Value of immunohistochemistry in the differential diagnosis of pleural sarcomatoid mesothelioma from lung sarcomatoid carcinoma

Histopathology. 2009 May;54(6):667-76. doi: 10.1111/j.1365-2559.2009.03298.x.


Aims: The differential diagnosis of pleural sarcomatoid mesothelioma (SM) from lung sarcomatoid carcinoma (LSC) invading parietal pleura and chest wall is a challenging issue. The aim of this study was to identify useful antibodies that can be used for the differential diagnosis of pleural SM from LSC.

Methods and results: Forty-five cases of pleural SM and 27 cases of LSC were immunohistochemically analysed by using 15 commercially available antibodies, including D2-40 and antibodies to calretinin, thrombomodulin, Wilms' Tumour 1, carcinoembryonic antigen (CEA), Napsin A, thyroid transcription factor (TTF)-1, pan-cytokeratin, CAM5.2, epithelial membrane antigen, Ber-EP4, MOC-31, alpha-smooth muscle actin, h-caldesmon and desmin. The results revealed that D2-40 positivity was significantly higher in pleural SM (86.7%) than in LSC (25.9%). The positivity of the adenocarcinoma markers, including CEA, Napsin A, and TTF-1, was low even in LSC.

Conclusions: Evaluating the positivity and degree of staining of the well-known mesothelial marker D2-40 could be applied to differentiate pleural SM from the sarcomatoid component of LSC, in addition to assessing clinical and radiological information.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies, Monoclonal / metabolism
  • Antibodies, Monoclonal, Murine-Derived
  • Biomarkers / metabolism
  • Biomarkers, Tumor / metabolism
  • Carcinoma / diagnosis*
  • Diagnosis, Differential
  • Humans
  • Immunohistochemistry*
  • Keratins / metabolism
  • Lung Neoplasms / diagnosis*
  • Mesothelioma / diagnosis*
  • Middle Aged
  • Pleural Neoplasms / diagnosis*


  • Antibodies, Monoclonal
  • Antibodies, Monoclonal, Murine-Derived
  • Biomarkers
  • Biomarkers, Tumor
  • CAM 5.2 antigen
  • monoclonal antibody D2-40
  • Keratins