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Thrombomodulin staining of mesothelioma cells
HUMAN PATHOLOGY
Guidelines
Volume 23, No. 8 (August
mesotheliomas and pulmonary adenocarcinomas. This antibody can be used to stain formalin-fixed, paraffinembedded tissues. All of 3 1 mesotheliomas stained positively, and only four of 50 adenocarcinomas stained positively.‘~” Metastatic mesotheliomas with adenomatous morphology, such as the one described by Dutt et a1,4 show positive staining with a monoclonal antibody against thrombomodulin (Fig 1).
for Letters
Letters to the Editor will be published at the discretion of the editor as space permits and are subject to editing and abridgement. They should be typewritten, double-spaced, and submitted in triplicate. They should be limited to 500 words or less and to no more than five pertinent references.
CURTIS L. COLLINS, MD LOUIS M. FINK, MD SU-MING Hsu, MD ROBERT SCHAEFER, MD University of Arkansas for Medical Sciences and John L. McClellan Memorial Veterans Hospital Little Rock, AR
L
Thrombomodulin of Mesothelioma
1992)
Staining Cells
To the Editor:-A recent article by Sheibani et al’ discussed extensively the applications of antibodies for differential diagnosis between mesothelioma and adenocarcinomas. It is of interest that all the antibodies show positive reactivity for adenocarcinomas and negative staining for mesotheliomas. Because these antibodies, such as anti-Leu-Ml or CEA, do not always react with adenocarcinoma cells, clear-cut distinction between adenocarcinoma and mesothelioma may sometimes be very difficult. Identification of antibodies that react with mesothelioma cells but not adenocarcinoma cells will be most helpful for definitive diagnosis. We have recently compared the anti-thrombomodulin staining of
NELSON ORDONEZ, MD The University of Texas, MD Anderson Houston, TX
Cancer
Center
1 SheihaniK, EstehanJM, Bailey A, et al: Immunopathologk and molecular studies as an aid to the diagnosis of malignant mesothelioma. HUM PATHOL 23: 107.116, 1992 2. Fink LM, Collins CI., Schaefer RF, et al: Thrombomodulin expression can he used to difterentiate between mesotheliomas and adenocarcinomas. Lab Invest 66: I 13A, 1992 3. Collins CL, Ordonez NG, Schaefer R, et al: Thrombomodulin expression in malignant pleural mesothelioma and pulmonary adenocarcinoma. Am J Parhol (in press) 4. Dutt PL, Page D, et al: Distant cutaneous metastasis of pleural malignant mesothelioma. J Cutan Pathol (in press)
FIGURE 1. (A) A metastatic mesothelioma in skin was positively stained for thrombomodulin (TM) (open arrow). Anti-TM antibody also reacted with squamous epithelium and endothelial cells (arrowhead). (B) Higher magnification shows that TM was mainly expressed on the luminal surface of tumor cells. (Avidin-biotin-peroxidase complex immunoperoxidase stain. Magnifications: A, x 100: B. x400.)
966
BOOK REVIEWS
for 28 days until the level of radiation has subsided to an insignificant level. If such tissues must be processed immediately, all solutions, paraffin wax, microtomes, etc, that come into contact with the indium will become contaminated. Additionally, radiation, however small, will have a cumulative effect on the staff handling the tissues and sections from the first and subsequent cases. With the increasing popularity of immunologic methods in the medical field, histology laboratories can expect to receive similar radioactive tagged specimens in the future and some thought must be given to their handling.
