Pathological Diagnosis of Malignant Mesothelioma

Article information

J Korean Med Assoc. 2009;52(5):456-464
Publication date (electronic) : 2009 May 30
doi : https://doi.org/10.5124/jkma.2009.52.5.456
Department of Pathology, Yonsei University Wonju College of Medicine, Seoul, Korea. soonheej@yonsei.ac.kr

Abstract

Malignant mesothelioma is a primary tumor of the serosal membranes, occurring in the pleura, peritoneum, pericardium, tunica vaginalis, and other related anatomical sites. It is well known that malignant mesothelioma may be a difficult tumor to diagnose pathologically. For the reliable diagnosis of mesothelioma, the adequate representative tissue samples are essential for the routine histology, histochemistry, electron microscopy, and immunohistochemical test. The main differential diagnosis includes metastatic adenocarcinomas or metastatic sarcomas, and even benign mesothelial diseases. As a practical diagnostic method for differential diagnosis of malignant mesothelioma, the immunohistochemistry using a panel of antibodies (positive and negative markers) is considered as the most valuable and useful tool. The use of at least 2 mesothelial markers and 2 or more epithelial markers is recommended, and a diagnostic panel including calretinin, Wilms tumor product 1, cytokeratin 5/6, carcinoembryonic antigen (CEA), and thyroid transcription factor (TTF)-1 could be helpful.

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Article information Continued

Figure 1

Pathogenesis of malignant mesothelioma.

Figure 2

Gross findings of malignant mesothelioma showing diffuse thickening of the pleura and encasing the lung with compression of residual lung tissues.

Figure 3

Histopathologic subtype of diffuse malignant mesothelioma (H & E stain). (A) Epithelioid type (x100), (B) Sarcomatoid type (x200), (C) Biphasic type (x200), (D) Desmoplastic type (x200).

Table 1

Immunohistochemistry for the distinction between benign mesothelial reactions and malignant mesothelioma* (11)

Table 1

*+/- indicates present in some tumor cells; +++, present in most tumor cells; and EMA, epithelialmembrane antigen.

Table 2

Antibodies usually positive in epithelioid malignant mesothelioma (12)

Table 2

Table 3

Antibodies usually positive in pulmonary adenocarcinoma metastatic to the pleura (12)

Table 3