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Published on: December 21, 2019
Pleural mesothelioma: diagnostic problems and evaluation of prognostic factors
Hoda M Ismail1, Mohamed A Akram A Nouh, Iman L Abulkheir
1The Department of Pathology, National Cancer Institute, Cairo University. hodanci@hotmail.com
Background:
Malignant pleural mesothelioma (MPM) in Egypt is mainly attributed to an environmental origin i.e exposure to asbestos, with a high incidence in women and young adults. Immunohistochemistry and ultrastructural features aid in the diagnosis. The p27Kip1 is a kinase inhibitor protein acting as a cell cycle regulator and a putative tumor suppressor gene playing a critical role in the pathogenesis of several human neoplasms.
Aim:
A clinicopathologic, immunohistochemical and ultrastructural study of mesothelioma in Egyptian patients, with identification of different prognostic factors.
Material And Methods:
Sixty-one cases of MPM were collected from the department of pathology at the NCI, Cairo. Cases were stained by monoclonal antibodies against CK5/6, calretinin, vimentin, CD15, CEA and p27.
Results:
More than half (57.4%) of the patients were residents in endemic areas; 50.8% were of epithelioid type. CK5/6 was positive in 45 (73.8%) cases, 39 (63.9%) cases were positive for vimentin, 49 (80.3%) cases were positive for calretinin. One case showed a focal weak positive reaction to CD15. None of the cases stained for CEA. There was a statistically significant relation between p27 expression and the histopathologic type (p=0.02) between overall survival and age (p=0.01), histopathologic type (p=0.02) and stage (p=0.006).
Conclusion:
MPM is an increasing disaster in Egypt which is underestimated and neglected. A panel of immunohistochemical markers should be used for proper evaluation. p27 has proven to be a potential biologic prognostic marker for mesothelioma and more studies as regard its significance are recommended on a larger number.
Insights
Malignant pleural mesothelioma (MPM) in Egypt, linked to asbestos, shows a high incidence. The study highlights p27 as a potential prognostic marker for this increasing health concern.
Area of Science:
- Oncology
- Pathology
- Environmental Health
Background:
- Malignant pleural mesothelioma (MPM) in Egypt is primarily linked to environmental asbestos exposure.
- The disease disproportionately affects women and young adults.
- Immunohistochemistry and ultrastructural analysis are crucial for diagnosis, with p27Kip1 identified as a key cell cycle regulator and potential tumor suppressor.
Purpose of the Study:
- To conduct a comprehensive clinicopathologic, immunohistochemical, and ultrastructural examination of mesothelioma in Egyptian patients.
- To identify significant prognostic factors influencing mesothelioma outcomes in the region.
Main Methods:
- A cohort of 61 MPM cases was analyzed.
- Immunohistochemical staining was performed using monoclonal antibodies for CK5/6, calretinin, vimentin, CD15, CEA, and p27.
Main Results:
- Over half of the patients resided in asbestos-endemic areas, with 50.8% presenting with the epithelioid type.
- Immunohistochemical markers showed high positivity rates: CK5/6 (73.8%), vimentin (63.9%), and calretinin (80.3%).
- A significant correlation was found between p27 expression and histopathologic type, and between overall survival and age, histopathologic type, and disease stage.
Conclusions:
- MPM represents a significant and underestimated public health issue in Egypt.
- A panel of immunohistochemical markers is essential for accurate mesothelioma evaluation.
- p27 demonstrates potential as a biologic prognostic marker for mesothelioma, warranting further investigation in larger cohorts.
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