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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 "Clinical presentation, diagnosis, and staging 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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Literature review current through: Sep 2016. | This topic last updated: Apr 2, 2014.
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