Histomorphological and Immunohistochemical Analysis of Pleural Neoplasms

Abstract

Lung neoplasms; Mesothelioma;Pleura; Sarcoma; Carcinoid Background & objective: Primary pleural neoplasms are rare entities compared with the pleural involvement by metastatic carcinoma.The current study aimed at investigating the complete spectrum of pleural neoplasms and differentiating between them with the aid of immunohistochemistry (IHC).Methods: Consecutive pleural biopsy specimens positive for a neoplasm, both primary and metastatic, were included in the study. Diagnosis or a differential diagnosis was suggested on histopathology confirmed by a panel of IHC markers such ascytokeratin(AE1/AE3), epithelial membrane antigen (EMA),vimentin, calretinin, CD34, CD99, SMA,bcl2, S100, CK7,CK20,TTF1,GCDFP, HMB45, LCA, synaptophysin, chromogranin, and naspsin.Results: A total of 35 cases of pleural neoplasms included 15 (42.9%) primary pleural neoplasms and 20 (57.1%) metastatic carcinoma. Synovial sarcoma, malignant mesothelioma (MM), and solitary fibrous tumor (SFT) accounted for 14.2%,11.4%, and 8.5% of metastatic cases, respectively. Epithelioid sarcoma(ES), neuroendocrine carcinoma, and inflammatory myofibroblastic tumor were less common, each contributing to 2.9% of pleural neoplasms. Among the 20 cases of metastatic carcinoma, 13 were from the lung and 7 from the breast. Lung neoplasms metastasizing to the pleura were adenocarcinoma (n=12) and atypical carcinoid (n=1).Conclusion: Analysis of histopathological pattern along with a panel of appropriate IHC markers distinguished the rare entities of pleural neoplasms essential to determine the prognosis and treatment modality.

Cytological Assessment of Desmoplastic Malignant Pleural Mesothelioma in an Autopsy Case

“…Asbestos bodies were not found in the parietal pleura or the lung. Upon immunohistochemical (IHC) analysis (Table 1) [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] , the tumor cells were positive for cytokeratin AE1/AE3 (Fig. 3g), α-smooth muscle actin (α-SMA) (Fig.…”

“…Immunohistochemical profile of mesothelioma[2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] in comparison with the current case. -SMA, α-smooth muscle actin; BerEP4, epithelial cell adhesion molecule antibody, clone BerEP4; CEA, carcinoembryonic antigen; DMPM, desmoplastic malignant pleural mesothelioma; EMA, epithelial membrane antigen; GLUT1, glucose transporter 1; HEG1, heart development protein with EGF like domains 1; IMP3, insulin-like growth factor II mRNA-binding protein-3; MOC31, Anti-epithelial cell adhesion molecule monoclonal antibody, clone number-31; TTF-1, thyroid transcription factor 1; WT-1, Wilms' tumor 1.…”

Introductory Chapter: Pathology of the Pleura

“…The most accurate differential diagnosis between primary lung cancer and pleural mesothelioma is immunohistochemical diagnosis [4][5][6][7].…”

“…By using several of these antibodies, epithelioid mesothelioma can be diagnosed with great certainty. Sarcomatoid mesothelioma can be diagnosed by using the following antibodies: cytokeratin, vimentin, HBME-1, and Fascin, but this type can be differentiated from pulmonary sarcomatoid carcinoma only by clinical findings [4][5][6][7][8]. Solitary fibrous tumor is fibroblastic neoplasm, consisting of primitive connective tissue cells, which can therefore mimic morphological picture of neurofibroma or hemangiopericytoma with zones of hypercellularity ( Figure 12) and hypocellularity (Figure 13).…”