J Korean Med Assoc.  2009 May;52(5):456-464. 10.5124/jkma.2009.52.5.456.

Pathological Diagnosis of Malignant Mesothelioma

• Jung SH

• KMID: 2188005
• DOI: http://doi.org/10.5124/jkma.2009.52.5.456

Abstract

Malignant mesothelioma is a primary tumor of the serosal membranes, occurring in the pleura, peritoneum, pericardium, tunica vaginalis, and other related anatomical sites. It is well known that malignant mesothelioma may be a difficult tumor to diagnose pathologically. For the reliable diagnosis of mesothelioma, the adequate representative tissue samples are essential for the routine histology, histochemistry, electron microscopy, and immunohistochemical test. The main differential diagnosis includes metastatic adenocarcinomas or metastatic sarcomas, and even benign mesothelial diseases. As a practical diagnostic method for differential diagnosis of malignant mesothelioma, the immunohistochemistry using a panel of antibodies (positive and negative markers) is considered as the most valuable and useful tool. The use of at least 2 mesothelial markers and 2 or more epithelial markers is recommended, and a diagnostic panel including calretinin, Wilms tumor product 1, cytokeratin 5/6, carcinoembryonic antigen (CEA), and thyroid transcription factor (TTF)-1 could be helpful.

Keyword

Malignant mesothelioma; Pathologic diagnosis; Immunohistochemistry

MeSH Terms

Adenocarcinoma
Antibodies
Calcium-Binding Protein, Vitamin D-Dependent
Carcinoembryonic Antigen
Diagnosis, Differential
Immunohistochemistry
Keratins
Membranes
Mesothelioma
Microscopy, Electron
Pericardium
Peritoneum
Pleura
Sarcoma
Thyroid Gland
Transcription Factors
Wilms Tumor
Antibodies
Calcium-Binding Protein, Vitamin D-Dependent
Carcinoembryonic Antigen
Keratins
Transcription Factors

Figure

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  Figure 1 Pathogenesis of malignant mesothelioma.

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  Figure 2 Gross findings of malignant mesothelioma showing diffuse thickening of the pleura and encasing the lung with compression of residual lung tissues.

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  Figure 3 Histopathologic subtype of diffuse malignant mesothelioma (H & E stain). (A) Epithelioid type (x100), (B) Sarcomatoid type (x200), (C) Biphasic type (x200), (D) Desmoplastic type (x200).

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