Immunohistochemistry
It is generally recommended to perform two mesothelioma markers and two carcinoma markers, since there is no single sensitive and specific marker for either entity. The data below is a snapshot of several studies.
|
IHC Marker
|
Adenocarcinoma
|
Mesothelioma
|
|
8%
|
100%
|
|
|
CK5/6 (CK5)
|
2%
|
100%
|
|
0%
|
93%
|
|
|
Thrombomodulin
|
14%
|
61-77%
|
|
N-Cadherin
|
30%
|
73%
|
|
93-100%
|
8%
|
|
|
80-100%
|
18%
|
|
|
BG8
|
96%
|
7%
|
|
81-88%
|
0%
|
|
|
84%
|
0%
|
|
|
72-74%
|
0%
|
|
|
72-85%
|
0%
|
Obviously the main source of adenocarcinoma in this differential setting is with a primary lung adenocarcinoma and mesothelioma. If a metastasis is likely, then the stain performance expectations for adenocarinoma may vary significantly (e.g. metastatic ovarian serous carcinoma would likely express WT-1).
References
Marchevsky AM. Application of immunohistochemistry to the diagnosis of malignant mesothelioma. Arch Pathol Lab Med. 2008;132: 397–401.
Sandeck HP, Røe OD, Kjærheim K, Willén H, Larsson E. Re-evaluation of histological diagnoses of malignant mesothelioma by immunohistochemistry. Diagnostic pathology. 2010;5: 47. doi:10.1186/1746-1596-5-47
Ordóñez NG. Immunohistochemical diagnosis of epithelioid mesothelioma: an update. Arch Pathol Lab Med. 2005;129: 1407–1414.