Indium-Ill: Recommended Handling of Radioactive Tagged Specimens To the Editor:--Pathologists and histotechnologists should be aware of a new diagnostic tool in use at some medical centers using radioactive compounds. In this procedure monoclonal antibodies are bound to a radioactive compound, indium-III, which has a half-life of 2.81 days. Following injection into the patient, scintigraphy is used to visualize the tagged tumors. Researchers have, on occasion, removed tumor masses and made radioactive counts to determine the binding capability of the radioactive substance. ‘,* Examination shows that the levels of radiation used are quite small, comparable to 20% of a bone scan, and radiate 5 &i of gamma radiation when first administered. This level is low and measurement of radiation from excised tissues requires use of an enclosed gamma counter to prevent background interference. However, the energy level of the remaining indium is high. One recommendation has been that histology laboratories receiving such specimens leave them in fixative
BOOK
MICHAEI. TITFORD, HLT(ASCP) University of South Alabama Mobile, AL 1. Edington HD, Watson CC, Levine G, et al: Radioimmunoimaging of metastaticmedullq carcinomaof the thyroid gland using an indium-1 1 l-labeled monoclonal antibody to CEA. Surgery 104:1004-1010,1988 2. Abdel-Nabi HH, Schwartz AN, Goldfogel G, et al: Colorectal tumors, Scintigraphy with In-l 11 anti-CEA monoclonal antibody and correlation with surgical, histopathologic, and immunohistochemical findings. Radiology 166: 747.752, 1988
REVIEWS
editors state in the preface that they have attempted to update the text in some areas, such as in situ hybridization of flow cytometry, very little of the text is actually devoted to this update. Nonetheless, the text is well written, covers a broad number of issues, and would generally be useful to surgical pathologists, pathology residents, and pathology technologists who are interested in, perform, or must interpret histochemical or immunohistochemical stains.-ANN D. THOR, MD, Associate
Histochemistry in Pathology 2E Review (ed 2). M. I. Filipe and B. D. Lake (eds). New York, NY, Churchill Livingstone, 1990,496 pages. This text, published in 1990, is an update of the 1983 edition of Histochemistry in Pathology. It has been expanded in the subsection of immunohistochemical methods and applications of these methods in fine needle aspiration cytology, soft tissue tumor diagnosis, and, more recently, developed methodologies such as in situ hybridization and flow cytometry. Contributing authors are from many countries, principally the United Kingdom, as well as the United States, Italy, The Netherlands, Portugal, Israel, and Czechoslovakia. The first five chapters provide a general review on the principals of fixation, processing, and routine and “special staining” criteria, as well as general applications of these methods. The remainingchapters provide a review of immunostaining applications for various organ systems and tissue types, with particular emphasis on their applications in tumor and tissue diagnosis. Included in each chapter are methods for differentiating benign from malignant lesions as well as subtyping of malignant lesions. A strength of the text is that it combines data that may be derived from traditional, special, immunohistochemical, and newly developed staining techniques. Approximately 50 pages of appendix are provided that give useful, very detailed staining methodology. The text is liberally illustrated (black and white) and numerous figures and tables are provided to illustrate the information presented in text form. A weakness of the text is that the references do not generally extend beyond 1987 or 1988; therefore, the information provided is not totally up to date for a reader in the 1990s. For example, in the breast chapter very little information is given regarding immunohistochemical staining for steroid receptors. Furthermore, some chapters are excessively short, such as the pancreas and fine needle aspiration cytology chapters. Unfortunately, while the
Professor, Harvard Medical School, and Associate Pathologist, Massachusetts General Hospital; and SUSAN M. EDGERTON, MA, HTL(ASCP), Senior Research Technologist, Massachusetts General Hospital, Boston, MA
PCR Topics. A. Rolfs, H. C. Schumacher, and P. Marx (eds). Berlin, Germany, Springer-Verlag, 1991, 258 pages, approximately $69. PCR Topics falls into that good news/bad news genre of scientific literature fostered by publishing collected presentations from scientific symposia. The good news is that investigators often present preliminary findings at these gatherings in interesting or new areas as well as creative speculations that have not yet passed the scrutiny of peer review. This can be useful for non-attendees if the symposium is published in a timely fashion, as seems to have been the case here. The bad news is that early results are of necessity often tentative. Moreover, non-peer-reviewed manuscripts are inherently less subject to editorial standards on content and format, particularly when there are many contributors. PCR Topics is a collection of 43 presentations from a June 1990 international symposium in Berlin on “Usage of Polymerase Chain Reaction (PCR) in Genetic and Infectious Diseases.” Over three quarters of the presentations are from investigators in Germany (then West Germany); only three are from non-European laboratories. Contributions encompass a diversity of applications grouped under the major themes of:
967
Guidelines
Volume 23, No. 8 (August
mesotheliomas and pulmonary adenocarcinomas. This antibody can be used to stain formalin-fixed, paraffinembedded tissues. All of 3 1 mesotheliomas stained positively, and only four of 50 adenocarcinomas stained positively.‘~” Metastatic mesotheliomas with adenomatous morphology, such as the one described by Dutt et a1,4 show positive staining with a monoclonal antibody against thrombomodulin (Fig 1).
