Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Pathology of malignant pleural mesothelioma

Leslie A Litzky, MD
Section Editors
Andrew Nicholson, MD
James R Jett, MD
Joseph S Friedberg, MD
Rogerio C Lilenbaum, MD, FACP
Deputy Editor
Sadhna R Vora, MD


Mesothelioma is a malignant tumor that arises from the mesothelial surfaces of the pleural and peritoneal cavities, the tunica vaginalis, or the pericardium. Eighty percent of all cases are pleural in origin.

The pathology of malignant mesothelioma, focusing on the most common form, diffuse pleural malignant mesothelioma, will be reviewed here. The pathology of peritoneal mesothelioma is discussed separately, as are other aspects of pleural mesothelioma. (See "Malignant peritoneal mesothelioma: Epidemiology, risk factors, clinical presentation, diagnosis, and staging", section on 'Histology' and "Epidemiology of malignant pleural mesothelioma" and "Presentation, initial evaluation, and prognosis of malignant pleural mesothelioma" and "Initial management of malignant pleural mesothelioma".)


Multiple factors have made the diagnosis of malignant mesothelioma a particular challenge for most practicing pathologists.

Malignant mesothelioma is rare, except in large referral centers or epidemiologic hotspots.

In many cases, only a limited amount of tissue is available for histologic evaluation and special studies. The use of video-assisted thoracoscopy (VAT) biopsies has made this issue less frequent in many practice settings. VAT has greatly improved the size of pleural biopsies and the choice of sampling sites, usually providing enough tissue for definitive diagnosis.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jan 24, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Pathology and Genetics: Tumors of the Lung, Pleura, Thymus, and Heart, IARC, 2004.
  2. Allen TC, Cagle PT, Churg AM, et al. Localized malignant mesothelioma. Am J Surg Pathol 2005; 29:866.
  3. Allen TC. Recognition of histopathologic patterns of diffuse malignant mesothelioma in differential diagnosis of pleural biopsies. Arch Pathol Lab Med 2005; 129:1415.
  4. Churg A, Colby TV, Cagle P, et al. The separation of benign and malignant mesothelial proliferations. Am J Surg Pathol 2000; 24:1183.
  5. Mangano WE, Cagle PT, Churg A, et al. The diagnosis of desmoplastic malignant mesothelioma and its distinction from fibrous pleurisy: a histologic and immunohistochemical analysis of 31 cases including p53 immunostaining. Am J Clin Pathol 1998; 110:191.
  6. Husain AN, Colby T, Ordonez N, et al. Guidelines for pathologic diagnosis of malignant mesothelioma: 2012 update of the consensus statement from the International Mesothelioma Interest Group. Arch Pathol Lab Med 2013; 137:647.
  7. Mayall FG, Goddard H, Gibbs AR. The diagnostic implications of variable cytokeratin expression in mesotheliomas. J Pathol 1993; 170:165.
  8. Chu AY, Litzky LA, Pasha TL, et al. Utility of D2-40, a novel mesothelial marker, in the diagnosis of malignant mesothelioma. Mod Pathol 2005; 18:105.
  9. Ordóñez NG. The diagnostic utility of immunohistochemistry in distinguishing between mesothelioma and renal cell carcinoma: a comparative study. Hum Pathol 2004; 35:697.
  10. Ordóñez NG. The diagnostic utility of immunohistochemistry in distinguishing between epithelioid mesotheliomas and squamous carcinomas of the lung: a comparative study. Mod Pathol 2006; 19:417.
  11. Hammar SP. Macroscopic, histologic, histochemical, immunohistochemical, and ultrastructural features of mesothelioma. Ultrastruct Pathol 2006; 30:3.