Attanoos R L, Dojcinov S D, Webb R, Gibbs A R
Department of Histopathology, Llandough Hospital and University Hospital of Wales NHS Trust, Penarth, Wales, UK.
Histopathology. 2000 Sep;37(3):224-31. doi: 10.1046/j.1365-2559.2000.00981.x.
To undertake a comparative evaluation of three antimesothelial markers (thrombomodulin, cytokeratin 5/6 and calretinin) with broad spectrum cytokeratin (AE1/AE3) in differentiating between sarcomatoid mesothelioma and a spectrum of spindle cell neoplasms.
Thirty-one malignant sarcomatoid mesotheliomas were studied. Calretinin expression was focally identified in 12 (39%) tumours and thrombomodulin and cytokeratin 5/6 immunoreactivity was seen in nine (29%) cases. In comparison there was strong diffuse cytoplasmic reactivity with the broad spectrum cytokeratin (AE1/AE3) in 24 of 31 (77%) tumours. Thirty mixed spindle cells neoplasms were studied. No calretinin expression was identified in any case. Thrombomodulin immunoreactivity was identified in four (16%) cases (two angiosarcomas, two high-grade sarcomas, not otherwise specified). Cytokeratin 5/6 expression was seen in one high-grade pulmonary sarcoma originally termed malignant fibrous histiocytoma. None of the antimesothelial markers was expressed in the four spindle cell carcinomas studied. In contrast, broad spectrum cytokeratin was diffusely expressed in all four spindle cell carcinomas (three pulmonary, one renal), both synovial sarcomas, both malignant mixed Müllerian tumours, one of three pulmonary leiomyosarcomas and two of nine sarcomas, not otherwise specified.
Immunohistochemistry has a more limited role in the diagnosis and distinction of sarcomatoid mesothelioma from other spindle cell neoplasms. The combination of a broad spectrum cytokeratin with calretinin combines both high sensitivity (77% for AE1/AE3) with high specificity (100% for calretinin) for sarcomatoid mesothelioma and can be diagnostically useful. The mesothelial markers, thrombomodulin and cytokeratin 5/6, are not useful alone in the diagnosis of sarcomatoid mesothelioma as each shows insufficient antibody sensitivity, although together they complement calretinin.
对三种抗间皮细胞标志物（血栓调节蛋白、细胞角蛋白5/6和钙结合蛋白）与广谱细胞角蛋白（AE1/AE3）在鉴别肉瘤样间皮瘤和一系列梭形细胞瘤方面进行比较评估。
对31例恶性肉瘤样间皮瘤进行了研究。12例（39%）肿瘤中局灶性检测到钙结合蛋白表达，9例（29%）病例中观察到血栓调节蛋白和细胞角蛋白5/6免疫反应性。相比之下，31例肿瘤中有24例（77%）与广谱细胞角蛋白（AE1/AE3）呈现强弥漫性细胞质反应。对30例混合性梭形细胞瘤进行了研究。所有病例均未检测到钙结合蛋白表达。4例（16%）病例（2例血管肉瘤、2例高级别肉瘤，未另作说明）检测到血栓调节蛋白免疫反应性。在1例最初诊断为恶性纤维组织细胞瘤的高级别肺肉瘤中观察到细胞角蛋白5/6表达。在研究的4例梭形细胞癌中，未检测到任何抗间皮细胞标志物表达。相比之下，广谱细胞角蛋白在所有4例梭形细胞癌（3例肺癌、1例肾癌）、2例滑膜肉瘤、2例恶性混合性苗勒管肿瘤、3例肺平滑肌肉瘤中的1例以及9例未另作说明的肉瘤中的2例中均呈弥漫性表达。
免疫组织化学在肉瘤样间皮瘤与其他梭形细胞瘤的诊断和鉴别中作用较为有限。广谱细胞角蛋白与钙结合蛋白联合使用，对肉瘤样间皮瘤具有高敏感性（AE1/AE3为77%）和高特异性（钙结合蛋白为100%），在诊断上具有实用价值。间皮细胞标志物血栓调节蛋白和细胞角蛋白5/6单独用于肉瘤样间皮瘤的诊断时并无用处，因为它们各自的抗体敏感性不足，不过二者联合可补充钙结合蛋白的不足。
