The importance of EZH2 and MOC‐31 expression in the differential diagnosis of benign and malignant effusions

Sadullahoğlu, Canan; Nart, Denız; Veral, Alı

doi:10.1002/dc.23653

Cited by 6 publications

(16 citation statements)

References 29 publications

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“…The results of this study were in concordance with those obtained by Sadullahoglu et al [16] on a total of 142 (53 benign and 89 malignant) patient archival samples. Of 89 malignant cases, 93% were reported to be EZH2 positive versus none in the mesothelial cells, with a remarkable sensitivity and specificity of 93 and 100% [16]. Similarly to our study, archival cell blocks with adequate cells of interest were used for the 2 studies [15,16].…”

Section: Discussionsupporting

confidence: 92%

“…The authors revealed that EZH2 was expressed in 90% of malignant effusions but negative in mesothelial cells, with a reported sensitivity and specificity of 90 and 100%, respectively [15]. The results of this study were in concordance with those obtained by Sadullahoglu et al [16] on a total of 142 (53 benign and 89 malignant) patient archival samples. Of 89 malignant cases, 93% were reported to be EZH2 positive versus none in the mesothelial cells, with a remarkable sensitivity and specificity of 93 and 100% [16].…”

Section: Discussionsupporting

confidence: 90%

“…Similarly to our study, archival cell blocks with adequate cells of interest were used for the 2 studies [15,16]. The 2 previous studies on EZH2 in effusion cytology reported the absence of EZH2 immunostaining in the reactive mesothelial cells [15,16]. Intriguingly, we did observe that very occasional reactive mesothelial cells demonstrated EZH2 immunoreactivity (Fig.…”

Section: Discussionsupporting

confidence: 70%

“…Of 89 malignant cases, 93% were reported to be EZH2 positive versus none in the mesothelial cells, with a remarkable sensitivity and specificity of 93 and 100% [16]. Similarly to our study, archival cell blocks with adequate cells of interest were used for the 2 studies [15,16]. The 2 previous studies on EZH2 in effusion cytology reported the absence of EZH2 immunostaining in the reactive mesothelial cells [15,16].…”

Section: Discussionsupporting

confidence: 63%

“…EZH2, a novel marker, has been extensively investigated in recent years in surgical pathology specimen. The efficacy of EZH2 as a diagnostic tool in effusion cytology remains unclear as only 2 studies [15,16] had been published thus far at the time of writing.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Value of the EZH2 Immunomarker in Malignant Effusion Cytology

Ang

Tan

Karim³

et al. 2019

Acta Cytologica

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Background: Differentiating reactive mesothelial cells from metastatic carcinoma in effusion cytology is a challenging task. The application of at least 4 monoclonal antibodies including 2 epithelial markers (Ber-EP4, MOC-31, CEA, or B72.3) and 2 mesothelial markers (calretinin, WT-1, CK5/6, or HBME-1) are often useful in this distinction; however, it is not readily available in many resource-limited developing countries. Aberrant immunoexpression of enhancer of zeste homolog 2 (EZH2), a transcriptional repressor involved in cancer progression, is observed widely in various malignancy. In this study, we evaluate the diagnostic value of EZH2 as a single reliable immunomarker for malignancy in effusion samples. Methods: A total of 108 pleural, peritoneal, and pericardial effusions/washings diagnosed as unequivocally reactive (n = 41) and metastatic carcinoma (n = 67) by cytomorphology over 18 months were reviewed. Among the metastatic carcinoma cases, 54 were adenocarcinoma and others were squamous cell carcinoma (n = 1), carcinosarcoma (n = 1), and carcinoma of undefined histological subtypes (n = 11). Cell block sections were immunostained by EZH2 (Cell Marque, USA). The percentages of EZH2-immunolabeled cells over the total cells of interest were calculated. Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal cut-off score to define EZH2 immunopositivity. Results: A threshold of 8% EZH2-immunolabeled cells allows distinction between malignant and reactive mesothelial cells, with 95.5% sensitivity, 100% specificity, 100% positive predictive value, and 93.2% negative predictive value (p < 0.0001). The area under the curve was 0.988. Conclusion: EZH2 is a promising diagnostic biomarker for malignancy in effusion cytology which is inexpensive yet trustworthy and could potentially be used routinely in countries under considerable economic constraints.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 70%

Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 99%

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Diagnostic Value of the EZH2 Immunomarker in Malignant Effusion Cytology

Ang

Tan

Karim³

et al. 2019

Acta Cytologica

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Diagnostic mesothelioma biomarkers in effusion cytology

Eccher¹,

Girolami

Lucenteforte

et al. 2021

Cancer Cytopathology

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Malignant mesothelioma is a rare malignancy with a poor prognosis whose development is related to asbestos fiber exposure. An increasing role of genetic predisposition has been recognized recently. Pleural biopsy is the gold standard for diagnosis, in which the identification of pleural invasion by atypical mesothelial cell is a major criterion. Pleural effusion is usually the first sign of disease; therefore, a cytological specimen is often the initial or the only specimen available for diagnosis. Given that reactive mesothelial cells may show marked atypia, the diagnosis of mesothelioma on cytomorphology alone is challenging. Accordingly, cell block preparation is encouraged, as it permits immunohistochemical staining. Traditional markers of mesothelioma such as glucose transporter 1 (GLUT1) and insulin‐like growth factor 2 mRNA‐binding protein 3 (IMP3) are informative, but difficult to interpret when reactive proliferations aberrantly stain positive. BRCA1‐associated protein 1 (BAP1) nuclear staining loss is highly specific for mesothelioma, but sensitivity is low in sarcomatoid tumors. Cyclin‐dependent kinase inhibitor 2A (CDKN2A)/p16 homozygous deletion, assessed by fluorescence in situ hybridization, is more specific for mesothelioma with better sensitivity, even in the sarcomatoid variant. The surrogate marker methylthioadenosine phosphorylase (MTAP) has been found to demonstrate excellent diagnostic correlation with p16. The purpose of this review is to provide an essential appraisal of the literature regarding the diagnostic value of many of these emerging biomarkers for malignant mesothelioma in effusion cytology.

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Adenomatoid Tumor: A Review of Pathology With Focus on Unusual Presentations and Sites, Histogenesis, Differential Diagnosis, and Molecular and Clinical Aspects With a Historic Overview of Its Description

Karpathiou

Hiroshima

Péoc’h

2020

Advances in Anatomic Pathology

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Adenomatoid tumors have been described almost a century ago, and their nature has been the subject of debate for decades. They are tumors of mesothelial origin usually involving the uterus, the Fallopian tubes, and the paratesticular region. Adenomatoid tumors of the adrenal gland, the liver, the extragenital peritoneum, the pleura, and the mediastinum have been rarely reported. They are usually small incidental findings, but large, multicystic and papillary tumors, as well as multiple tumors have been described. Their pathogenesis is related to immunosuppression and to TRAF7 mutations. Despite being benign tumors, there are several macroscopic or clinical aspects that could raise diagnostic difficulties. The aim of this review was to describe the microscopic and macroscopic aspects of adenomatoid tumor with a special focus on its differential diagnosis and pathogenesis and the possible link of adenomatoid tumor with other mesothelial lesions, such as the well-differentiated papillary mesothelioma and the benign multicystic mesothelioma, also known as multilocular peritoneal cysts.

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The importance of EZH2 and MOC‐31 expression in the differential diagnosis of benign and malignant effusions

Abstract: In conclusion, it could be considered cost-effective to use a double immunohistochemical antibody kit for these two markers, MOC-31 membranous and EZH2 nuclear staining, in the diagnosis of malignant effusions. Diagn. Cytopathol. 2017;45:118-124. © 2016 Wiley Periodicals, Inc.

Cited by 6 publications

References 29 publications

Diagnostic Value of the EZH2 Immunomarker in Malignant Effusion Cytology

Diagnostic Value of the EZH2 Immunomarker in Malignant Effusion Cytology

Diagnostic mesothelioma biomarkers in effusion cytology

Adenomatoid Tumor: A Review of Pathology With Focus on Unusual Presentations and Sites, Histogenesis, Differential Diagnosis, and Molecular and Clinical Aspects With a Historic Overview of Its Description

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