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Pleural Pathology 20/04/14 - pathkids.com · Sarcomatoid pleural Neoplasm •Sarcomatoid Mesotheloima •Sarcomatoid bronchogenic carcinoma •Primary pleural sarcoma (rare) -Synovial

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Text of Pleural Pathology 20/04/14 - pathkids.com · Sarcomatoid pleural Neoplasm •Sarcomatoid...

  • Pleural Pathology 20/04/14

    Katherine Syred

  • What History?

    • Needs to correlate to a diffuse pleural abnormality to consider meso as diagnsosis

    • Asbestos history probably doesn't help in reality

  • Pleural diagnosis

    Diffuse pleural

    abnormality

    MDT discussion

    Morphology and Immuno

  • PM Diffuse abnormality

  • 28194/14

  • BerEP4

  • Calretinin

  • CK 5

  • EMA

  • WT 1

  • MOC31 – (focal!)

  • Diagnosis

    • Monophasic epithelioid Mesothelioma

  • 19227/14

  • TTF-1

  • CEA

  • CK5 superficial +

  • MOC 31

  • CEA

  • D240

  • MNF diffusely +

  • EMA

  • WT1 – nuclear positive

  • Diagnosis

    • Biphasic Malignant Mesothelioma

  • Immuno Panel, Epithelioid Meso

    Epithelial/ glandular

    Mesothelial Cytokeratins

    CEA Calretinin Ck 5 (meso)

    MOC 31 Thrombomodulin

    Moc31 D240

    BerEP4 WT-1 nuclear

    TTF-1

  • • Use immuno panel according to markers validated in your lab. Use 6 markers or +.

    • If CEA positive, probably carcinoma.

    • MOC31/ BER EP4 focal often seen in Meso.

  • Sarcomatoid Mesothelioma

    • Add Pan cytokeratin Ae1/3, MNF116

  • Differential Diagnosis Epithelioid Meso

    • Metastatic adenocarcinoma (lung/ other)

    • Epithelioid haemangioendothelioma/ Angiosarcoma (can have focal cytoketin +, beware vessels stain for thrombomodulin)

  • What are the differential Diagnoses? Sarcomatoid pleural Neoplasm

    • Sarcomatoid Mesotheloima

    • Sarcomatoid bronchogenic carcinoma

    • Primary pleural sarcoma (rare)

    -Synovial sarcoma, Cd99

    -Solitary Fibrous tumour, Cd34,

  • Sarcomatoid Mesothelioma

  • Sarcomatoid Meso

  • Desmoplastic Mesothelioma

  • Synovial Sarcoma of pleura

  • Angiosarcoma, Cd31, Cd34

  • MESO biphasic

  • Calretinin

  • CEA

  • WT1 +both areas