Mesothelioma thrombomodulin

Ordonez NG. Value of thrombomodulin immunostaining in the diagnosis of mesothelioma. Histopathology. 1997 31 25-30. 

The same basic approach may be used when the differential diagnosis is that of metastatic serosal melanoma versus malignant mesothelioma, except that antibodies to calretinin, thrombomodulin, and HBME-1 should be included. The great majority of mesotheliomas, if not all of them, will express at least one of the latter three determinants, whereas MM is non-reactive for all of them.i " ... 

Lucas and colleagues immunostained 20 mesotheliomas with sarcomatoid components (10 biphasic and 10 sarcomatoid) for pan cytokeratin, CK5/6, cal-retinin, WTl, thrombomodulin, and smooth muscle actin. They compared the immunophenotypic profile of these tumors with 24 high-grade sarcomas, 10 pulmonary sarcomatoid carcinomas, and 16 epithelioid mesotheliomas. The 10 pulmonary sarcomatoid carcinomas were also immunostained for TTF-1. Their results are shown in Table 12.24. They concluded that 1) there was a decrease in epithelial and mesothelial epitopes in sarcomatoid mesothelioma 2) there was a wide immunophenotypic overlap among sarcomatoid... 

Attanoos and associates evaluated 31 sarcomatoid mesotheliomas and a spectrum of other spindle cell neoplasms with antibodies directed against cytokeratin, thrombomodulin, calretinin, and CK5/6. Twenty-four of 31 (77%) sarcomatoid mesotheliomas expressed cytokeratin, 9 of 31 (29%) expressed thrombomodulin, 12 of 31 (39%) expressed calretinin, and 9 of 31 (29%) expressed CK5/6. Two of 9 (22%) sarcomas not otherwise specified expressed broad-spectrum cytokeratin and thrombomodulin, and 1 of 9 (11%) expressed CK5/6. As might be expected, 100% of synovial sarcomas expressed broad-spectrum keratin but showed no immu-nostaining for thrombomodulin, calretinin, and CK5/6. Two of 3 (67%) angiosarcomas expressed thrombomodulin, which is not surprising since thrombomodulin... 

Concerning mesothelial-related antigens, 28 of 57 (49.1%) epithelial mesotheliomas immunostained for thrombomodulin compared to 13 of 211 (6.1%) adenocarcinomas, of which 7 were pulmonary adenocarcinomas. HBME-1 immunoreactivity was observed in 45 of 57 (78.9%) epithelial mesotheliomas, usually in a circumferentially thick or moderately thick distribution. 

Marchevsky evaluated sarcomatoid mesotheliomas and correctly pointed out that the diagnosis of sarcomatoid mesothelioma was particularly difficult as the sensitivity and specificity of mesothelial markers was considerably lower in these lesions than in malignant epithelial mesothelioma. Marchevsky correctly stated that immunostains for calretinin, thrombomodulin, and WTl were positive in fewer than 20% of sarcomatoid mesotheliomas. Marchevsky stated that immunostain-ing for AE1/AE3 keratin was the most helpful in that it showed staining in almost all cases of sarcomatoid... 

Cury PM, Butcher DN, Fisher C, et al. Value of mesothelium-associated antibodies thrombomodulin, cytokeratin 5/6, calretinin and CD44H in distinguishing epithelioid mesothelioma from adenocarcinoma metastatic to the pleura. Mod Pathol. 2000 13 107-112. 

Fink L, Collins CL, Schaefer R, et al. Thrombomodulin expression can be used to differentiate between mesotheliomas and adenocarcinomas. Lab Invest. 1992 66 113A. 

GominGE,NovelliL,BoddiV,etal.Galretinin, thrombomodulin, GEA and GDI5 A useful combination of immunohistochemical markers for differentiating pleural epithelial mesothelioma from peripheral pulmonary adenocarcinoma. Hum Pathol. 2001 32 529-536. 

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