Cytopathology of Mesothelioma in Serous Effusion And Adjunctival Diagnostic Value Of Immunocytochemistry
Sunnita R. Broembling, B.Sc., Roxanne Smith, M.L.T., and Gia-Khanh Nguyen, M.D.
Department of Laboratory Medicine and Pathology
University of Alberta Hospitals
Edmonton, Alberta, Canada

Abstract:
Objectives: To study the cytologic manifestations of pleural mesotheliomas in associated effusions and to evaluate the value of immunocytochemical studies in the cytodiagnosis of mesotheliomas

Materials and Methods:
Thirty-eight histological confirmed pleural mesotheliomas with cytologic evaluation of association pleural effusions were reviewed. Cytospin smears prepared from the pleural fluid samples were stained with the Papanicolaou method. Sections from the effusion cell-blocks in 21 cases stained with commercial antibodies against carcinoembryonic antigen (CEA), Ber-Ep4, Leu-M1, epithelial membrane antigen (EMA) and calretinin, using the avidin-biotin-complex (EMA) and calretinin, using the alvidin-biotin-complex (ABC) technique. In 5 cases, the immunocytochemical staining with the above-mentioned antibodies were performed on Papanicolaou-stained smears, using the ABC method.

Results:
There were 20 epithelial mesotheliomas, 12 mixed mesotheliomas and 6 sarcomatous mesotheliomas. By routinely stained cytologic materials, a cytodiagnosis of malignancy was made in 26 cases (68.4%), a specific diagnosis of epithelial mesothelioma was made in 12 cases (31.6%), and epithelial mesothelioma was made in 11 cases (29%). With immunostaining of tumor cells, 23 cases of mesothelioma with an epithelial component were confirmed (71.9%). In 15 cases including 5 epithelial epitheliomas, 4 mixed mesoepitheliomas and 6 sarcomatous mesoepitheliomas, the pleural effusions were either negative for cancer cells or showing cancer cells with equivocally negative reactions with epithelial antibodies, a pleural biopsy was required to establish the diagnosis.

Conclusions:
The diagnosis of pleural mesoepithelioma by routinely stained cytologic materials was challenging, and immunocytochemical staining of tumor cells with epithelial and calretinin antibodies have markedly increased the cytodiagnostic accuracy rate of the tumors.

Vietnamese Medical Journal, 1: 2-7, 2001

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