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Myxoid variant epithelioid pleural mesothelioma defines a favourable prognosis group: an analysis of 191 patients with pleural malignant mesothelioma
  1. Fouad Sami Alchami,
  2. Richard Luther Attanoos,
  3. Andrew Richard Bamber
  1. Department of Cellular Pathology, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
  1. Correspondence to Dr Richard Luther Attanoos, Department of Cellular Pathology, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, CF 14 4XW, UK; Richard.attanoos{at}


Malignant pleural mesothelioma shows marked cytoarchitectural diversity. The aim of the study was to evaluate how morphological phenotype impacted upon overall survival. 191 cases of malignant pleural mesothelioma with available follow-up were identified, examined and classified according to histological types. The epithelioid mesotheliomas were further subdivided according to morphological subtypes: myxoid, microcystic, tubulopapillary, solid epithelioid, micropapillary and pleomorphic; biphasic mesotheliomas were divided into epithelioid component dominant and sarcomatoid component dominant; pure sarcomatoid mesotheliomas were divided into not otherwise specified, leiomyoid, desmoplastic and heterologous. All cases were confirmed by two experienced observers. Myxoid variant malignant pleural epithelioid mesothelioma was observed to have a favourable overall survival compared with pleomorphic form (p=0.00008). Pleomorphic phenotype had the worst overall survival. Morphological phenotype is an important histological factor that should be included in pathology reports to convey potential favourable prognostic subgroups of patients with mesothelioma.

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  • Handling editor Cheok Soon Lee

  • Contributors FSA and RLA designed the study. FSA and RLA analysed the pathological aspects. ARB conducted the statistical analysis. All authors contributed to the writing of the manuscript. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. The lead author (FSA) (the manuscript's guarantor) affirms that the manuscript is an honest, accurate and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as have been explained.

  • Competing interests RLA undertake expert testimony work, which is used in asbestos litigation for both claimants and defendants. This study is non-commissioned and unfunded.

  • Provenance and peer review Not commissioned; externally peer reviewed.