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Mesothelioma: Lab Studies
by: emedicine.com
- Pleural fluid findings in patients with mesothelioma typically are not diagnostic. The specific gravity of the pleural fluid is nondiagnostic.
- Typically, patients have less than 1000 leukocytes/mL, few erythrocytes, elevated protein levels, and normal lactate dehydrogenase levels.
- Results of cytologic examination are occasionally positive for malignant mesothelial cells; however, most often the plural fluid cytology results are not diagnostic.
- Diagnosis is made based on the following:
- More than 90% of patients present with pleural effusion that decreases after thoracentesis. Cytologic examination findings are diagnostic in only 32% of patients and are suggestive in 56% of patients. Thoracoscopically guided biopsy should be performed if mesothelioma is suggested, and results are diagnostic in 98% of cases.
- Careful scrutiny of routinely stained biopsy preparations is the most valuable diagnostic tool for making a diagnosis. A battery of commercial immunohistochemistry stains (eg, for cytokeratins, vimentin, human milk fat globulin 2, anti-Leu M1, BerEP4, and carcinoembryonic antigen) can be used.
- Diagnostic features distinguishing malignant mesothelioma from adenocarcinoma include negative test results for periodic acid-Schiff stain, mucicarmine stain, carcinoembryonic antigen, and Leu M1 and positive test results for calretinin, vimentin and cytokeratin. Electron microscopy reveals that cells have long microvilli, in contrast to adenocarcinomas, which have short microvilli. One of the new most intriguing markers is serum mesothelin-related protein (SMRP) measured in fluid or serum. The circulating SMRP level was reported to be elevated in 84% of patients with malignant mesothelioma and in 2% of patients with lung cancer.
- Recently, 4 new mesothelioma cell lines have been characterized based on ultrastructural and immunophenotypic analysis. Cell lines express vimentin, cytokeratins 8 and 18, and mesothelial antigen recognized by HBME-1 monoclonal antibody. Surface HLA class I and intercellular adhesion molecule I are present in all lines.
- While HLA class II and CD 86 are undetectable, HLA class II is present after interferon gamma stimulation. All cell lines display abnormal karyotypes with chromosome 6 abnormalities. The persistence of large T antigen with HLA class I and intercellular adhesion molecule I suggests large T antigen as a target for cytotoxic-based immunotherapy.
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