Pathology of malignant pleural mesothelioma
- Leslie A Litzky, MD
Leslie A Litzky, MD
- Professor of Pathology and Laboratory Medicine
- University of Pennsylvania Medical Center
- Section Editors
- Andrew Nicholson, MD
Andrew Nicholson, MD
- Section Editor — Pulmonary Pathology
- Professor of Respiratory Pathology
- Imperial College School of Medicine, London
- James R Jett, MD
James R Jett, MD
- Section Editor — Lung Cancer
- Professor of Medicine Emeritus
- National Jewish Health
- Joseph S Friedberg, MD
Joseph S Friedberg, MD
- Section Editor — Thoracic Surgery
- Charles Reid Edwards Professor of Surgery
- University of Maryland
- Rogerio C Lilenbaum, MD, FACP
Rogerio C Lilenbaum, MD, FACP
- Section Editor — Lung Cancer
- Yale Cancer Center
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.
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