for Letters
Letters to the Editor will be published at the discretion of the editor as space permits and are subject to editing and abridgement. They should be typewritten, double-spaced, and submitted in triplicate. They should be limited to 500 words or less and to no more than five pertinent references.
CURTIS L. COLLINS, MD LOUIS M. FINK, MD SU-MING Hsu, MD ROBERT SCHAEFER, MD University of Arkansas for Medical Sciences and John L. McClellan Memorial Veterans Hospital Little Rock, AR
L
Thrombomodulin of Mesothelioma
1992)
Staining Cells
To the Editor:-A recent article by Sheibani et al’ discussed extensively the applications of antibodies for differential diagnosis between mesothelioma and adenocarcinomas. It is of interest that all the antibodies show positive reactivity for adenocarcinomas and negative staining for mesotheliomas. Because these antibodies, such as anti-Leu-Ml or CEA, do not always react with adenocarcinoma cells, clear-cut distinction between adenocarcinoma and mesothelioma may sometimes be very difficult. Identification of antibodies that react with mesothelioma cells but not adenocarcinoma cells will be most helpful for definitive diagnosis. We have recently compared the anti-thrombomodulin staining of
NELSON ORDONEZ, MD The University of Texas, MD Anderson Houston, TX
Cancer
Center
1 SheihaniK, EstehanJM, Bailey A, et al: Immunopathologk and molecular studies as an aid to the diagnosis of malignant mesothelioma. HUM PATHOL 23: 107.116, 1992 2. Fink LM, Collins CI., Schaefer RF, et al: Thrombomodulin expression can he used to difterentiate between mesotheliomas and adenocarcinomas. Lab Invest 66: I 13A, 1992 3. Collins CL, Ordonez NG, Schaefer R, et al: Thrombomodulin expression in malignant pleural mesothelioma and pulmonary adenocarcinoma. Am J Parhol (in press) 4. Dutt PL, Page D, et al: Distant cutaneous metastasis of pleural malignant mesothelioma. J Cutan Pathol (in press)
FIGURE 1. (A) A metastatic mesothelioma in skin was positively stained for thrombomodulin (TM) (open arrow). Anti-TM antibody also reacted with squamous epithelium and endothelial cells (arrowhead). (B) Higher magnification shows that TM was mainly expressed on the luminal surface of tumor cells. (Avidin-biotin-peroxidase complex immunoperoxidase stain. Magnifications: A, x 100: B. x400.)
966
BOOK REVIEWS
for 28 days until the level of radiation has subsided to an insignificant level. If such tissues must be processed immediately, all solutions, paraffin wax, microtomes, etc, that come into contact with the indium will become contaminated. Additionally, radiation, however small, will have a cumulative effect on the staff handling the tissues and sections from the first and subsequent cases. With the increasing popularity of immunologic methods in the medical field, histology laboratories can expect to receive similar radioactive tagged specimens in the future and some thought must be given to their handling.
