Malignant Mesothelioma With CD30-Positivity.A Case Report and Review of the Literature
An immunoglobulin G1 antibody, Ber-H2 belongs to the CD30 cluster and reacts with a 105- to 120- kd membrane-bound glycoprotein.[1,2] The CD30 antigen is an activation marker not found on resting B cells, T cells, or monocytes monocytes,
n.pl the largest of the white blood cells. They have one nucleus and a large amount of grayish-blue cytoplasm. Develop into macrophages and both consume foreign material and alert T cells to its presence. . Ber-H2 positivity may be seen in the following types of cells in normal or reactive conditions: cells at the margin of germinal centers and around lymphoid follicles in reactive lymph nodes and tonsils tonsils, name commonly referring to the palatine tonsils, two ovoid masses of lymphoid tissue situated on either side of the throat at the back of the tongue. , immunoblast-like cells in B-cell and T-cell zones, plasma cells, a few medullary medullary /med·ul·lary/ (med´ah-lar?e)
1. pertaining to a medulla.
2. pertaining to bone marrow.
3. pertaining to the spinal cord. thymocytes, rare cells in extranodal lymphoid tissue and bone marrow cells, including mature neutrophils, normoblasts, and erythrocytes, as well as pancreatic acini acini Plural of acinus, eg, milk-producing glands of breast , neurons from the cerebral cortex, and Purkinje cells.[1-3]
Ber-H2 positivity can be seen in lymphomatous and nonhematopoietic tumors. Ber-H2 reacts with approximately 95% of cases of anaplastic large cell lymphoma Anaplastic large cell lymphoma (ALCL) is a type of non-Hodgkin lymphoma that features in the World Health Organisation (WHO) classification of lymphomas. Diagnosis
To make this diagnosis under its present system of classification, the WHO:
A salivary gland tumor is an uncontrolled growth of cells that originates in one of the many saliva-producing glands in the mouth. , and embryonal carcinomas. Ber-H2 positivity in malignant mesothelioma has not previously been described and is the purpose of this case report.
REPORT OF A CASE
The patient was a 65-year-old man presenting with a 2-month history of worsening right-sided chest pain. Pertinent history included previous asbestos and toxic chemical exposures as well as a 25-year smoking history. Chest x-ray examination and a computed tomographic (CT) scan of the chest revealed 2 elliptical soft tissue masses (right posterior hemithorax, pleural Pleural
Pleural refers to the pleura or membrane that enfolds the lungs.
Mentioned in: Pneumothorax
emanating from or pertaining to the pleura. based [Figure 1] and right medial pleural reflection [Figure 2]), the larger measuring 2.0 x 4.0 cm in greatest dimensions. A CT-guided needle biopsy specimen from the larger mass (right posterior hemithorax) was considered insufficient for diagnosis. Thus, the patient underwent a right thoracotomy thoracotomy /tho·ra·cot·o·my/ (-kot´ah-me) pleurotomy; incision of the chest wall.
Incision into the chest wall. Also called pleurotomy. and resection of a pleural mass. During thoracotomy, numerous pleural-based masses were noted. A frozen-section diagnosis rendered during the thoracotomy was "tumor; probable lymphoma, small cell; rule out oat cell carcinoma oat cell carcinoma
A highly malignant carcinoma, especially of the lungs, composed of small ovoid undifferentiated cells. Also called small cell carcinoma. ." Thus, a portion of the specimen was submitted to our institution for flow cytometric immunophenotyping; a portion was also received in formalin for routine histologic examination.
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MATERIALS AND METHODS
Fresh tissue designated "lung mass" was submitted for flow cytometric analysis with a diagnosis of "rule out lymphoma." Touch preparations of the lung mass were Wright stained. A single cell suspension of the tissue was prepared in RPMI medium (Cellgro Mediatech Tissue Culture Media, Fisher Scientific, Pittsburgh, Pa) and analyzed for various antigens on an Ortho Cytoron absolute flow cytometer (Ortho Diagnostic Systems, Raritan, NJ) using standard techniques and the following monoclonal antibodies: CD3, CD20, and CD45 (Becton-Dickinson, San Jose, Calif); CD4, CD5, CD10, and HLA-DR (Ortho); CD14 and CD19 (Coulter Clone, Coulter Immunology, Hialeah, Fla); and CD23, [Kappa] and [Lambda] (Dako Corporation, Carpinteria, Calif). Dual staining of antibodies was performed as follows: CD3/4, 19/5, 20/HLA-DR, 45/10, 14/23, and [Kappa]/[Lambda].
Also received with the fresh tissue was a formalin-filled container with a portion of the lung mass. A portion of this specimen was postfixed in B-5 fixative fixative /fix·a·tive/ (fik´sit-iv) an agent used in preserving a histological or pathological specimen so as to maintain the normal structure of its constituent elements.
adj. . Subsequently, the formalin-fixed and B-5-fixed tissue were routinely processed for sectioning and staining with hematoxylin-eosin (HE). The B-5 tissue was also stained with the following special and immunoperoxidase stains: periodic acid-schiff (PAS) with diastase diastase (dī`əstās'): see amylase. ; alcian blue with and without hyaluronidase Hyaluronidase
Any one of a family of enzymes, also known as hyaluronate lyases or spreading factors, produced by mammals, reptiles, insects, and bacteria, which catalyze the breakdown of hyaluronic acid. ; LCA (CD45), L26 (CD20), CD3, KP-1 (CD68), [Kappa], vimentin, HMB-45, cytokeratin, epithelial membrane antigen (EMA), and carcinoembryonic antigen (CEA, polyclonal) (Dako); Ber-H2 (CD30) (Nova Castra, Vector Laboratories, Burlingame, Calif); Leu-M1 (CD15) (Becton-Dickinson); [Lambda], S100, and B72.3 (BioGenex, San Ramon, Calif); and calretinin (Zymed, San Francisco, Calif). The PAS with diastase stain was performed following the McManus method, and the alcian blue with and without hyalurondiase stains were performed following the method described by Carson.
