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Cytopathologic Diagnosis of Mesothelioma: Can We Diagnose Mesothelioma Based on Fluid Cytological Materials Without Biopsy?

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Malignant Pleural Mesothelioma

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Abstract

Early diagnosis and initiation of treatment lead to longer survival in malignant pleural mesothelioma (MPM). Since more than 80% of MPM cases start with pleural effusions, cytologic diagnosis with effusion smears is critical for improved clinical outcomes. A three-step approach is usually undertaken for the diagnosis of MPM. The first step is to detect atypical mesothelial cells; the second step is to verify its mesothelial origin using immunohistochemistry (IHC); the third step is differentiating MPM cells from reactive mesothelial hyperplasia (RMH) or reactive mesothelial cells (RMC). Genomic-based ancillary assays that can effectively distinguish MPM from RMH/RMC, including BRCA-1 associated protein-1 (BAP1) and methylthioadenosine phosphorylase (MTAP) IHC and 9p21 and neurofibromin 2 (NF2) fluorescence in situ hybridization (FISH), have recently been developed. These ancillary assays enable the confirmation of the neoplastic and malignant nature of atypical mesothelial cells detected in the cytologic preparations or that of a single layer of surface mesothelial cells found in the in situ phase of mesothelioma. However, cautious interpretation and familiarity with potential challenges of data interpretation while assessing BAP1 and MTAP IHC results in cell blocks are warranted.

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Authors and Affiliations

  1. Department of Pathology, Fukuoka University School of Medicine and Hospital, Fukuoka, Japan

    Kazuki Nabeshima, Makoto Hamasaki, Yoshiaki Kinoshita, Masayo Yoshimura & Shinji Matsumoto

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  1. Kazuki Nabeshima
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  2. Makoto Hamasaki
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  3. Yoshiaki Kinoshita
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  4. Masayo Yoshimura
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  5. Shinji Matsumoto
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Correspondence to Kazuki Nabeshima .

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Editors and Affiliations

  1. Center Respiratory Medicine, Otemae Hospital, Osaka, Japan

    Takashi Nakano

  2. Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan

    Takashi Kijima

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Nabeshima, K., Hamasaki, M., Kinoshita, Y., Yoshimura, M., Matsumoto, S. (2021). Cytopathologic Diagnosis of Mesothelioma: Can We Diagnose Mesothelioma Based on Fluid Cytological Materials Without Biopsy?. In: Nakano, T., Kijima, T. (eds) Malignant Pleural Mesothelioma. Respiratory Disease Series: Diagnostic Tools and Disease Managements. Springer, Singapore. https://doi.org/10.1007/978-981-15-9158-7_10

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  • DOI: https://doi.org/10.1007/978-981-15-9158-7_10

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