The Role of Immunohistochemistry Studies in Distinguishing Malignant Mesothelioma from Metastatic Lung Carcinoma in Malignant Pleural Effusion

Our plain-English summary of The Role of Immunohistochemistry Studies in Distinguishing Malignant Mesothelioma from Metastatic Lung Carcinoma in Malignant Pleural Effusion, by M. Halimi, S. BeheshtiRouy, D. Salehi, et al (Iranian Journal of Pathology, 2019).

The study

• Authors: M. Halimi, S. BeheshtiRouy, D. Salehi, S.Z. Rasihashemi
• Journal: Iranian Journal of Pathology
• Published: 2019;14(2):122-126
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background And Objective: Early diagnosis of malignant pleural mesothelioma (MPM) is the key point of its treatment. The main problem is the precise diagnosis of mesothelioma and its differentiation from metastatic lung adenocarcinoma. Mesothelioma exhibits complex immunohistochemical characteristics. The aim of this study was to study hybrid immunohistochemistry in the differential diagnosis of primary malignant pleural effusion from metastatic pulmonary cancers.

Material And Methods: Twenty tissue samples in paraffin blocks from the pathology department of Imam Reza Hospital in Tabriz whose pathology reports cited mesothelioma or metastatic lung adenocarcinomas, were included in the studies. These tissues were deemed appropriate for IHC in terms of tissue quality and quantity. They were studied and evaluated for pathological markers.

Results: In patients with adenocarcinoma CK7 in 100% of patients (13 patients), TTF1 in 61.5% of patients (8 patients) and CEA in 53.8% of patients (7 patients) were positive, but HBME1 and Calretinin were negative for all patients. In patients with mesothelioma, HBME1 and Calretinin were positive in 100% of patients (7 patients) and TTF1, CEA and CK7 were negative.

Conclusion: The results of this study showed that CEA, CK7, TTF1, Calretinin and HBME1 are suitable criteria for differentiating between metastatic lung adenocarcinoma and mesothelioma, and can differentiate the mesothelioma and adenocarcinoma with high accuracy.

In plain English

This descriptive-analytical study, from Imam Reza Hospital in Tabriz, Iran, asked whether five tissue stains (immunohistochemistry markers CEA, CK7, TTF1, Calretinin and HBME1) can tell malignant pleural mesothelioma apart from lung adenocarcinoma that has spread to the pleura. The authors re-examined archived tissue from 20 patients diagnosed between 2009 and 2013: 13 with adenocarcinoma and 7 with mesothelioma. Asbestos exposure was not studied. HBME1 and Calretinin were positive in all 7 mesothelioma patients and negative in all 13 adenocarcinoma patients. CK7 was positive in all 13 adenocarcinoma patients and negative in all mesothelioma patients. TTF1 was positive in 8 adenocarcinoma patients (61.5%) and CEA in 7 (53.8%), and both were negative in all mesothelioma patients. For CEA, the article calls the difference statistically significant but prints P = 0.44. The authors concluded that the five markers are proper markers for telling the two cancers apart with high precision. They noted that the small sample, due to the rarity of mesothelioma, may cause bias.

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: descriptive-analytical study of archived tumor tissue samples (immunohistochemistry)
• Who was studied: 20 patients from Imam Reza Hospital, Tabriz, Iran, diagnosed 2009 to 2013: 13 with metastatic lung adenocarcinoma (9 male, 4 female) and 7 with malignant pleural mesothelioma (3 male, 4 female)
• Exposure: No asbestos exposure was assessed. The study tested five immunohistochemistry markers (CEA, CK7, TTF1, Calretinin, HBME1) on tumor tissue.
• Main results:
  • HBME1 was positive in all 7 mesothelioma patients and negative in all 13 adenocarcinoma patients (P less than 0.001)
  • Calretinin was positive in all 7 mesothelioma patients and negative in all 13 adenocarcinoma patients (P less than 0.001)
  • CK7 was positive in all adenocarcinoma patients (100%) and negative in all mesothelioma patients (100%) (P less than 0.001)
  • TTF1 was positive in 8 of the 13 adenocarcinoma patients (61.5%) and negative in all 7 mesothelioma patients (P = 0.015)
  • CEA was positive in 7 of the 13 adenocarcinoma patients (53.8%) and negative in all mesothelioma patients. The article calls this difference statistically significant but reports P = 0.44.
  • The two groups did not differ significantly in age (mean 59.53 years in the adenocarcinoma group, 65 years in the mesothelioma group; P = 0.84)
• The authors' conclusion: The authors concluded that CEA, CK7, TTF1, Calretinin and HBME1 are proper markers for distinguishing lung adenocarcinoma from mesothelioma with high precision.
• Limitations the authors state:
  • The sample size was small because mesothelioma is rare, which may cause bias
  • Finding a specific antibody for mesothelioma needs additional studies

Topics

Medical terms in this study, explained in our Lexicon: Immunohistochemistry, Mesothelioma, Carcinoma, Pleural Effusion, Pleural Mesothelioma, Lung Adenocarcinoma, Differential Diagnosis, Paraffin Block.

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