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D2-40, combined with calretinin, WT-1, CEA, and TTF-1, an immunohistochemical panel for differentiating malignant pleural mesothelioma from lung adenocarcinoma

Introduction One of the most common diagnostic problems in surgical pathology is the difficulty in discriminating malignant pleural mesothelioma (MPM), especially the epithelioid variant, from lung adenocarcinoma (LAD). Immunohistochemistry was proven to be valuable for the diagnosis of the mesothelioma, although it is sometimes difficult to differentiate it from LAD if a single antibody is used. Aim The aim of this work was to study the potential utility of D2-40 in the diagnosis of MPM and to identify an immunohistochemical panel ideally suited for the definite diagnosis of MPM and for differentiating it from LAD. Methods All cases of this study (15 mesotheliomas and 10 LADs) were examined immunohistochemically for the expression of a panel composed of D2-40, calretinin, WT-1, carcinoembryonic antigen (CEA), and thyroid transcription factor-1 (TTF-1). Results The cases of mesothelioma examined showed positive D2-40 immunoreactivity in 87% of cases, calretinin was positive in 87% of cases and WT-1 in 53% of cases. However, all cases of LAD showed negative D2-40 immunoreactivity, whereas calretinin was positive in two cases and WT-1 was detected in one case of LAD. CEA and TTF-1 were positive in 90 and 80% of LAD, respectively. In terms of mesothelioma, D2-40 was as sensitive as calretinin and more sensitive than WT-1. Conclusion These data strongly suggest the significant usefulness of D2-40, calretinin, WT-1, CEA, and TTF-1 as an immunohistochemical panel to differentiate between MPM and LAD.