The common differential diagnoses vary for the diverse patterns seen in mesotheliomas1:
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principle differentials |
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epithelioid |
tubopapillary |
Mesothelioma with glandular component from adenocarcinoma. Many antibodies have been applied to this problem, none of them totally specific. |
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acinar (glandular) |
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adenomatoid |
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solid well differentiated |
reactive mesothelial proliferation |
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solid poorly differentiated |
large cell carcinoma, lymphoma |
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clear cell |
metastatic renal cell carcinoma, clear cell carcinoma of the lung, clear cell melanoma |
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Mesothelioma with squamous differentiation |
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deciduoid |
squamous cell carcinoma, pseudotumoral deciduosis, anaplastic large cell lymphoma, oxyphilic variant of ovarian clear cell carcinoma, trophoblastic neoplasia |
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adenoid cystic |
metastatic adenoid cystic carcinoma |
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signet ring cell (lipid rich) |
signet ring cell carcinoma |
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small cell |
small cell carcinoma, desmoplastic small round cell tumour, PNET, lymphoma |
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sarcomatoid |
osteosarcomatous/chondrosarcomatous |
osteosarcoma and chondrosarcoma |
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lymphohistiocytoid |
inflammatory processes, lymphoma, Hodgkin lymphoma |
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desmoplastic |
fibrous pleuritis |
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see the immunohistochemistry of the differential diagnosis of spindle cell tumours of the pleura. |
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biphasic |
carcinosarcoma, biphasic pulmonary blastoma, biphasic synovial sarcoma |
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pleomorphic |
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transitional |
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The morphological differentiation of benign mesothelial proliferation from diffuse malignant mesothelioma may be very difficult2. Cytokeratins may help by demonstrating mesothelial cells infiltrating fat or skeletal muscle. Various markers of malignancy have ben proposed for both histological and cytological specimens but are of uncertain value.
References
This page last revised 8.8.06.
©SMUHT/PW Bishop