[Differential diagnosis of preneoplastic lesions of the pleura and of early mesothelioma: immunohistochemical and morphological findings].
The morphological diagnosis of small mesothelial lesions in pleural biopsies is gaining importance in view of more aggressive, multimodal therapeutic options and of medicolegal aspects if a malignant mesothelioma is diagnosed. We present a light microscopically and immunohistochemically based morphological classification for the planning of further clinical follow-up procedures. A reactive mesothelial hyperplasia heals without scars. Mesothelial inclusions in pleuritic scars are common in recurrent pleuritis and must not be confused with an epithelioid component of a desmoplastic mesothelioma. In case of atypical mesothelial proliferations, further diagnostic procedures have to be performed to obtain a clear diagnosis of malignancy. Mesothelioma in situ is the first morphological step in neoplastic mesothelial changes, also with regard to medicolegal aspects for the unambiguous diagnosis of a mesothelioma. Early infiltrative growth is characteristic of so called early mesothelioma. A useful immunohistochemical panel for the differential diagnosis consists of anti-cytokeratin, Ck 5/6, calretinin, EMA and MiB-1, whereas the immunohistochemical detection of telomerase is not helpful.
Krismann
M
M
Institut für Pathologie an der Augusta-Krankenanstalt, Bochum. michael.krismann@rub.de
Thattamparambil
P
P
Simon
F
F
Johnen
G
G
D014408:Biomarkers, Tumor / Q000032:analysis*; D002278:Carcinoma in Situ / Q000473:pathology; D002455:Cell Division / Q000502:physiology; D002471:Cell Transformation, Neoplastic / Q000473:pathology; D003937:Diagnosis, Differential; D006801:Humans; D006965:Hyperplasia / Q000473:pathology; D007124:Immunoenzyme Techniques; D008654:Mesothelioma / Q000175:diagnosis / Q000473:pathology*; D018261:Mesothelioma, Cystic / Q000175:diagnosis / Q000473:pathology; D009367:Neoplasm Staging; D010994:Pleura / Q000473:pathology; D010997:Pleural Neoplasms / Q000175:diagnosis / Q000473:pathology*; D010998:Pleurisy / Q000473:pathology; D011230:Precancerous Conditions / Q000175:diagnosis / Q000473:pathology*; D019098:Telomerase / Q000032:analysis
D014408:Biomarkers, Tumor; D019098:Telomerase