A case of pleural mesothelioma with immunohistochemical staining positive for Krebs von den Lungen-6

Our plain-English summary of A case of pleural mesothelioma with immunohistochemical staining positive for Krebs von den Lungen-6, by Y. Matsumura, S. Sato, K. Haji, et al (Respiratory Medicine Case Reports, 2024).

The study

• Authors: Y. Matsumura, S. Sato, K. Haji, T. Masuda, H. Yoneda, H. Ogino, H. Ogawa, M. Hanibuchi, N. Hattori, Y. Nishioka
• Journal: Respiratory Medicine Case Reports
• Published: 2024;50:102040
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

A 71-year-old male visited a hospital with a chief complaint of exertional dyspnea. A chest CT revealed multiple nodular lesions on the parietal pleura. Thoracoscopic pleural biopsy was performed resulting in a diagnosis of pleural mesothelioma with epithelioid type. When chemotherapy was initially initiated, his serum level of Krebs von den Lungen-6 (KL-6) was high. However, once chemotherapy was started, the serum KL-6 level gradually decreased with tumor shrinkage. Immunohistochemical staining revealed the expression of KL-6 from the tumor cells. This is the first report of KL-6 production directly from tumor cells in epithelial-type pleural mesothelioma.

© 2024 The Authors. Published by Elsevier Ltd.

In plain English

This was a case report, by authors in Japan, about one 71-year-old man with pleural mesothelioma of the epithelioid type. He had worked in construction for 50 years without known asbestos exposure and had never smoked. A biopsy taken through a scope into the chest confirmed the diagnosis, and the cancer was staged cT4N0M0, Stage IIIB. Scans showed no interstitial pneumonia, a lung disease that usually raises a blood marker called KL-6. Even so, his blood KL-6 was elevated at 1778 IU/mL. Chemotherapy with cisplatin and pemetrexed was stopped after two cycles because of drug-induced kidney injury. While treatment was paused, KL-6 rose as the tumor grew. After he started the drug nivolumab, KL-6 fell as the tumors shrank. Staining of the tumor tissue showed KL-6 on the surface of the mesothelioma cells. The authors concluded this was the first report of KL-6 made directly by tumor cells in this cancer, and that KL-6 may help track response to treatment. They noted that known mesothelioma markers such as soluble mesothelin-related peptide and CYFRA-21-1 were not measured. Only CEA was measured, and it was normal.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report (a single patient)
• Who was studied: One 71-year-old man with shortness of breath on exertion. He had been a construction worker for 50 years and did not smoke. The authors were based at Tokushima University and Hiroshima University in Japan.
• Exposure: No known asbestos exposure was reported. The patient worked in the construction industry for 50 years.
• Main results:
  • The patient's tumor cells were negative for TTF-1 and MOC-31 and positive for D2-40 and mesothelin. This led to a diagnosis of pleural mesothelioma (epithelioid type).
  • The patient's lung scans showed no signs of interstitial pneumonia.
  • On admission to the authors' hospital, the patient's serum KL-6 was elevated at 1778 IU/mL.
  • On admission, the patient's serum CEA was within normal limits.
  • First-line cisplatin plus pemetrexed was stopped after two cycles because of drug-induced kidney injury.
  • While chemotherapy was stopped, the patient's serum KL-6 rose as the mesothelioma progressed.
  • After nivolumab was started, the patient's serum KL-6 gradually fell as the tumors shrank.
  • Staining of the patient's mesothelioma tissue showed KL-6 on the surface of the tumor cells. The authors took this to suggest that the tumor cells themselves produced KL-6.
• The authors' conclusion: The authors concluded that KL-6 expression was confirmed in this pleural mesothelioma, indicating its potential as a biomarker for response to therapy. They called this the first report examining the source of KL-6 production in pleural mesothelioma, and said further studies are needed.
• Limitations the authors state:
  • Known pleural mesothelioma tumor markers, such as soluble mesothelin-related peptide and CYFRA-21-1, were not measured; only CEA was. How KL-6 relates to these markers needs further investigation.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Immunohistochemistry, Dyspnea, Parietal Pleura, Pleural Biopsy, Epithelioid, Chemotherapy.

Related studies

• Serum concentrations of Krebs von den Lungen-6, surfactant protein D, and matrix metalloproteinase-2 as diagnostic biomarkers in patients with asbestosis and silicosis: a case-control study — C. Xue, N. Wu, et al. (2017)
• Mesothelioma versus adenocarcinoma: false-positive CEA and Leu-M1 staining due to hyaluronic acid — J.A. Robb (1989)
• Immunohistochemical staining for vimentin and keratin in malignant mesothelioma — A. Churg (1985)
• Comparative immunohistochemical staining for desmin and muscle-specific actin. A study of 576 cases — S. Rangdaeng, L.D. Truong (1991)
• Immunohistochemical staining in malignant mesotheliomas — J.G. Strickler, B.G. Herndier, et al. (1987)
• Immunohistochemical staining of ras oncogene product in neoplastic and non-neoplastic mesothelial tissues: immunoreactivity for N-ras and lack of immunohistochemical staining for Ha-ras and K-ras — M. Ramael, I. Deblier, et al. (1993)

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