Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0268596 (EMA)
 2,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The separation of benign from malignant mesothelial proliferations has emerged as a major problem in the pathology of the serosal membranes. For both epithelial and spindle cell mesothelial processes, true stromal invasion is the most accurate indicator of malignancy, but stromal invasion is often difficult to assess, especially in small biopsies. In the pleural cavity, deep penetration of a thickened and fibrotic pleura or penetration of mesothelial cells into the fat of the chest wall are good indicators of malignancy; however, superficial entrapment of mesothelial cells and glands by organizing effusions is common in benign reactions and needs to be distinguished from invasion. In the peritoneal cavity, invasion of fat or of organ walls is again the most reliable indicator of malignancy, but entrapment of benign cells in organizing granulation tissue or between fat lobules is frequent and confusing. Proliferations confined to the pleural or peritoneal space, particularly linear arrays of atypical mesothelial cells on the free surface, should not be called malignant in the absence of unequivocal invasion. Cytologic atypia is often not helpful in separating benign from malignant reactions, because benign processes are commonly atypical and mesotheliomas are often deceptively monotonous. Densely packed mesothelial cells within the pleural space are frequent in benign reactions, but densely packed mesothelial cells within the stroma favor a diagnosis of malignancy. Organizing effusions (fibrous pleurisy) typically show zonation with high cellularity and cytologic atypia toward the pleural space and increasing fibrosis with decreasing cellularity and lesser atypia toward the chest wall, whereas sarcomatous (including desmoplastic) mesotheliomas do not demonstrate this type of zonation. Elongated capillaries perpendicular to the pleural surface are seen in organizing effusions but are not a feature of sarcomatous mesotheliomas. The combination of a paucicellular storiform pattern, plus invasion of the stroma (including fat and adjacent tissues), or bland necrosis, overtly sarcomatous foci, or distant metastases, is required for the diagnosis of desmoplastic mesothelioma. Necrosis is usually a sign of malignancy but is occasionally seen in benign mesothelial reactions. Keratin staining is useful in indicating the distribution of mesothelial cells, and particularly in demonstrating penetration of mesothelial cells into the stroma or adjacent structures, but is of no help in separating benign and malignant proliferations because both are keratin-positive. Although both p53 and EMA staining have been proposed as markers of mesothelial malignancy, in our experience they are not helpful for the individual case.
 ...
PMID:The separation of benign and malignant mesothelial proliferations. 1125 37

The clinical introduction of new methods for processing fluid samples and the application of supplementary methods for improving the diagnostic accuracy of the pattern of pleurisy is very important for differential diagnosis. The possibilities of using immunocytochemical assay in the practical work of a clinical diagnostic (cytological) laboratory were studied in 96 patients, including 78 and 18 patients with pleural and ascitic fluids, respectively). A Cytospin-IV centrifuge was used for immunocytochemical assay by the routine procedure. The Streptadivin-biotin LSAB2 and EnVision+ test systems were employed to visualize an antigen/antibody reaction. Diaminobenzidine (DAB) was used as a chromogen. A set of markers, comprising 11 antibodies, was applied to the verification of a neoplasm from serous cavities. Mesothelioma was diagnosed in 65 patients. Epithelial mesothelioma was identified in 62 (95.4%) cases. Mesothelioma cells were positive to vimentin and ceratins, calretinin, mesothelin, and thrombomodulin. In 31 cases, adenogenic carcinoma metastases to the serous cavities were typified by an immunopositive reaction to CEA, Ber-EP4, EMA, and cytokeratins and a negative reaction to calretinin, mesothelin, and thrombomodulin. There was occasionally a positive reaction to CD-15 and vimentin.
 ...
PMID:[Use of immunocytochemical assays in the study of exudates from serous cavities in the practical work of a laboratory]. 1831 75