Mesothelioma and Antibodies to Epithelial Membrane Antigen

One attention-grabbing study is named, "The use of histological and immunohistochemical markers to tell apart pleural malignant mesothelioma and in situ mesothelioma from reactive mesothelial hyperplasia and reactive pleural fibrosis" by P. M. Cury, D. N. Butcher, B. Corrin, A. G. Nicholson - The Journal of Pathology Volume 189, Issue 2, pages 251–257, October 1999.  Here is an excerpt: "Abstract - Distinguishing malignant mesothelioma from reactive mesothelial hyperplasia and reactive fibrosis will be a diagnostic downside in little pleural biopsies, created harder by the recent recognition of mesothelioma-in-situ. Antibodies to epithelial membrane antigen (EMA), p53, and bcl-2 have all been advocated for differentiating reactive from neoplastic conditions, however reports are inconsistent. These antibodies have so been applied to thirty one cases of malignant mesothelioma, thirty four cases of reactive pleural disease (20 reactive mesothelial hyperplasia and fourteen reactive pleural fibrosis) and 4 little biopsies that were initially coded as suspicious, from patients who later developed frank mesothelioma. Thirty out of thirty one (97 per cent) cases of mesothelioma showed positive nuclear staining for p53, with a better incidence of positivity in epithelioid than in sarcomatoid components and 30/31 (97 per cent) showed diffuse linear membrane staining for EMA, additional} more intense within the epithelioid components. No mesothelioma was positive for bcl-2. In seven cases that contained each in situ and invasive mesothelioma, the in situ components showed similar staining patterns to the invasive epithelioid components. 13 out of twenty (65 per cent) cases of reactive mesothelial hyperplasia showed occasional nuclear positivity for p53 and 5/20 (25 per cent) cases showed focal weak membrane staining for EMA. 3 out of fourteen (21 per cent) cases of reactive pleural fibrosis showed positive nuclear staining for p53 and 6/14 (43 per cent) cases showed focal membrane staining with EMA. No reactive cases stained for bcl-2. All four suspicious cases showed diffuse linear staining with EMA and 3 showed focal staining for p53. it's concluded that sturdy diffuse linear staining for EMA could be a sensible marker of malignancy when differentiating epithelioid malignant mesothelioma and mesothelioma-in-situ from reactive mesothelial hyperplasia, though weak focal staining might occur in reactive conditions. Nuclear staining for p53 is additionally suggestive of epithelioid mesothelioma, however ought to be considered no over suspicious. The antibodies utilized in this investigation are less useful in differentiating sarcomatoid mesothelioma from reactive pleural fibrosis."

Another attention-grabbing study is named, "Effusion cytology within the diagnosis of malignant epithelioid and biphasic pleural mesothelioma." Arch Pathol Lab Med. 1990 Aug;114(8):845-51 by Sherman ME, Mark EJ - James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Boston.  Here is an excerpt: "Abstract -
We reviewed the cytologic findings in pleural effusions of thirty six patients in whom a diffuse epithelioid or biphasic malignant mesothelioma of the pleura developed between 1978 and 1988. Malignant neoplasms were diagnosed in twenty six (72%) of the thirty six patients. a selected diagnosis of a mesothelioma was rendered or suspected in sixty fourth (23/36 patients). Mesothelioma was favored over adenocarcinoma in eighty one (29/36) of patients with positive fluid cytologic findings. The contribution of effusion cytology to the ultimate diagnosis and patient treatment was assessed. These information instructed that a cytologic diagnosis contributed helpful data in most patients with malignant epithelioid and biphasic pleural mesotheliomas."

Another attention-grabbing study is named, "A randomised trial in malignant mesothelioma (M) of early (E) versus delayed (D) chemotherapy in symptomatically stable patients: the MED trial" by M. E. R. O'Brien, D. Watkins, C. Ryan, K. Priest, C. Corbishley, A. Norton, S. Ashley, N. Rowell  and R. Sayer - Ann Oncol (February 2006) seventeen (2): 270-275.   Here is an excerpt: "Abstract - Background: previous part II trials have demonstrated the therapeutic activity of cytotoxic chemotherapy in mesothelioma. Currently there are few randomised information assessing the role of chemotherapy versus best supportive care (BSC) within the management of patients with stable symptoms once management of any pleural effusion. A policy of observation is commonly adopted over initial use of chemotherapy. during this prospective randomised trial we tend to assess the utilization of early versus delayed cytotoxic therapy. The study opened in 1998, and closed in read of a competing national study (MSO 1) in 2003.   Methods: Eligible patients had a performance standing ≤2, life expectancy >3 months and had stable symptoms for a minimum of four weeks before randomisation. Patients were randomised to receive immediate chemotherapy or initial BSC with the addition of chemotherapy at time of symptomatic progression. All patients received a similar platinum-based chemotherapy regimen, MVP [mitomycin C eight mg/m2 cycles one, 2, 4 and 6, vinblastine six mg/m2, most ten mg, and cisplatin fifty mg/m2 (or carboplatin AUC 5)], each three weeks for up to 6 cycles.   Results: a complete of forty three patients were recruited, of that twenty one were randomised to the first treatment cluster and twenty two to the delayed treatment cluster. The median ages were fifty nine years (range 50–78) and sixty seven years (range 48–75), respectively (P = zero.1); different baseline parameters were similar temperament between the 2 teams. All twenty one patients within the early cluster received chemotherapy versus seventeen patients within the delayed cluster. Median time to symptomatic progression was twenty five weeks within the early cluster compared with eleven weeks for the delayed cluster (P = zero.1). Median survival was fourteen months (1-year survival 66%) for the first cluster compared with ten months (1-year survival 36%) for the delayed cluster (P = zero.1). Quality of life was normally higher maintained for early treatment and therefore the health resources use was similar in each arms.   Conclusions: during this patient cluster, presenting with stable symptoms once management of pleural effusion, the first use of chemotherapy provided an extended amount of symptom management, and during this little trial a trend to survival advantage."