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Pathology of Mesothelioma

Since its first recognition over a century ago, malignant mesothelioma has been the subject of social, epidemiological, legal and scientific interest. From an epidemiological and social viewpoint, this interest has derived largely from the strong association between malignant mesothelioma and exposure to asbestos, often with implications for litigation.

For the pathologist, the diagnosis of mesothelioma is challenging, not only because of the histological diversity of this tumour, but also because of the difficulty in distinguishing mesothelioma from both reactive serosal processes and from metastatic disease involving the serosa. There has been controversy in the past, as to whether a diagnosis of mesothe- lioma could be established reliably on cytological examination of serous effusions or fine needle aspiration (FNA) samples – or histological examination of small biopsy specimens and there have been claims that the diagnosis should only be made after a full postmortem examination or evaluation of substantive tissue derived at thoracotomy or laparotomy.

More recently, however, there has been a gradual shift towards acceptance that the diagnosis can be confidently reached on cytological specimens or small tissue samples, given the support of ancillary studies – in particular immunohistochemical and ultrastructural assessment. The pathology of mesothelioma continues to stimulate interest, reflected in the relative explosion in the literature in the last few years in the form of papers dealing mainly with the differential diagnosis of malignant mesothelioma.
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