Update on Diagnosing and Reporting Malignant Pleural Mesothelioma

Abstract

In this review, we summarize current approaches to diagnosis of malignant pleural mesothelioma, focusing on the distinction from benign mesothelial proliferations and other malignant tumors. Current recommendations for reporting histological sub-type and tumor grade are also reviewed. Particular emphasis is placed on immunohistochemical and molecular tools that may help in establishing the diagnosis of mesothelioma with greater confidence. Immunohistochemical stains for BRCA1-associated protein (BAP1) and methylthioadenosine phosphorylase (MTAP) and homozygous deletion of p16 using fluorescence in situ hybridization (FISH) are emphasized as important methods for distinguishing benign from malignant mesothelial prolifera- tions.

Conclusions. Diffuse malignant pleural mesothelioma is a heterogeneous group of aggressive pleural tumors for which histological classification plays an increasingly important role in patient management. Stage and resectability remain key drivers of therapeutic strategies and outcomes. There is an increasingly robust suite of diagnostic tools, including immunohistochemical stains for BAP1 and MTAP and p16 FISH, for differentiating benign from malignant mesothelial proliferations in cytology and tissue specimens.