Guidelines for pathologic diagnosis of malignant mesothelioma: 2017 update of the consensus statement from the International Mesothelioma Interest Group Journal Article


Authors: Husain, A. N.; Colby, T. V.; Ordóñez, N. G.; Allen, T. C.; Attanoos, R. L.; Beasley, M. B.; Butnor, K. J.; Chirieac, L. R.; Churg, A. M.; Dacic, S.; Galateau-Sallé, F.; Gibbs, A.; Gown, A. M.; Krausz, T.; Litzky, L. A.; Marchevsky, A.; Nicholson, A. G.; Roggli, V. L.; Sharma, A. K.; Travis, W. D.; Walts, A. E.; Wick, M. R.
Article Title: Guidelines for pathologic diagnosis of malignant mesothelioma: 2017 update of the consensus statement from the International Mesothelioma Interest Group
Abstract: Context.-Malignant mesothelioma (MM) is an uncommon tumor that can be difficult to diagnose. Objective.-To provide updated, practical guidelines for the pathologic diagnosis of MM. Data Sources.-Pathologists involved in the International Mesothelioma Interest Group and others with an interest and expertise in the field contributed to this update. Reference material included up-to-date, peer-reviewed publications and textbooks. Conclusions.-There was discussion and consensus opinion regarding guidelines for (1) distinguishing benign from malignant mesothelial proliferations (both epithelioid and spindle cell lesions), (2) cytologic diagnosis of MM, (3) recognition of the key histologic features of pleural and peritoneal MM, (4) use of histochemical and immunohisto-chemical stains in the diagnosis and differential diagnosis of MM, (5) differentiating epithelioid MM from various carcinomas (lung, breast, ovarian, and colonic adenocarcinomas, and squamous cell and renal cell carcinomas), (6) diagnosis of sarcomatoid MM, (7) use of molecular markers in the diagnosis of MM, (8) electron microscopy in the diagnosis of MM, and (9) some caveats and pitfalls in the diagnosis of MM. Immunohistochemical panels are integral to the diagnosis of MM, but the exact makeup of panels employed is dependent on the differential diagnosis and on the antibodies available in a given laboratory. Depending on the morphology, immunohistochemical panels should contain both positive and negative markers for mesothelial differentiation and for lesions considered in the differential diagnosis. Immunohistochemical markers should have either sensitivity or specificity greater than 80% for the lesions in question. Interpretation of positivity generally should take into account the localization of the stain (eg, nuclear versus cytoplasmic) and the percentage of cells staining (>10% is suggested for cytoplasmic and membranous markers). Selected molecular markers are now being used to distinguish benign from malignant mesothelial proliferations. These guidelines are meant to be a practical diagnostic reference for the pathologist; however, some new pathologic predictors of prognosis and response to therapy are also included.
Keywords: immunohistochemistry; adenocarcinoma; metabolism; consensus; diagnosis, differential; lung neoplasms; differential diagnosis; practice guideline; pathology; tumor marker; lung tumor; chemistry; lung; mesothelioma; cytodiagnosis; public opinion; procedures; humans; human; biomarkers, tumor
Journal Title: Archives of Pathology & Laboratory Medicine
Volume: 142
Issue: 1
ISSN: 0003-9985
Publisher: College of American Pathologists  
Date Published: 2018-01-01
Start Page: 89
End Page: 108
Language: English
DOI: 10.5858/arpa.2017-0124-RA
PUBMED: 28686500
PROVIDER: scopus
DOI/URL:
Notes: Review -- Export Date: 1 February 2018 -- Source: Scopus
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  1. William D Travis
    545 Travis