Malign plevral mezotelyomalarda doku mikroarray yöntemiyle immünprofilin incelenmesi
Özet
PURPOSE: Malignant mesothelioma is an aggressive primary tumor that mainly develops from pleura and peritoneum and has 100 % mortality rate. In our country, especially in Central and Southeastern Anatolia, incidence of malignant mesothelioma is significantly high, due to non-occupational asbestos and erionit exposure. In this study we aimed to investigate the morphological and immunohistochemical features of malignant mesothelioma in our series.MATERIALS AND METHODS: Total of 228 malignant pleural mesothelioma cases diagnosed in Ankara University, Faculty of Medicine, Department of Pathology and two private pathology laboratories, between 1996-2010 have been included in the study. The control group consisted of 53 cases of non-mesothelial malignant tumors and 9 cases of reactive mesothelial hyperplasia. 5 tissue microarray blocks were obtained by taking 1 mm tissue cylinders from selected blocks with a microarrayer. These microarray blocks were stained by calretinin, CK5/6, HMWCK, LMWCK, monoclonal ve polyclonal CEA, BCL-2, desmin, HBME1, D2-40, GLUT1, EMA, CerbB2, MOC31, WT1, ER, TTF1, Ki67, p53 and EGFR.RESULTS: 148 of 228 (64.9 %) cases were epitheloid, 26 of 228 (11.4%) cases were sarkomatoid and 51 of 228 (22.4 %) cases were biphasic mesothelioma. Male / female ratio was 1.73 / 1. The mean ages of men and women were similar. The youngest patient was a 20-year-old female.Calretinin, CK5/6, WT1, D2-40, HBME1 were positive in 91 %, 97.3 %, 92.1 %, 67.3 % , 94.5 % epitheloid mesothelioma cases, respectively. In sarcomatoid mesotheliomas positive staining with the above mentioned markers were observed in 31,6 %, 21.7 %, 38.1%, 9.7 % and 27.8 % respectively. In the biphasic group, the percentage of positive cases were 78.9 % for calretinin, 80.6 % for CK5/6, 68.6 % for WT1, 23.5 % for D2-40 and 74.4 % for HBME1.Desmin was positive in 44 % of reactive mesothelial proliferations and 5 % of malignant mesotheliomas. EMA was negative in all reactive mesothelial proliferations, but positive in 80.7 % of epitheloid, 41.9 % of sarcomatoid, and 79.6 % of biphasic mesotheliomas. 59.3 % of epitheloid mesotheliomas, 52.6 % of sarcomatoid mesotheliomas and 66.7 % of biphasic mesotheliomas was immunoreactive with GLUT1. GLUT1 was negative in all reactive mesothelial proliferations. The mean labeling indexes for Ki67 in malignant mesothelioma and reactive mesothelial proliferations were 10.1 % and 10.2 %, respectively. The mean values of p53 in mesotheliomas and reactive mesothelial proliferations were 19.2 % and 10.1 %, respectively.TTF1, CEA(m), CEA(p) were totaly negative in mesothelioma cases. MOC31 was positive in 14.2 % of epitheloid and 4.8 % of sarcomatoid mesotheliomas.CONCLUSION: Immunhistochemistry is an essential method in mesotheloma diagnosis. CK5/6 and calretinin must be present in immunhistochemical panel of epithelioid and biphasic mesotheliomas. Keratins and WT1 should be added to this panel, in sarcomatoid tumors