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The differential diagnosis between pleural sarcomatoid mesothelioma and spindle cell/pleomorphic (sarcomatoid) carcinomas of the lung: evidence-based guidelines from the International Mesothelioma Panel and the MESOPATH National Reference Center
- Source :
- Human pathology. 67
- Publication Year :
- 2017
-
Abstract
- Immunohistochemistry is used to distinguish sarcomatoid malignant mesotheliomas (SMM) from spindle cell and pleomorphic carcinomas (SPC) but there are no guidelines on how to interpret cases that show overlapping or equivocal immunohistochemical findings. A systematic literature review of the immunophenotype of these lesions was performed and the experience with 587 SMM and 46 SPC at MESOPATH was collected. Data were analyzed with Comprehensive Meta-Analysis 2.0 software (Biostat, Englewood, NJ). There were insufficient data to evaluate the differential diagnosis between SPC and localized SMM or peritoneal SMM. Meta-analysis showed considerable overlap in the immunophenotype of these neoplasms and significant data heterogeneity amongst many of the results. Survival data from MESOPATH patients showed no significant differences in overall survival between SMM and SPC patients. Best available evidence was used to formulate several evidence-based guidelines for the differential diagnosis between pleural SMM and SPC. These guidelines emphasize the need to correlate the histopathological findings with clinical and imaging information. Diffuse SMM can be diagnosed with certainty in the presence of malignant spindle cell pleural lesions showing immunoreactivity for cytokeratin and mesothelial markers and negative staining for epithelial markers. Criteria for the interpretation of various other combinations of immunoreactivity for cytokeratin and mesothelial and/or epithelial markers are proposed. Localized sarcomatoid mesotheliomas can only be diagnosed in the presence of spindle cell malignancies that exhibit immunoreactivity for cytokeratin and mesothelial markers and negative immunoreactivity for epithelial lesions, in patients that show no multifocal or diffuse pleural spread and no evidence for extrapleural lesions.
- Subjects :
- 0301 basic medicine
Adult
Male
Mesothelioma
Pathology
medicine.medical_specialty
Lung Neoplasms
Biopsy
Pleural Neoplasms
Pathology and Forensic Medicine
Diagnosis, Differential
03 medical and health sciences
Cytokeratin
0302 clinical medicine
Immunophenotyping
Predictive Value of Tests
Biomarkers, Tumor
Medicine
Humans
Aged
Aged, 80 and over
Evidence-Based Medicine
business.industry
Mesothelioma, Malignant
Sarcoma
Middle Aged
Sarcomatoid Mesothelioma
medicine.disease
Prognosis
Immunohistochemistry
Pleural Sarcomatoid Mesothelioma
030104 developmental biology
Phenotype
030220 oncology & carcinogenesis
Practice Guidelines as Topic
Female
Differential diagnosis
business
Spindle cell carcinoma
Subjects
Details
- ISSN :
- 15328392
- Volume :
- 67
- Database :
- OpenAIRE
- Journal :
- Human pathology
- Accession number :
- edsair.doi.dedup.....7803ea99b2a8e7ab9b22afd38b57d042