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Objective: To see the importance and frequencies of different IHC markers in the diagnosis of Malignant Mesothelioma
(MM) in patients with suspected mesothelioma presented with pleural effusion.
Material and Methods: This was a cross sectional analysis, conducted at Pulmonology unit, Lady Reading Hospital
Peshawar, Pakistan from January 2016 to December 2017. Patients with pleural effusion and suspected mesothelioma
were included. Pleural biopsies were sent for IHC and SPSS was used for statistical analysis. Those with Granulomatous
inflammation, possible TB and chronic non specific inflammation on histopathology were excluded from the study.
Results: A total of 141 cases were identified of which 60 patients were excluded who turned out to be Granulomatous
inflammation/chronic non specific inflammation or non diagnostic biopsies report. Remaining 81 patients were included
with median age 55.04% years range, 24–75 years ±15.688 SD, 46 patients (56.8%) were males and most of the
cases (one fourth) were from age group above 50 years. MM was relatively common in males as compared to female
(56.8% vs 43.2%). Of those 53 (65%) were diagnosed with MM and 28(34.6%) were Metastatic Adeno-carcinoma on
the basis of histopathology and IHC markers. Calretinin was the most frequent marker present in 46 (86.8%) cases of
MM followed by WT1 and Cytokeratin in 45 (84.9%) cases each. Similarly the most commonly found marker in cases of
Metastatic Adeno-carcinoma (MA) was TTF1 in 22 (78.5%) which was absent in 100% cases of MM. Similarly, Calretinin
and HBME was absent in 26 (92.8%) cases of MA. On the other hand Cytokeratin was also present in 42.8% cases of
MA. Calretinin was found to have more sensitivity (86.79%), specificity (92.86%), PPV (95.83%) and accuracy (88.89%)
in diagnosing MM on histological samples and TTF1 was the most suitable IHC for the identification of MA
Conclusions: Calretinin, Cytokeratin , HBME and WT1 are useful IHC marker in the diagnosis of MM. Calretinin is
the most sensitive and specific IHC markers on histopathological samples in MM. While in case of MA , TTF1 was the
most suitable marker.
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