Mesothelioma and Adenocarcinomas of the Lung

Mesothelioma and Adenocarcinomas of the Lung

Another interesting study is called, “Mesothelioma: profile of keratin proteins and carcinoembryonic antigen: an immunoperoxidase study of 20 cases and comparison with pulmonary adenocarcinomas.” – Am J Pathol. 1982 July; 108(1): 80–87 by J. M. Corson and G. S. Pinkus.  Here is an excerpt: “Abstract – The distribution of keratin proteins and carcinoembryonic antigen (CEA) in 20 diffuse pleural malignant mesotheliomas and 20 adenocarcinomas of the lung was determined with the use of an indirect  mmunoperoxidase method. Keratin proteins were identified in all of the mesotheliomas, with strong staining observed in 17 of the cases. Tumor cells of various histologic types (tubular, papillary, solid, and spindle) revealed staining for keratin proteins. A variety of staining patterns were observed, but the homogeneous pattern predominated, in either a diffuse (16 cases) or focal form (4 cases). CEA was usually absent (11 cases), but weak or equivocal staining was also observed (8 cases), and 1 case uniquely exhibited moderate staining for CEA. In contrast, adenocarcinomas of the lung usually stained weakly or negatively (18 cases) for keratin proteins and exhibited a predominantly peripheral staining pattern. All cases, however, stained strongly or moderately for CEA. The profile of strong keratin staining and weak or absent CEA staining appears characteristic of mesotheliomas and may be diagnostically useful in defining the epithelial element of these neoplasms and in distinguishing them from adenocarcinomas.”

Another interesting study is called, “Distinction of mesothelioma from adenocarcinoma. An immunohistochemical approach” by Hector Battifora MD, Mary I. Kopinski BS – Cancer Volume 55, Issue 8, pages 1679–1685, 15 April 1985.  Here is an excerpt: “Abstract – The authors investigated the expression of keratin, carcinoembryonic antigen (CEA), and an epithelial marker derived from milk fat globule membranes in 12 mesotheliomas and 100 diverse adenocarcinomas with immunohistochemical methods. The authors employed a monoclonal antibody to keratin designated as AE1, as well as the following commercially available antisera: rabbit anti-whole human keratin, rabbit anti-CEA, and a monoclonal antibody to an epithelial factor designated as MFG-2. Expression of keratin was found in all the mesotheliomas and adenocarcinomas with antibody AE1 as well as with the rabbit antiserum; CEA was detectable in 65% of the adenocarcinomas but two mesotheliomas also reacted weakly. With antibody MFG-2, positive results were obtained in 85% of the adenocarcinomas and in none of the mesotheliomas. All of 64 (100%) breast-, lung- and ovary-derived adenocarcinomas immunostained positively with antibody MFG-2. This is of particular significance because pulmonary and ovarian adenocarcinoma frequently may be indistinguishable clinically and histologically from epithelial mesothelioma. The authors conclude that antikeratin antibodies are not useful in the distinction of adenocarcinoma from mesothelioma. Because of its greater sensitivity and specificity, MFG-2 is superior to CEA in this differential diagnosis.”

Another interesting study is called, “The Immunohistochemical Diagnosis of Mesothelioma: A Comparative Study of Epithelioid Mesothelioma and Lung Adenocarcinoma” by Ordóñez, Nelson G. M.D. – American Journal of Surgical Pathology: August 2003 – Volume 27 – Issue 8 – pp 1031-1051.  Here is an excerpt: “Abstract – A large number of immunohistochemical markers that can facilitate the distinction between epithelioid pleural mesotheliomas and pulmonary peripheral adenocarcinomas have recently become available. The aim of this study is to compare the value of these new markers with others that are already commonly used for this purpose and to determine which are, at present, the best for discriminating between these malignancies. Sixty epithelioid mesotheliomas and 50 lung adenocarcinomas were investigated for expression of the following markers: Even though there is general agreement that the immunohistochemical panels should be composed of both negative and positive mesothelioma markers, a great deal of controversy exists regarding the value of some of these markers, as well as which combination is the most useful in assisting in distinguishing between epithelioid mesotheliomas and pulmonary adenocarcinomas (Table 1). One of the factors that has contributed to the disparities in the conclusions reached in many of the studies is that different pools of markers were evaluated. Contributing to this is the continual introduction of new markers that could potentially be useful in the diagnosis of mesothelioma. In this study, we investigate the value of 19 markers for which there is either evidence that they could be useful in the diagnosis of mesothelioma or their value remains controversial, and discuss the causes of some of the discrepancies. A detailed review of the literature on these markers is also provided.”

We all owe a debt of gratitude to these fine researchers.  If you found any of these excerpts interesting, please read the studies in their entirety.

Monty Wrobleski is the author of this article.  For more information please click on the following links

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