The Value Of Immunocytochemistry And Fluorescence In Situ Hybridization In The Diagnosis Of Serous Effusion Malignant Mesothelioma

Malignant mesothelioma(MM)is a highly aggressive malignant tumor that can be divided into three types:epithelioid mesothelioma,sarcomatoid mesothelioma,and mixed(or biphasic)mesothelioma.Pathology,imaging and clinical manifestations are three important methods for the diagnosis of MM.Histopathology is considered to be the gold standard for the diagnosis of MM.However,many patients are difficult to obtain histopathological diagnosis.Serous effusion is often the most common first symptom in the early stage of MM.Serous effusions of epithelioid and biphasic mesothelioma often contain shedding tumor cell,cytopathology can be diagnosed based on serous effusion samples,serous effusion cytology has certain advantages for the early diagnosis of MM and is one of the most advantageous methods for early diagnosis of MM.The contents of this study are divided into two sections as followed:Section 1:Value of morphology combined with immunocytochemistry(ICC)in diagnosis of malignant mesothelioma(MM).The diagnosis of MM in serous effusions often needs to be differentiated from reactive mesothelial cells(RM)or metastatic adenocarcinoma(MA).In this study,149 serous cavity effusion specimens with cytological or histological results from 2012 to 2017 were selected,of which 102 cases had been performed ICC,sixty-seven cases of serous cavity effusions were successfully embedded.The cell blocks were sectioned and BAP1 ICC were stained to investigate the value of BAP1 in diagnosis of MM,RM,and MA.The relationship of BAP1 staining results and cell morphological heterogenetity was also performed.The results showed that the expression of CK5/6 and E-cadherin in MM was significantly higher than RM;the expression of CK5/6,Calretinin and D2-40 in MM was significantly higher than MA,The expression of BerEp4,CK7,MOC-31,NapsinA and TTF-1 in MA was significantly higher than MM;the expression of CK5/6,Calretinin and D2-40 in RM was significantly higher than MA,The expression of BerEp4,CK7,E-cadherin,MOC-31,NapsinA and TTF-1 in MA was significantly higher than RM.13 of 24 MM did not express BAP1.0 of 21 RM did not express BAP1.The sensitivity of BAP 1 in diagnosing MM was 54.2%(13/24)and the specificity was 100%(21/21);In addition,0 of 22 MA did not express BAP1.MM with BAP1 expression obtain more obvious cell morphological heterogenetitySection 2:The occurrence and development of malignant mesothelioma(MM)is the result of multi-gene,multi-factor and multi-step synergistic effects.In recent years,molecular biology research has developed rapidly.Molecular biology indicators related to the diagnosis and prognosis of MM have also become a research hotspot.In this study,45 cases of MM and reactive mesothelial cells(RM)from 2015 to 2017 were successfully embedded and sectioned and CDKN2A fluorescence in situ hybridization(FISH)was performed to investigate the value of CDKN2A in the diagnosis of MM.The value of this study is to provide ideas for the early diagnosis of MM and improve the prognosis of patients with MM.The results showed that CDKN2A gene deletion was found in 12 of 24 cases of MM,and CDKN2A gene deletion was found in 0 of 21 cases of RM.The sensitivity of CDKN2A FISH was 50%(12/24)and the specificity was 100%(21/21);19 of 24 cases of MM was found BAP1 immunocytochemistry(ICC)did not express or CDKN2A FISH gene deletion,The sensitivity of BAP1 ICC combined with CDKN2A FISH was 79.2%(19/24)and the specificity was 100%(21/21).In addition,Morphological diagnosis,ICC,BAP1 ICC,and CDKN2A FISH were performed in 16 cases of mesothelioma,the results showed that the diagnostic rate of mesothelioma was 12.5%(2/16)by morphology.Morphology supplemented by ICC was 50%(8/16),and the diagnosis rate was 81.3%(13/16)by morphology,ICC and BAP1 ICC.The diagnostic rate of a combination of morphology,ICC,BAP1 ICC,and CDKN2A FISH was 93.8%(15/16).