Abstract
Malignant mesothelioma is a relatively rare but unique neoplasm of the pleura and other serosal surfaces. During the past 50 years, mesothelioma has been the subject of numerous epidemiologic, clinical, experimental, and pathologic studies. Pathologic diagnosis of mesotheliomas can be accomplished at several levels during the pathologic evaluation, beginning with gross and microscopic examination and extending through immunohistochemical, molecular, and electron microscopic confirmation.
Malignant mesotheliomas are classified based on their histomorphologic features. The most common is the epithelial type with its morphologic variants like tubulopapillary, solid, and adenomatoid (microglandular) patterns. Sometimes, one pattern predominates but several different patterns are commonly seen in the same tumor. Less common patterns include small cell, clear cell, and the deciduoid.
Sarcomatous mesothelioma is an aggressive type of malignant mesothelioma; histologically it may show a wide range of architectural complexity from hypocellular quiet bland spindle cells to densely cellular areas with obviously high-grade cytology. Two histologic variants are recognized; lymphohistiocytoid and desmoplastic diffuse malignant mesothelioma (DMM).
Biphasic malignant mesothelioma is characterized by the coexistence of epithelial and sarcomatous types.
The differential diagnosis of malignant mesothelioma includes pleural diffuse or localized neoplastic or non-neoplastic processes. The distinction between these entities demands the integration of clinical, radiographic, and immunohistochemical studies, and several key differentiating features are discussed when enough tissue is available for evaluation by the pathologist. The most important and frequent differential diagnosis includes metastatic adenocarcinoma and sarcomas and chronic fibrous pleuritis.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Yates DH, Corrin B, Stidolp PN, Browne K. Malignant mesothelioma in south east England: clinicopathological experience of 272 cases. Thorax. 1997;52:507–12.
McCaughey WT, Colby TV, Battifora H, et al. Diagnosis of diffuse malignant mesothelioma: experience of a US/Canadian Mesothelioma Panel. Mod Pathol. 1991;4:342–53.
Sporn TA, Roggli VL. Mesothelioma. In: Roggli VL, Oury TD, Sporn TA, editors. Pathology of asbestos-associated diseases. New York: Springer; 2004. pp. 104–67.
Boutin C, Rey F, Gouvernet J, Viallat JR, Astoul P, Ledoray V. Thoracoscopy in pleural malignant mesothelioma: a prospective study of 188 consecutive patients. 2. prognosis and staging. Cancer. 1993;72:394–4.
Robinson BWS, Lake RA. Advances in malignant mesothelioma. N Engl J Med. 2005;353:1591–603.
Elmes PC, Simpson JC. The clinical aspects of mesothelioma. Quar J Med. 1976;45:427–48.
Churg A, Roggli VL, Galateau-Salle F, et al. Tumours of the pleura: mesothelial tumours. In: Travis WD, Brambilla E, Harris CC, Muller-Hermelink HK, editors. Pathology and genetics of tumours of the lung, pleura, thymus and heart. Lyon: IARC Press; 2004. World Health Organization Classification of Tumours.
Galateau-Salle F, Brambilla E, Cagel PT, et al. Classification and histologic features of epithelioid mesotheliomas. In: Galateau-Salle F, editor. Pathology of malignant mesothelioma. London: Springer-Verlag; 2006.
Churg A, Cagle PT, Roggli VL. Tumors of the serosal membranes. Washington, DC: American Registry of Pathology; 2006. Atlas of tumor pathology; 4th series, fascicle 3.
Cagle PT. Pleural histology. In Light RW, Lee YCG, editors. Pleural disease: An international textbook. London: Arnold; 2003. pp. 249–255.
Galateau-Sallé F, Vignaud JM, Burke L, et al. Well-differentiated papillary mesothelioma of the pleura: a series of 24 cases. Am J Surg Pathol. 2004;28:534–40.
Umezu H, Kuwata K, Ebe Y, et al. Microcystic variant of localizd malignant mesothelioma accompanying an adenomatoid tumor-like lesion. Pathol Int. 2002;52:416–22.
Arai H, Endo M, Sasai Y, et al. Histochemical demonstration of hyaluronic acid in a case of pleural mesothelioma. Am Rev Respir Dis. 1975;111:699–2.
Mayall FG, Gibbs AR. The histology and immunochemistry of small cell mesothelioma. Histopathology. 1992;20:47–51.
Cavazza A, Rossi G, Agostini L, et al. Small-cell mesothelioma of the pleura: description of a case. Pathologica. 2002;94:247–52.
Dessy E, Falleni M, Braidotti P, et al. Unusual clear-cell variant of epithelioid mesothelioma. Arch Pathol Lab Med. 2001;125:1588–90.
Serio G, Scattone A, Pennela A, et al. Malignant deciduoid mesothelioma of the pleura. Histopathology. 2002;40:348–52.
Shia J, Erlandson RA, Klimstra DS. Deciduoid mesothelioma: a report of 5 cases and literature review. Ultrastruct Pathol. 2002;26:355–63.
Monaghan H, Al-Nafussi A. Deciduoid pleural mesothelioma. Histopathology. 2001;39:104–6.
Hammar SP, Bolen JW. Sarcomatoid pleural mesothelioma. Ultrastruct Pathol. 1985;9:337–43.
Lucas DR, Pass HI, Madan Sk, et al. Sarcomatoid mesothelioma and its histological mimics: a comparative immunohistochemical study. Histopathology. 2003;42:270–79.
Corson JM. Pathology of diffuse malignant pleural mesothelioma. Semin Thorac Cardiovasc Surg. 1997;9:347–55.
