My approach to the diagnosis of mesothelial lesions

University of Vermont/Fletcher Allen Health Care, Burlington, VT 05401, USA.
Journal of Clinical Pathology (Impact Factor: 2.92). 07/2006; 59(6):564-74. DOI: 10.1136/jcp.2005.029652
Source: PubMed


Mesothelial lesions pose considerable diagnostic challenges not only because benign tumours, reactive proliferations and malignant mesothelioma can mimic one another, but also because the morphological patterns displayed by malignant mesothelioma can simulate a variety of epithelial and non-epithelial malignancies. Immunohistochemical markers can aid in distinguishing epithelioid malignant mesothelioma from metastatic adenocarcinoma, but because no single marker reliably separates all cases, a panel of stains is recommended. Immunohistochemical studies are of more limited value in sarcomatoid malignant mesothelioma, and other features often play an essential role. The separation of reactive mesothelial proliferations from malignant mesothelioma on small biopsy can be quite difficult, as distinguishing features, such as stromal invasion, often cannot be adequately assessed. In adequately sampled lesions, however, the distinction between malignant mesothelioma, benign mesothelial proliferations and other tumours can be achieved in most cases by using a carefully integrated approach that incorporates clinical and radiographic data, immunohistochemical studies and, in selected cases, histochemical and ultrastructural techniques.

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    • "Desmoplastic mesothelioma (DMM) is a rare and highly lethal variant of malignant pleural mesothelioma: This subtype, which accounts for 5–10% of malignant mesotheliomas, most commonly affects the pleura[1] and less commonly the peritoneum and the pericardium.[2–4] DMM was first described by Kannerstein and Churg in 1980[5] and since then the number of reports, although sporadic, has been constantly increasing.[2] Findings of the disease include a male-to-female ratio 2:1, a wide range of ages (12–77 years), and a documented asbestos exposure in 14% of cases.[3] "
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    ABSTRACT: Desmoplastic mesothelioma (DMM) is a rare and highly lethal subtype of diffuse malignant mesothelioma and is often difficult to distinguish from reactive pleural fibrosis. The term "desmoplastic" refers to the growth of fibrous or connective tissue. We report the clinical, radiological, and pathological features of a primary DMM of the pericardium and a short review of the literature. A 72-year-old man was admitted presenting shortness of breath, cough, and asthenia. Computed tomography scan showed thickenings and effusions both in the pleura and in the pericardium. Histopathological diagnosis was performed by surgical pericardial biopsy and confirmed by autopsy. The patient had a history of asbestos exposure. Primary mesothelioma of the pericardium is a rare tumor occurring in the fourth to seventh decades with nonspecific symptoms and a rapid clinical course. The diagnosis is difficult and often needing a surgical pericardial biopsy. The prognosis is poor although newer antiblastic drugs seem to prolong survival times.
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    Clinical Lung Cancer 07/2007; 8(7):436-8. DOI:10.3816/CLC.2007.n.029 · 3.10 Impact Factor
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