffin sections from cell blocks. All mesothelioma effusions stained positive for the antibody, whereas, in contrast, all metastatic carcinoma specimens failed to react. These results (100 percent specificity and 100% sensitivity for mesothelioma) provide a basis for a reliable use of the antibody in the cytologic examination of suspicious or malignant serous effusions.

Calretinin

“…Calretinin has been proposed as a selective marker for mesotheliomas, allowing their differentiation from metastatic adenocarcinomas. 12,15 The results of the present study support these findings in cytologic preparations both on destained archival smears and in cell suspensions by demonstrating the exclusive capability of living mesothelial cells to bind anticalretinin serum.…”

“…5,6,9,11,12,27 Recently Gotzos et al 15 showed that calretinin, a 29-kd calcium-binding protein normally present in neurons of the central and peripheral nervous system and in certain nonneural cells, 16,18,21,25 is a selective marker of mesotheliomas of the epithelial type and is absent from lung adenocarcinomas. Similar observations were reported by Doglioni et al, 10 who included in their larger survey cytologic preparations from 26 cases with histologic and/or clinical confirmation of reactive mesothelioma or metastatic serous effusions.…”

Serous effusions: diagnosis of malignancy beyond cytomorphology. An analytic review

“…Therefore, a panel of antibodies is often used to confirm or to exclude the possibility of an adenocarcinoma. 10 11 Specific mesothelial cell markers include ME1 monoclonal antibody, 12 OV-CAR3, 13 14 thrombomodulin, 15 HBME-1, 15 N-cadherin, 16 and calretinin [17][18][19][20] In addition, mesotheliomas show positivity for both low and high molecular weight cytokeratins. 21 22 The epithelial mesothelioma expresses thrombomodulin ranging from 49.1% to 100% positivity in different series.…”

Immunocytochemistry in effusion cytology

“…Over the last several years, other epithelial/carcinoma markers (including MOC‐31, blood group‐related antigens, HMFG‐2, and E‐cadherin) have been studied, but often with conflicting results 5, 18, 29, 36. “Positive” mesothelial markers also have been introduced as part of the panel, including OV632, thrombomodulin, CK 5/6, calretinin, HBME‐1, N‐cadherin, CD44S, and WT1, also with varying results 5, 18, 20, 24, 25, 29, 30, 35–37, 39, 40, 43, 45–49, 51–63. Finally, there is speculation that markers such as p53, E‐cadherin, and MOC‐31 may be useful for the identification of reactive mesothelial cells 43, 46, 47, 64…”

“…Epithelial membrane antigen (EMA) belongs to a group of proteins known as human milk fat globule membrane proteins. It is present in a wide variety of epithelia of both normal and neoplastic types 24, 31, 33, 34, 40, 56, 68. Immunoreactivity, indicated by a membranous staining pattern, is evident in mammary epithelium, glandular epithelia, epithelial and squamous cell tumors, and in some lymphoid neoplasms (i.e., anaplastic large cell lymphomas).…”