Información del artículo
Abstract
The distinction between reactive mesothelium and carcinoma in serous effusions can be very difficult. Immunocytochemistry (ICC) is the most widely used tool to improve the diagnostic accuracy of body fluid cytology, with several ICC markers being proposed. Ber-EP4 antibody has shown high sensitivity and specificity rates for diagnosing metastatic carcinoma. In our department, we have detected Ber-EP4 positivity in mesothelium in some cytological specimens. We reviewed all articles on Ber-EP4 staining in effusion cytology, summarized current findings and analyzed the staining pattern of all cases expressing Ber-EP4. Some cases showing Ber-EP4 positivity in mesothelium have been reported, most of which showed only weak Ber-EP4 staining or staining of less than 50% of mesothelial cells. However, some cases may show strong positivity both in cytological and histological specimens. Clinicians and pathologists should be aware of this source of misdiagnosis, and ICC results in mesothelium should be always interpreted cautiously and correlated with clinical tests, other ICC markers and patient's previous history.
Keywords:
Ber-EP4
Carcinoma
Mesothelium
Cytology
Histology
Resumen
El diagnóstico diferencial entre mesotelio reactivo y carcinoma en efusiones puede ser muy difícil. La inmunocitoquímica (ICQ) es la técnica más utilizada para mejorar la precisión de la citología en este contexto, y se han propuesto múltiples marcadores. En estudios previos, el anticuerpo Ber-EP4 ha mostrado alta sensibilidad y especificidad para identificar carcinoma metastásico en derrames cavitarios. En nuestra institución, hemos observado positividad para Ber-EP4 en células mesoteliales en algunos especímenes citológicos. Por ello hemos revisado todos los artículos que analizan la reactividad de Ber-EP4 en mesotelio en muestras citológicas. En esta revisión hemos resumido las peculiaridades de la citología de derrames, y analizado el patrón de tinción de todos los casos publicados con positividad para Ber-EP4 en mesotelio en muestras citológicas. La mayor parte de casos descritos muestran tinción débil para Ber-EP4 o tinción en menos del 50% de las células mesoteliales. Sin embargo, algunos casos pueden mostrar positividad fuerte tanto en muestras citológicas como histológicas. Los clínicos y patólogos deben ser conscientes de esta posible causa de falsos positivos, y la interpretación de los marcadores ICQ en mesotelio debe realizarse con cautela y correlacionarse con los demás marcadores ICQ, los datos clínicos del paciente y su historia previa.
Palabras clave:
Ber-EP4
Carcinoma
Mesotelio
Citología
Histología
Artículo
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