Yousem SA, Hochholzer, L. Malignant mesotheliomas with osseous and cartilaginous differentiation. Arch Pathol Lab Med. 1987;111:62–66.
Okamoto T, Yokota S, Shinkawa K, et al. Pleural malignant mesothelioma with osseous, cartilaginous, and rhabdomyoblastic differentiation. J Jpn Resp Soc. 1998;36:696–1.
Suen HC, Sudholt B, Anderson WM, Lakho MH, Daily BB. Malignant mesothelioma with osseous differentiation. Ann Thorac Surg. 2002;73:665.
Henderson DW, Attwood HD, Constance TJ, Shilkin KB, Steele RH. Lymphohistocytoid mesothelioma: a rare lymphomatoid variant of predominantly sarcomatoid mesothelioma. Ultrastruct Pathol. 1988;12:367–84.
Khalidi HS, Medeiros LJ, Battifora H. Lymphohistiocytoid mesothelioma. An often misdiagnosed variant of sarcomatoid malignant mesothelioma. Am J Clin Pathol. 2000;113:649–54.
Cantin R, Al-Jabi M, McCaughey WTE. Desmoplastic diffuse mesothelioma. Am J Surg Pathol. 1982;6:215–22.
Colby TV. The diagnosis of desmoplastic malignant mesothelioma. Am J Clin Pathol. 1998;110:135–36.
Wilson GE, Hasleton PS, Chatterjee AK. Desmoplastic malignant mesothelioma: a review of 17 cases. J Clin Pathol. 1992;45:295–98.
Kannerstein M, Churg J. Desmoplastic diffuse malignant mesothelioma. Prog Surg Pathol. 1980;1:19–27.
Churg A, Cagle P, Colby TV, et al. US-Candadian mesothelioma reference panel. The fake fat phenomenon in organizing pleuritis: a source of confusion with desmoplastic malignant mesotheliomas. Am J Surg Pathol. 2011;35(12):1823–29.
Mangano WE, Cagle PT, Churg A, Vollmer RT, Roggli VL. The diagnosis of desmoplastic malignant mesothelioma and its distinction from fibrous pleurisy: a histologic and immunohistochemical analysis of 31 cases including p53 immunostaining. Am J Clin Pathol. 1998;110:191–99.
Bedrossian CW, Bonsib S, Moran C. Differential diagnosis between mesothelioma and adenocarcinoma: a multimodal approach based on ultrastructure and immunocytochemistry. Semin Diagn Pathol. 1992;9:124–40.
Koss M, Travis W, Moran C, Hochholzer L. Pseudomesotheliomatous adenocarcinoma: a reappraisal. Sem Diag Pathol. 1992;9:117–23.
Nishimoto Y, Ohno T, Saito K. Pseudomesotheliomatous carcinoma of the lung with histochemical and immunohistochemical study. Acta Pathol Jap. 1983;33:415–23.
Dardick I, Jabi M, McCaughey WTE, et al. Diffuse epithelial mesothelioma: a review of the ulstrastructural spectrum. Ultrastruct Pathol. 1987;11:503–33.
Wick MR, Loy T, Mills SE, Legier JF, Maniverl JC. Malignant epithelioid pleural mesothelioma versus peripheral pulmonary adenocarcinoma: a histochemical, ultrastructural, and immunohistologic study of 103 cases. Hum Pathol. 1990;21:759–766.
Husain AN, Colby TV, Ordóñez NG, Krausz T, Borczuk A, Cagle PT, Chirieac LR, Churg A, Galateau-Salle F, Gibbs AR, Gown AM, Hammar SP, Litzky LA, Roggli VL, Travis WD, Wick MR. Guidelines for patologic diagnosis of maliganant mesothelioma: a consensus statement from the international mesothelioma interest group. Arch Pathol Lab Med. 2009;133:1317–331.
Cagle PT, Churg A. Differential diagnosis of benign and malignant mesothelial proliferations on pleural biopsies. Arch Pathol Lab Med. 2005;129(11):1421–427.
Churg A, Colby TV, Cagle P, et al. The separation of benign and malignant mesothelial proliferations. Am J Surg Pathol. 2000;24:1183–200.
Allen TC. Recognition of histopathologic patterns of diffuse malignant mesothelioma in differential diagnosis of pleural biopsies. Arch Pathol Lab Med. 2005;129:1415–420.
Churg A, Galateau-Salle F. The separation of benign and malignant mesothelial proliferations. Arch Pathol Lab Med. 2012;136:1217–1226.
Crotty TB, Myers JL, Katzenstein AL, et al.: Localized malignant mesothelioma: a clinicopathologic and flow cytometric study. Am J Surg Pathol. 1994;18:357–63.
Okamura H, Kamai T, Mitsuno A, et al. Localized malignant mesothelioma of the pleura. Pathol Int. 2001;51:654–60.
Allen TC, Cagle PT, Churg AM, et al. Localized malignant mesothelioma. Am J Surg Pathol. 2005;29:866–73.
Gotfried MH, Quan SF, Sobonya RE. Diffuse epithelial pleural mesothelioma presenting as a solitary lung mass. Chest. 1983;84:99–101.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer Science+Business Media New York
About this chapter
Cite this chapter
Eltorky, M. (2015). Histology. In: Allen, T. (eds) Diffuse Malignant Mesothelioma. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2374-8_4
Download citation
DOI: https://doi.org/10.1007/978-1-4939-2374-8_4
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4939-2373-1
Online ISBN: 978-1-4939-2374-8
eBook Packages: MedicineMedicine (R0)