Indium-Ill: Recommended Handling of Radioactive Tagged Specimens To the Editor:--Pathologists and histotechnologists should be aware of a new diagnostic tool in use at some medical centers using radioactive compounds. In this procedure monoclonal antibodies are bound to a radioactive compound, indium-III, which has a half-life of 2.81 days. Following injection into the patient, scintigraphy is used to visualize the tagged tumors. Researchers have, on occasion, removed tumor masses and made radioactive counts to determine the binding capability of the radioactive substance. ‘,* Examination shows that the levels of radiation used are quite small, comparable to 20% of a bone scan, and radiate 5 &i of gamma radiation when first administered. This level is low and measurement of radiation from excised tissues requires use of an enclosed gamma counter to prevent background interference. However, the energy level of the remaining indium is high. One recommendation has been that histology laboratories receiving such specimens leave them in fixative
BOOK
MICHAEI. TITFORD, HLT(ASCP) University of South Alabama Mobile, AL 1. Edington HD, Watson CC, Levine G, et al: Radioimmunoimaging of metastaticmedullq carcinomaof the thyroid gland using an indium-1 1 l-labeled monoclonal antibody to CEA. Surgery 104:1004-1010,1988 2. Abdel-Nabi HH, Schwartz AN, Goldfogel G, et al: Colorectal tumors, Scintigraphy with In-l 11 anti-CEA monoclonal antibody and correlation with surgical, histopathologic, and immunohistochemical findings. Radiology 166: 747.752, 1988
REVIEWS
editors state in the preface that they have attempted to update the text in some areas, such as in situ hybridization of flow cytometry, very little of the text is actually devoted to this update. Nonetheless, the text is well written, covers a broad number of issues, and would generally be useful to surgical pathologists, pathology residents, and pathology technologists who are interested in, perform, or must interpret histochemical or immunohistochemical stains.-ANN D. THOR, MD, Associate
Histochemistry in Pathology 2E Review (ed 2). M. I. Filipe and B. D. Lake (eds). New York, NY, Churchill Livingstone, 1990,496 pages. This text, published in 1990, is an update of the 1983 edition of Histochemistry in Pathology. It has been expanded in the subsection of immunohistochemical methods and applications of these methods in fine needle aspiration cytology, soft tissue tumor diagnosis, and, more recently, developed methodologies such as in situ hybridization and flow cytometry. Contributing authors are from many countries, principally the United Kingdom, as well as the United States, Italy, The Netherlands, Portugal, Israel, and Czechoslovakia. The first five chapters provide a general review on the principals of fixation, processing, and routine and “special staining” criteria, as well as general applications of these methods. The remainingchapters provide a review of immunostaining applications for various organ systems and tissue types, with particular emphasis on their applications in tumor and tissue diagnosis. Included in each chapter are methods for differentiating benign from malignant lesions as well as subtyping of malignant lesions. A strength of the text is that it combines data that may be derived from traditional, special, immunohistochemical, and newly developed staining techniques. Approximately 50 pages of appendix are provided that give useful, very detailed staining methodology. The text is liberally illustrated (black and white) and numerous figures and tables are provided to illustrate the information presented in text form. A weakness of the text is that the references do not generally extend beyond 1987 or 1988; therefore, the information provided is not totally up to date for a reader in the 1990s. For example, in the breast chapter very little information is given regarding immunohistochemical staining for steroid receptors. Furthermore, some chapters are excessively short, such as the pancreas and fine needle aspiration cytology chapters. Unfortunately, while the
Professor, Harvard Medical School, and Associate Pathologist, Massachusetts General Hospital; and SUSAN M. EDGERTON, MA, HTL(ASCP), Senior Research Technologist, Massachusetts General Hospital, Boston, MA
PCR Topics. A. Rolfs, H. C. Schumacher, and P. Marx (eds). Berlin, Germany, Springer-Verlag, 1991, 258 pages, approximately $69. PCR Topics falls into that good news/bad news genre of scientific literature fostered by publishing collected presentations from scientific symposia. The good news is that investigators often present preliminary findings at these gatherings in interesting or new areas as well as creative speculations that have not yet passed the scrutiny of peer review. This can be useful for non-attendees if the symposium is published in a timely fashion, as seems to have been the case here. The bad news is that early results are of necessity often tentative. Moreover, non-peer-reviewed manuscripts are inherently less subject to editorial standards on content and format, particularly when there are many contributors. PCR Topics is a collection of 43 presentations from a June 1990 international symposium in Berlin on “Usage of Polymerase Chain Reaction (PCR) in Genetic and Infectious Diseases.” Over three quarters of the presentations are from investigators in Germany (then West Germany); only three are from non-European laboratories. Contributions encompass a diversity of applications grouped under the major themes of:
967