Hanna Atef, Pang Yijun, Bedrossian Carlos W M, Dejmek Annika, Michael Claire W
Department of Pathology, University of Michigan, Ann Arbor, Michigan 48109-0054, USA.
Diagn Cytopathol. 2010 Apr;38(4):264-9. doi: 10.1002/dc.21340.
The diagnosis of malignant mesothelioma in serosal effusions continues to be a major challenge because some of its cytomorphological features closely resemble adenocarcinomas. Immunohistochemistry is a valuable tool in the differentiation of epithelioid mesothelioma from metastatic adenocarcinomas. However, no single antibody has demonstrated absolute sensitivity or specificity. In this study, we evaluated the value of immunostaining pattern for podoplanin to differentiate mesothelioma from adenocarcinomas of various origins.Cell blocks from previously collected paraffin-embedded cell blocks of 86 effusions (18 mesothelioma, 35 reactive mesothelium, 9 breast adenocarcinoma, 14 ovarian adenocarcinoma, and 10 lung adenocarcinoma) were retrieved from the file of the Department of Pathology at University of Michigan and Lund University in Sweden and were used for the study. Slides prepared from the cell blocks were stained for podoplanin. The percentage of immunostained cells was recorded as follows: 1+ (5-25%), 2+ (26-50%), and 3+ (>50%). A stain result involving <5% of cells was considered negative. The intensity of positive results was evaluated as strong, moderate, or weak.Podoplanin is expressed in 94% of malignant mesothelioma cases (17/18), 97% (30/31) of cases of reactive mesothelial, 0% of lung adenocarcinoma cases (0/9), 0% of breast adenocarcinoma (0/9), and 7% of ovarian adenocarcinoma (1/14). All positive cases of malignant mesothelioma and reactive mesothelium showed strong membranous reactivity to podoplanin. The one positive case of ovarian adenocarcinoma showed a weak membranous podoplanin immunostaining.On the basis of our results and published data, we believe that membranous podoplanin immunoreactivity, in conjunction with calretinin, would be more specific than CK5/6 and WT-1 in differentiating epithelioid malignant mesothelioma from adenocarcinoma of the lung, breast, and ovary.
在浆膜腔积液中诊断恶性间皮瘤仍然是一项重大挑战，因为其一些细胞形态学特征与腺癌极为相似。免疫组织化学是鉴别上皮样间皮瘤与转移性腺癌的一项重要工具。然而，尚无单一抗体能展现出绝对的敏感性或特异性。在本研究中，我们评估了血小板内皮细胞黏附分子（podoplanin）免疫染色模式在鉴别间皮瘤与各种来源腺癌方面的价值。从密歇根大学病理学系和瑞典隆德大学的档案中检索出先前收集的86例积液石蜡包埋细胞块（18例间皮瘤、35例反应性间皮、9例乳腺腺癌、14例卵巢腺癌和10例肺腺癌）的细胞块用于研究。从细胞块制备的玻片进行血小板内皮细胞黏附分子染色。免疫染色细胞的百分比记录如下：1+（5%-25%）、2+（26%-50%）和3+（>50%）。染色结果涉及细胞<5%被视为阴性。阳性结果的强度评估为强、中或弱。血小板内皮细胞黏附分子在94%的恶性间皮瘤病例（17/18）、97%的反应性间皮病例（30/31）、0%的肺腺癌病例（0/9）、0%的乳腺腺癌（0/9）和7%的卵巢腺癌（1/14）中表达。所有恶性间皮瘤和反应性间皮的阳性病例均显示对血小板内皮细胞黏附分子有强膜反应性。卵巢腺癌的一例阳性病例显示血小板内皮细胞黏附分子免疫染色呈弱阳性。基于我们的结果和已发表的数据，我们认为膜性血小板内皮细胞黏附分子免疫反应性联合钙视网膜蛋白，在鉴别上皮样恶性间皮瘤与肺、乳腺和卵巢腺癌方面比细胞角蛋白5/6（CK5/6）和威尔姆斯瘤蛋白1（WT-1）更具特异性。