Cytomorphologic examination of the Wright-stained touch preparations of the lung mass revealed numerous clusters of acellular connective tissue with rare hematopoietic hematopoietic /he·ma·to·poi·et·ic/ (-poi-et´ik)
1. pertaining to hematopoiesis.
2. an agent that promotes hematopoiesis.
1. pertaining to or affecting the formation of blood cells. elements, including small lymphocytes, histiocytes, and plasma cells. Flow cytometric analysis of the suspension prepared from the lung mass revealed 23% of cells within the lymphocyte region, 8% within the monocyte monocyte /mono·cyte/ (mon´o-sit) a mononuclear, phagocytic leukocyte, 13µ to 25µ in diameter, with an ovoid or kidney-shaped nucleus, and azurophilic cytoplasmic granules. (large cell) region, and 69% within the granulocyte granulocyte /gran·u·lo·cyte/ (gran´u-lo-sit?) granular leukocyte.granulocyt´ic
band-form granulocyte band cell.
n. region. Cells within the lymphocyte region were composed of approximately 77% T cells and 17% B cells with polyclonal surface light-chain expression. Cells within the large cell region failed to reveal an aberrant T-cell or monoclonal B-cell population.
The HE-stained sections of the formalin-fixed and B-5-fixed lung mass tissue revealed fragments of dense fibrous connective tissue Fibrous connective tissue
Dense tissue found in various parts of the body containing very few living cells.
Mentioned in: Corneal Transplantation , consistent with pleura pleura (plr`ə), membranous lining of the upper body cavity and covering for the lungs. ; lung parenchyma Parenchyma
A ground tissue of plants chiefly concerned with the manufacture and storage of food. The primary functions of plants, such as photosynthesis, assimilation, respiration, storage, secretion, and excretion—those associated with living was not identified. The connective tissue was infiltrated by clusters and sheets of large malignant cells with irregular nuclear membranes, vesicular chromatin, prominent nucleoli nucleoli
plural form of nucleolus. , and abundant eosinophilic eosinophilic /eo·sin·o·phil·ic/ (-fil´ik)
1. readily stainable with eosin.
2. pertaining to eosinophils.
3. pertaining to or characterized by eosinophilia. cytoplasm associated with a brisk mitotic rate (Figure 3). In areas, the malignant cells had a spindled appearance. In other areas were large zones of tumor necrosis with residual aggregates of malignant cells surrounding occasional small blood vessels. There was a mixed inflammatory infiltrate at the periphery of the tumor consisting predominantly of small lymphocytes, histiocytes, and plasma cells.
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The malignant cells stained intensely with cytokeratin (cytoplasmic), EMA (cytoplasmic and membrane), calretinin (cytoplasmic) (Figure 4), and Ber-H2 (cytoplasmic) (Figure 5) and were not immunoreactive immunoreactive
exhibiting immunoreactivity. with LCA, L26, CD3, KP-1, Leu-M1, [Kappa], [Lambda], vimentin, S100, HMB-45, B72.3, or CEA. They did not stain with PAS with diastase or with alcian blue with and without hyaluronidase.
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We report a case of a malignant mesothelioma originally submitted by the referring pathologist for flow cytometric immunophenotyping to exclude a malignant lymphoma. Flow cytometric immunophenotyping did not reveal an aberrant T-cell or monoclonal B-cell population. Subsequent histologic review with appropriate immunohistochemical stains established the diagnosis.
The diagnosis of malignant mesothelioma was supported by the intense reactivity of the malignant cells with cytokeratin, EMA, and calretinin. Negativity of the malignant cells with PAS with diastase, alcian blue with and without hyaluronidase, CEA, B72.3, and Leu-M1 excluded a diagnosis of adenocarcinoma.
Of interest, Ber-H2 was intensely present within the cytoplasm of the malignant cells. To our knowledge, Ber-H2 positivity has not previously been described in malignant mesothelioma and is the purpose of the case report. Anaplastic [CD30.sup.+] large cell lymphoma large cell lymphoma
Lymphoma composed of large mononuclear cells of undetermined type.
large cell lymphoma may have a varied histologic growth pattern with cohesive malignant cells, and the present finding expands the differential diagnosis of a CD[30.sup.+] cohesive large cell malignancy.
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Accepted for publication November 17, 1999.
From the Division of Hematopathology, Department of Pathology, Saint Louis University Saint Louis University, mainly at St. Louis, Mo.; Jesuit; coeducational; opened 1818 as an academy, became a college 1820, chartered as a university 1832. Parks College (est. 1927 as Parks College of Aeronautical Technology) in Cahokia, Ill. Health Sciences Center St Louis, Mo.
Reprints: Cherie H. Dunphy, MD, Department of Pathology, Saint Louis University School of Medicine Saint Louis University School of Medicine is one of the eleven schools which comprise Saint Louis University. It was established in 1836 as the Medical Department of the university and had the distinction, in 1839, of awarding the first M.D. , 1402 Grand, St Louis, MO 63104.