04 - Pathology of malignant mesothelioma 1 -> 8

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Official reprint from UpToDate ® www.uptodate.com ©2010 UpToDate ® Author Leslie A Litzky, MD Section Editors Arthur T Skarin, MD Andrew Nicholson, MD Deputy Editor Michael E Ross, MD Pathology of malignant mesothelioma Last literature review version 18.1: Ocak 2010 | This topic last updated: Şubat 17, 2009 INTRODUCTION — 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" and "Clinical presentation, diagnosis, and staging of malignant pleural mesothelioma" and "Treatment approaches for localized malignant pleural mesothelioma and solitary fibrous tumor of the pleura" .) DIAGNOSTIC DIFFICULTIES — 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. GROSS PATHOLOGY — 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 [ 1 ]. 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
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This note was uploaded on 05/24/2010 for the course MED 122 taught by Professor Tera during the Winter '08 term at Anadolu University.

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04 - Pathology of malignant mesothelioma 1 -> 8

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