pleural pathology 20/04/14 - pathkids.com · sarcomatoid pleural neoplasm •sarcomatoid...
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Pleural Pathology 20/04/14
Katherine Syred
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What History?
• Needs to correlate to a diffuse pleural abnormality to consider meso as diagnsosis
• Asbestos history probably doesn't help in reality
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Pleural diagnosis
Diffuse pleural
abnormality
MDT discussion
Morphology and Immuno
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PM Diffuse abnormality
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28194/14
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BerEP4
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Calretinin
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CK 5
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EMA
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WT 1
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MOC31 – (focal!)
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Diagnosis
• Monophasic epithelioid Mesothelioma
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19227/14
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TTF-1
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CEA
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CK5 superficial +
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MOC 31
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CEA
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D240
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MNF diffusely +
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EMA
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WT1 – nuclear positive
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Diagnosis
• Biphasic Malignant Mesothelioma
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Immuno Panel, Epithelioid Meso
Epithelial/ glandular
Mesothelial Cytokeratins
CEA Calretinin Ck 5 (meso)
MOC 31 Thrombomodulin
Moc31 D240
BerEP4 WT-1 nuclear
TTF-1
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• 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.
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Sarcomatoid Mesothelioma
• Add Pan cytokeratin Ae1/3, MNF116
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Differential Diagnosis Epithelioid Meso
• Metastatic adenocarcinoma (lung/ other)
• Epithelioid haemangioendothelioma/ Angiosarcoma (can have focal cytoketin +, beware vessels stain for thrombomodulin)
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What are the differential Diagnoses? Sarcomatoid pleural Neoplasm
• Sarcomatoid Mesotheloima
• Sarcomatoid bronchogenic carcinoma
• Primary pleural sarcoma (rare)
-Synovial sarcoma, Cd99
-Solitary Fibrous tumour, Cd34,
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Sarcomatoid Mesothelioma
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Sarcomatoid Meso
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Desmoplastic Mesothelioma
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Synovial Sarcoma of pleura
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Angiosarcoma, Cd31, Cd34
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MESO biphasic
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Calretinin
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CEA
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WT1 +both areas
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