subject: Pleurectomy And Decortication Followed By Immediate Intrapleural Chemotherapy [print this page] An interesting study is called, Aggressive multimodality therapy for malignant pleural Mesothelioma - The Annals of Thoracic Surgery - Volume 58, Issue 1, July 1994, Pages 24-29 by Thomas W. Rice MD, David J. Adelstein MD, Thomas J. Kirby MD, Matthew G. Saltarelli MD, Siva R. Murthy MD, Marjorie A. Van Kirk RN, Herbert P. Wiedemann MD and James K. Weick MD Here is an excerpt: Abstract - Nineteen patients with clinical stage I malignant pleural mesothelioma were treated with aggressive multimodality therapy. Nine patients underwent pleurectomy and decortication followed by immediate intrapleural chemotherapy with cisplatin and mitomycin C. Ten patients required pleuropneumonectomy followed within 1 week to 2 weeks by intrapleural administration of cisplatin (100 mg). Four to 8 weeks after operation, 15 patients underwent postoperative adjuvant cisplatin-based systemic chemotherapy. There were three postoperative complications (16%) requiring reoperation and one postoperative death (5%). Intrapleural chemotherapy was well tolerated with no complications. Systemic chemotherapy was poorly tolerated, and there was one chemotherapy-related death. Sixteen patients (84%) experienced good to excellent palliation. Three patients are currently alive with no evidence of recurrent disease at 10, 35, and 43 months. The median overall survival was 13 months and the median disease-free survival, 11 months. Overall and disease-free 3 year survivals were 17% and 22%, respectively. Patients with epithelial malignant pleural mesothelioma had significantly better overall survival (p = 0.037) and disease-free survival (p = 0.02) than patients with sarcomatous or biphasic malignant pleural mesothelioma. We conclude that despite major toxicity, in select patients with clinical stage I malignant pleural mesothelioma, aggressive multimodality therapy offers effective palliation and occasional long-term disease-free survival.
Another interesting study is called, Cytologic differential diagnosis among reactive mesothelial cells, malignant mesothelioma, and adenocarcinoma - Utility of combined E-cadherin and calretinin immunostaining by Hiromi Kitazume C.T., Kazuhisa Kitamura C.T. Katsuhiko Mukai M.D., Yoshiaki Inayama M.D., Naomi Kawano M.D., Nobuo Nakamura M.D., Jinyu Sano M.D., Kunihiro Mitsui C.T., Sachiko Yoshida M.D., Yukio Nakatani M.D. - Cancer Cytopathology - Volume 90, Issue 1, pages 5560, 25 February 2000. Here is an excerpt: The differential diagnosis between reactive mesothelial cells (RMs), malignant mesotheliomas (MMs), and adenocarcinomas (ACs) is often difficult in cytologic specimens, and the utility of various immunohistochemical markers have been explored. Because recent immunohistologic studies have suggested that E-cadherin (E-cad) and calretinin (Cal) may be useful markers for epithelial and mesothelial differentiations, respectively, the authors investigated their utility in cytologic diagnosis. METHODS - In this retrospective study, immunostaining was performed on smears retrieved from Papanicolaou-stained slides of effusions using the labeled streptavidin-biotin method. Sixteen cases of RM, 9 cases of MM, and 52 cases of AC from various sites, including 13 pulmonary primaries, were examined with primary antibodies against E-cad and Cal RESULTS The positive rates for E-cad and Cal, respectively, were as follows: RM, 0/16 (0%) and 16/16 (100%); MM, 9/9 (100%) and 8/8 (100%); and AC, 45/52 (86.5%) and 0/51 (0%). The E-cad expression by neoplastic cells was strongest in the intercellular junctions, and poorly differentiated neoplastic cells in the single cell form showed the weakest expression. CONCLUSIONS - In contrast to the results of previous immunohistochemical studies, the current study indicates that MMs constantly express E-cad, whereas RMs lack its expression in cytologic specimens, which would be useful in the differential diagnosis between the two. On the other hand, E-cad expression is not reliable for distinguishing AC from MM. The Cal expression can be a very useful marker for the distinction between AC and the mesothelial lineage. The combined immunostaining for E-cad and Cal has utility in differential diagnosis among RM, MM, and AC. Cancer (Cancer Cytopathol) 2000;90:5560. 2000 American Cancer Society.
It has long been a major diagnostic challenge to distinguish among reactive mesothelial cells (RMs), malignant mesothelioma (MM), and adenocarcinoma (AC) in both cytologic and surgical pathologic specimens. For differential diagnosis between MM and AC, previous immunohistochemical and immunocytochemical studies established panels of useful antibodies against immunodeterminants, including carcinoembryonic antigen (CEA), CD15 (recognized by the monoclonal antibody Leu M1), tumor-associated glycoprotein 72 (recognized by the monoclonal antibody B72.3), BerEP4 glycoprotein, and MOC-31 glycoprotein.15 Most of these are markers for AC and can be useful in the setting of differential diagnosis between RM and AC as well. For differentiation between RMs and MMs, on the other hand, only a few markers have been reported to be of utility. Among these are epithelial membrane antigen (EMA) and p53 protein, which are often expressed in MMs but usually not in RMs.6, 7 Recently, two new immunohistochemical markers have come into notice: E-cadherin for ACs8, 9 and calretinin for the mesothelial lineage.10 Because there are only a few reports of experience with the immuonostaining of these new markers in cytologic specimens,11, 12 we investigated their utility in cytologic differential diagnosis.
We all owe a debt of gratitude to these fine researchers. If you found any of these excerpts interesting, please read the studies in their entirety.
