MY APPROACH

My approach to the diagnosis of mesothelial lesions

K J Butnor

Correspondence to:
Correspondence to:
K J Butnor
University of Vermont/Fletcher Allen Health Care, 111 Colchester Avenue, Burlington, VT 05401, USA; kelly.butnor{at}vtmednet.org

Mesothelial lesions pose considerable diagnostic challenges not only because benign tumours, reactive proliferations and malignant mesothelioma can mimic one another, but also because the morphological patterns displayed by malignant mesothelioma can simulate a variety of epithelial and non-epithelial malignancies. Immunohistochemical markers can aid in distinguishing epithelioid malignant mesothelioma from metastatic adenocarcinoma, but because no single marker reliably separates all cases, a panel of stains is recommended. Immunohistochemical studies are of more limited value in sarcomatoid malignant mesothelioma, and other features often play an essential role. The separation of reactive mesothelial proliferations from malignant mesothelioma on small biopsy can be quite difficult, as distinguishing features, such as stromal invasion, often cannot be adequately assessed. In adequately sampled lesions, however, the distinction between malignant mesothelioma, benign mesothelial proliferations and other tumours can be achieved in most cases by using a carefully intergrated approach that incorporates clinical and radiographic data, immunohistochemical studies and, in selected cases, histochemical and ultrastructural techniques.

Abbreviations: BMM, biphasic malignant mesothelioma; CEA, carcinoembryonic antigen; DMM, desmoplastic malignant mesothelioma; EMM, epithelioid malignant mesothelioma; SMM, sarcomatoid malignant mesothelioma; TTF-1, thyroid transcription factor-1; HBME-1, human mesothelial Cell-1; WT1, Wilms tumour gene 1

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?