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