ORIGINAL ARTICLE

Immunohistochemistry in the distinction between malignant mesothelioma and pulmonary adenocarcinoma: a critical evaluation of new antibodies

A S Abutaily¹, B J Addis² and W R Roche¹

¹ Respiratory Cell and Molecular Biology, University of Southampton, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK
² Department of Cellular Pathology, Southampton University Hospitals NHS Trust, Southampton SO16 6YD, UK

Correspondence to:
Correspondence to:
Professor W R Roche, Respiratory Cell and Molecular Biology, Mailpoint 813, Level E, South Block, University of Southampton, Southampton General Hospital, Southampton SO16 6YD, UK;
wrr{at}soton.ac.uk

Aim: The value of immunohistochemical staining in differentiating between malignant mesothelioma and pulmonary adenocarcinoma was re-examined using newly available commercial antibodies, with the aim of increasing the sensitivity and specificity of diagnosis, and simplifying the antibody panel required.

Methods: Forty one malignant mesotheliomas and 35 lung adenocarcinomas were studied. Commercial antibodies to calretinin, E-cadherin, N-cadherin, surfactant apoprotein A (SP-A), thyroid transcription factor 1 (TTF-1), thrombomodulin, and cytokeratin 5/6 were applied using the streptavidin–biotin–peroxidase complex procedure on formalin fixed, paraffin wax embedded tissue.

Results: E-cadherin was expressed in all adenocarcinomas and in 22% of the mesotheliomas. TTF-1 expression was detected in 69% of the adenocarcinomas and none of the mesotheliomas. Positive staining with polyclonal anticalretinin was detected in 80% of the mesotheliomas and 6% of the adenocarcinomas. N-cadherin was expressed in 78% of mesotheliomas and 26% of adenocarcinomas. Thrombomodulin was expressed in 6% of the adenocarcinomas and in 53% of the mesotheliomas. Cytokeratin 5/6 expression was detected in 6% of the adenocarcinomas and 63% of the mesotheliomas. The results were compared with the standard laboratory panel for mesothelioma diagnosis: anticarcinoembryonic antigen (anti-CEA), LeuM1, BerEP4, and HBME-1.

Conclusion: Of the antibodies used in this study, E-cadherin was 100% sensitive for pulmonary adenocarcinoma and TTF-1 was 100% specific for pulmonary adenocarcinoma. The application of these two antibodies alone was adequate for the diagnosis of 69% of adenocarcinomas and 78% of mesotheliomas. Where TTF-1 is negative and E-cadherin is positive, a secondary panel of antibodies, including BerEP4 and LeuM1 (CD15) and antibodies directed against CEA, calretinin, cytokeratin 5/6, thrombomodulin, and N-cadherin, is required for differentiation between malignant mesothelioma and pulmonary adenocarcinoma.

Keywords: mesothelioma; adenocarcinoma; immunohistochemistry; diagnosis

Abbreviations: CEA, carcinoembryonic antigen; SP-A, surfactant apoprotein A; TBS, Tris buffered saline; TTF-1, thyroid transcription factor 1

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Lindholm, P M, Soini, Y, Myllarniemi, M, Knuutila, S, Heikinheimo, M, Kinnula, V L, Salmenkivi, K (2009). Expression of GATA-6 transcription factor in pleural malignant mesothelioma and metastatic pulmonary adenocarcinoma. J. Clin. Pathol. 62: 339-344 [Abstract] [Full Text]  
• Niedre, M. J., de Kleine, R. H., Aikawa, E., Kirsch, D. G., Weissleder, R., Ntziachristos, V. (2008). Early photon tomography allows fluorescence detection of lung carcinomas and disease progression in mice in vivo. Proc. Natl. Acad. Sci. USA 105: 19126-19131 [Abstract] [Full Text]  
• Yang, N., Ying, C., Xu, M., Zuo, X., Ye, X., Liu, L., Nara, Y., Sun, X. (2007). High-fat diet up-regulates caveolin-1 expression in aorta of diet-induced obese but not in diet-resistant rats. Cardiovasc Res 76: 167-174 [Abstract] [Full Text]  
• Holloway, A. J., Diyagama, D. S., Opeskin, K., Creaney, J., Robinson, B. W.S., Lake, R. A., Bowtell, D. D.L. (2006). A Molecular Diagnostic Test for Distinguishing Lung Adenocarcinoma from Malignant Mesothelioma Using Cells Collected from Pleural Effusions. Clin. Cancer Res. 12: 5129-5135 [Abstract] [Full Text]  
• Soini, Y, Kinnula, V, Kahlos, K, Paakko, P (2006). Claudins in differential diagnosis between mesothelioma and metastatic adenocarcinoma of the pleura.. J. Clin. Pathol. 59: 250-254 [Abstract] [Full Text]  
• Ramos-Vara, J. A., Miller, M. A., Johnson, G. C. (2005). Usefulness of Thyroid Transcription Factor-1 Immunohistochemical Staining in the Differential Diagnosis of Primary Pulmonary Tumors of Dogs. Vet Pathol 42: 315-320 [Abstract] [Full Text]  
• Zhang, F., Pao, W., Umphress, S. M., Jakowlew, S. B., Meyer, A. M., Dwyer-Nield, L. D., Nielsen, L. D., Takeda, K., Gelfand, E. W., Fisher, J. H., Zhang, L., Malkinson, A. M., Mason, R. J. (2003). Serum Levels of Surfactant Protein D Are Increased in Mice with Lung Tumors. Cancer Res. 63: 5889-5894 [Abstract] [Full Text]