Shield P W, Koivurinne K
Cytology Department, Sullivan Nicolaides Pathology, Taringa, Australia.
Cytopathology. 2008 Aug;19(4):218-23. doi: 10.1111/j.1365-2303.2007.00482.x. Epub 2007 Oct 4.
OBJECTIVE: To determine the value of calretinin and cytokeratin (CK) 5/6 in discriminating mesothelioma from adenocarcinoma in serous effusion specimens. METHODS: A total of 101 recent, histologically or clinically confirmed malignant effusions with immunostained cell block preparations were reviewed. The cases consisted of 34 mesotheliomas and 67 adenocarcinomas. This included 17 ascitic fluid and 84 pleural fluid samples. The adenocarcinomas included metastatic carcinomas from the breast (12), lung (19), stomach (3), colon (1), pancreas (2), ovary (6) endometrium (1) and 23 histologically confirmed metastases from unknown primary sites. The cases were assessed as negative or positive (>5% of cells stained). The staining pattern was recorded as cytoplasmic, cell membrane, nuclear or cytoplasmic and nuclear staining. RESULTS: Calretinin staining was present in 97% (33/34) of the mesothelioma cases with a majority of them showing both cytoplasmic and nuclear staining (29/33). Only 3% (2/67) of adenocarcinomas were positive for calretinin, one being a lung adenocarcinoma and the other an adenocarcinoma of unknown primary site in an ascitic fluid. Cytokeratin 5/6 staining was also present in 33/34 (97%) of mesothelioma cases. Six (9%) adenocarcinomas were positive, including metastases from the lung (1), breast (1), ovary (2) and unknown primary site (2). Four of the six adenocarcinoma cases positive for CK5/6 were in ascitic fluids. No cases of mesothelioma were negative for both calretinin and CK5/6. Only one adenocarcinoma case, (which was from unknown primary site in an ascitic fluid sample), was positive for both markers. CONCLUSIONS: The results confirm that calretinin and CK 5/6 are useful markers for mesothelioma in effusion specimens. CK5/6 staining may be less useful for peritoneal fluid specimens where metastatic adenocarcinomas may be more likely to express the antigen. Further study of ascitic/peritoneal specimens is warranted. However, positive staining, particularly for both antigens, is highly indicative of a mesothelial origin for cells. The two markers make a useful addition to EMA and the panel of adenocarcinoma markers routinely applied to effusion specimens.
目的：确定钙视网膜蛋白和细胞角蛋白（CK）5/6在鉴别浆液性积液标本中恶性间皮瘤与腺癌方面的价值。 方法：回顾了101例近期经组织学或临床确诊的恶性积液且有免疫染色细胞块制备的病例。这些病例包括34例间皮瘤和67例腺癌。其中有17例腹水样本和84例胸水样本。腺癌包括来自乳腺（12例）、肺（19例）、胃（3例）、结肠（1例）、胰腺（2例）、卵巢（6例）、子宫内膜（1例）的转移癌以及23例经组织学确诊的原发部位不明的转移癌。病例被评估为阴性或阳性（>5%的细胞染色）。染色模式记录为细胞质、细胞膜、细胞核或细胞质及细胞核染色。 结果：钙视网膜蛋白染色在97%（33/34）的间皮瘤病例中出现，其中大多数表现为细胞质及细胞核染色（29/33）。腺癌中仅3%（2/67）为钙视网膜蛋白阳性，1例为肺腺癌，另1例为腹水中原发部位不明的腺癌。细胞角蛋白5/6染色在33/34（97%）的间皮瘤病例中也有出现。6例（9%）腺癌为阳性，包括来自肺（1例）、乳腺（1例）、卵巢（2例）及原发部位不明（2例）的转移癌。6例CK5/6阳性的腺癌病例中有4例在腹水中。没有间皮瘤病例钙视网膜蛋白和CK5/6均为阴性。仅1例腺癌病例（腹水中原发部位不明的样本）两种标志物均为阳性。 结论：结果证实钙视网膜蛋白和CK5/6是积液标本中间皮瘤的有用标志物。CK5/6染色对腹水标本可能用处较小，因为转移性腺癌更可能表达该抗原。有必要对腹水/腹膜标本进行进一步研究。然而，阳性染色，尤其是两种抗原均阳性，高度提示细胞来源于间皮。这两种标志物是对上皮膜抗原（EMA）以及常规应用于积液标本的腺癌标志物组合有益的补充。
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