Guidelines for Pathologic Diagnosis of Mesothelioma

Aliya N Husain; David B Chapel; Richard Attanoos; Mary Beth Beasley; Luka Brcic; Kelly Butnor; Lucian R Chirieac; Andrew Churg; Sanja Dacic; Francoise Galateau-Salle; Kenzo Hiroshima; Yin P Hung; Sonja Klebe; Thomas Krausz; Andras Khoor; Leslie Litzky; Alberto Marchevsky; Kazuki Nabeshima; Andrew G Nicholson; Elizabeth N Pavlisko; Anja C Roden; Victor Roggli; Jennifer L Sauter; Jefree J Schulte; Michael Sheaff; William D Travis; Ming-Sound Tsao; Ann E Walts; Thomas V Colby

doi:10.5858/arpa.2023-0304-RA

Guidelines for Pathologic Diagnosis of Mesothelioma

Arch Pathol Lab Med. 2024 Apr 8. doi: 10.5858/arpa.2023-0304-RA. Online ahead of print.

Authors

Aliya N Husain¹, David B Chapel², Richard Attanoos³, Mary Beth Beasley⁴, Luka Brcic⁵, Kelly Butnor⁶, Lucian R Chirieac⁷, Andrew Churg⁸, Sanja Dacic⁹, Francoise Galateau-Salle¹⁰, Kenzo Hiroshima¹¹, Yin P Hung¹², Sonja Klebe¹³, Thomas Krausz¹, Andras Khoor¹⁴, Leslie Litzky¹⁵, Alberto Marchevsky¹⁶, Kazuki Nabeshima¹⁷, Andrew G Nicholson¹⁸, Elizabeth N Pavlisko¹⁹, Anja C Roden²⁰, Victor Roggli¹⁹, Jennifer L Sauter²¹, Jefree J Schulte²², Michael Sheaff²³, William D Travis²¹, Ming-Sound Tsao²⁴, Ann E Walts¹⁶, Thomas V Colby²⁵

Affiliations

¹ From the Department of Pathology, University of Chicago, Chicago, Illinois (Husain, Krausz).
² The Department of Pathology, University of Michigan, Ann Arbor (Chapel).
³ The Department of Cellular Pathology and School of Medicine, University Hospital of Wales and Cardiff University, Cardiff, United Kingdom (Attanoos).
⁴ The Department of Pathology, Mount Sinai Hospital, New York, New York (Beasley).
⁵ The Department Diagnostic and Research Institute of Pathology Medical University of Graz, Graz, Austria (Brcic).
⁶ The Department of Pathology & Laboratory Medicine, University of Vermont College of Medicine, Burlington (Butnor).
⁷ The Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Chirieac).
⁸ The Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada (Churg).
⁹ The Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dacic).
¹⁰ Laboratoire d'Anatomie Pathologique, Caen-Cedex, France (Galateau-Salle).
¹¹ The Department of Biochemistry and Genetics, Chiba University Graduate School of Medicine, Chiba, Japan (Hiroshima).
¹² The Department of Pathology, Massachusetts General Hospital, Boston (Hung).
¹³ The Department of Anatomical Pathology, SA Pathology and Flinders University, Bedford Park SA, Australia (Klebe).
¹⁴ The Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida (Khoor).
¹⁵ The Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia (Litzky).
¹⁶ The Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California (Marchevsky, Walts).
¹⁷ The Department of Clinical Pathology, Fukuoka Tokushukai Hospital, Kasuga City, Fukuoka Prefecture, Japan (Nabeshima).
¹⁸ The Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (Nicholson).
¹⁹ The Department of Pathology, Duke University Medical Center, Durham, North Carolina (Pavlisko, Roggli).
²⁰ The Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, Minnesota (Roden).
²¹ The Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York (Sauter, Travis).
²² The Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison (Schulte).
²³ The Department of Cellular Pathology, Barts Health NHS Trust, London, United Kingdom (Sheaff).
²⁴ The Department of Laboratory Medicine and Pathobiology, University of Health Network and University of Toronto, Toronto, Ontario, Canada (Tsao).
²⁵ Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale (Emeritus) (Colby).

PMID: 38586983
DOI: 10.5858/arpa.2023-0304-RA

Abstract

Context.—: Mesothelioma is an uncommon tumor that can be difficult to diagnose.

Objective.—: To provide updated, practical guidelines for the pathologic diagnosis of mesothelioma.

Data sources.—: Pathologists involved in the International Mesothelioma Interest Group and others with expertise in mesothelioma contributed to this update. Reference material includes peer-reviewed publications and textbooks.

Conclusions.—: There was consensus opinion regarding guidelines for (1) histomorphologic diagnosis of mesothelial tumors, including distinction of epithelioid, biphasic, and sarcomatoid mesothelioma; recognition of morphologic variants and patterns; and recognition of common morphologic pitfalls; (2) molecular pathogenesis of mesothelioma; (3) application of immunohistochemical markers to establish mesothelial lineage and distinguish mesothelioma from common morphologic differentials; (4) application of ancillary studies to distinguish benign from malignant mesothelial proliferations, including BAP1 and MTAP immunostains; novel immunomarkers such as Merlin and p53; fluorescence in situ hybridization (FISH) for homozygous deletion of CDKN2A; and novel molecular assays; (5) practical recommendations for routine reporting of mesothelioma, including grading epithelioid mesothelioma and other prognostic parameters; (6) diagnosis of mesothelioma in situ; (7) cytologic diagnosis of mesothelioma, including use of immunostains and molecular assays; and (8) features of nonmalignant peritoneal mesothelial lesions.