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2014, Volume 30, Number 1, Page(s) 001-010
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DOI: 10.5146/tjpath.2013.01210 |
The Diagnosis of Thoracic Malignant Mesothelioma: Practical Considerations and Recent Developments |
Maxwell SMITH, Thomas COLBY |
Mayo Clinic Arizona, Laboratory Medicine and Pathology, SCOTTSDALE, USA |
Keywords:
Mesothelioma, Thoracic neoplasms, Differential diagnosis, Immunohistochemistry, Pathology |
Pleural biopsies for the evaluation of malignant mesothelioma can be
some of the most challenging cases faced by the practicing surgical
pathologist. We review the epidemiology, clinical presentation,
and imaging studies in patients with malignant mesothelioma,
and then present a practical approach to the diagnosis using the
cytologic features for malignancy and whether there is an epithelioid
or spindled morphology; four main scenarios are discussed. The
pertinent immunohistochemical work-up is reviewed for each
scenario. Following this general overview, more unusual histologic
patterns are compared and unusual presentations are discussed. Brief
mention of grading systems for malignant mesothelioma and the
use of electron microscopy and molecular studies is made. Practical
considerations in the diagnosis of malignant mesothelioma are made
throughout.
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