Official reprint from UpToDate
Leslie A Litzky, MD
Arthur T Skarin, MD
Andrew Nicholson, MD
Michael E Ross, MD
Pathology of malignant mesothelioma
Last literature review version 18.1:
Ocak 2010 |
This topic last updated:
Şubat 17, 2009
— Mesothelioma is a malignant tumor that arises from the mesothelial surfaces
of the pleural and peritoneal cavities, the tunica vaginalis, or the pericardium. Eighty percent of all
cases are pleural in origin.
The pathology of malignant mesothelioma, focusing on the most common form, diffuse pleural
malignant mesothelioma, will be reviewed here. Other aspects of pleural mesothelioma are
discussed separately. (See
"Epidemiology of malignant mesothelioma"
diagnosis, and staging of malignant pleural mesothelioma"
"Treatment approaches for
localized malignant pleural mesothelioma and solitary fibrous tumor of the pleura"
— Multiple factors have made the diagnosis of malignant
mesothelioma a particular challenge for most practicing pathologists.
Malignant mesothelioma is rare, except in large referral centers or epidemiologic hotspots.
In many cases, only a limited amount of tissue is available for histologic evaluation and special
studies. The use of video-assisted thoracoscopy (VAT) biopsies has made this issue less frequent in
many practice settings. VAT has greatly improved the size of pleural biopsies and the choice of
sampling sites, usually providing enough tissue for definitive diagnosis.
Malignant mesothelioma can vary greatly in histologic appearance within any one patient. In
addition, a number of other tumors, both originating within the thorax or metastatic from an
extrathoracic site, can mimic malignant mesothelioma. There are also a number of benign pleural
diseases that may be difficult to separate from pleural malignancy.
The widespread availability and use of immunohistochemistry has greatly improved the accuracy of
diagnosis in recent years. Molecular studies, although not always available, have also improved
diagnostic accuracy in certain situations.
Finally, a thorough clinical history that includes a history of prior malignancy as well as past
medical diseases and previous therapies is essential to appropriate pathologic examination. High
quality radiographic studies and astute radiographic assessment can also make a substantial
contribution to pathologic diagnosis.
— Early stage malignant pleural mesothelioma presents as multiple small
nodules that characteristically are more pronounced on the parietal pleura but can also involve the
visceral pleura [
]. As the tumor progresses, these nodules coalesce to form a thickened rind of
tumor that fuses the parietal and visceral pleurae.
At a more advanced stage, the tumor typically encases the entire lung and extends along the