Diagnosis of Mesothelioma

Our plain-English summary of Diagnosis of Mesothelioma, by D.R. Fels Elliott, K.D. Jones (Surgical Pathology Clinics, 2020).

The study

• Authors: D.R. Fels Elliott, K.D. Jones
• Journal: Surgical Pathology Clinics
• Published: 2020;13(1):73-89
• Type of article: Review
• Cited by: 30 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Mesothelioma is a rare neoplasm that arises from mesothelial cells lining body cavities including the pleura, pericardium, peritoneum, and tunica vaginalis. Most malignant mesotheliomas occur in the chest and are frequently associated with a history of asbestos exposure. The diagnosis of malignant mesothelioma is challenging and fraught with pitfalls, particularly in small biopsies. This article highlights what the pathologist needs to know regarding the clinical and radiographic presentation of mesothelioma, histologic features including subtypes and variants, and recent advances in immunohistochemical markers and molecular testing.

Copyright © 2019 Elsevier Inc. All rights reserved.

In plain English

This is a review by two authors from the University of California San Francisco Department of Pathology. It reported no new patient data. It summarized published work on diagnosing malignant mesothelioma. Citing other studies, the authors wrote that most malignant mesotheliomas (70%–90%) occur in the chest and are frequently associated with a history of asbestos exposure, the best established risk factor. They wrote that the average time from exposure to disease ranges from 20 to greater than 40 years and depends on the severity and duration of exposure. Epithelioid mesothelioma was described as the most common type (60%–70%). The authors recommended a stain panel with two mesothelial markers and two markers for adenocarcinoma or another suspected tumor. They reported published accuracy figures for newer tests: BAP-1 loss, 55% to 85% sensitivity and 98% to 100% specificity in epithelioid mesothelioma; p16/CDKN2A deletion, 70% to 90% sensitivity and 100% specificity. A cited genetic study of 74 pleural mesotheliomas found no mutational signature specific to asbestos exposure. The authors called diagnosis challenging and fraught with pitfalls, particularly in small biopsies.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review of published literature on the pathologic diagnosis of mesothelioma (not an original study)
• Who was studied: No study population; a literature review written by authors at the Department of Pathology, University of California San Francisco
• Exposure: No exposure was studied. The review states that asbestos exposure is the best established risk factor for mesothelioma; no fiber types are named.
• Main results:
  • Citing other sources, the review states that most malignant mesotheliomas (70%–90%) occur in the chest and are frequently associated with a history of asbestos exposure.
  • Citing other sources, the review states that the average time from asbestos exposure to mesothelioma is long, ranging from 20 to greater than 40 years, and depends on the severity and duration of exposure.
  • Epithelioid mesothelioma is described as the most common subtype of malignant mesothelioma (60%–70%).
  • The review recommends a stain panel that includes two mesothelial markers and two markers specific for adenocarcinoma or another tumor in the differential diagnosis.
  • Citing a published review, the article gives the sensitivity of BAP-1 loss in epithelioid mesothelioma as 55% to 85% and its specificity as 98% to 100%.
  • Citing a published review, the article states that homozygous p16/CDKN2A deletion detected by FISH is 70% to 90% sensitive and 100% specific for a diagnosis of mesothelioma.
  • A cited genomic study (The Cancer Genome Atlas) analyzed 74 cases of malignant pleural mesothelioma.
  • In that cited genomic study, no smoking mutational signature was observed and no mutational signature specific to asbestos exposure was identified.
• The authors' conclusion: The authors stated that diagnosing malignant mesothelioma is challenging and fraught with pitfalls, particularly in small biopsies.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, Neoplasm, Mesothelial Cells, Pleura, Pericardium, Peritoneum, Tunica Vaginalis, Malignant Mesothelioma.

Related studies

• Mesothelioma--VATS biopsy and lung mobilization improves diagnosis and palliation — M.W. Grossebner, A.A. Arifi, et al. (1999)
• Radiologic Diagnosis of Asbestosis in Korea — Y.K. Cha, J.S. Kim, et al. (2016)
• Retroperitoneal fibrosis: new insights into clinical presentation and diagnosis — A. Vaglio (2009)
• Positron emission tomography in the diagnosis of mesothelioma — U. Haberkorn (2004)
• A case of malignant peritoneal mesothelioma suggesting the utility of combining double-contrast radiography and endoscopy with computed tomography for diagnosis — H. Saito, S. Hasuda, et al. (2017)
• Utility of Site-Specific Biopsy for Diagnosis of Desmoplastic Malignant Mesothelioma — T. Sakai, K. Tane, et al. (2018)

Browse more research in Surgical Pathology Clinics, or return to medical research.