Department of Pathology, Geetanjali Medical College and Hospital, Udaipur, Rajasthan, India.
Indian J Pathol Microbiol. 2021 Oct-Dec;64(4):655-663. doi: 10.4103/IJPM.IJPM_617_20.
Malignant mesothelioma is an aggressive neoplasm arising from serosal lining and has a poor prognosis. Definite diagnosis requires confirmation through a biopsy; however, it is sometimes difficult on microscopic evaluation alone and requires the use of a wide panel of immunohistochemical markers. So, immunohistochemistry (IHC) is of paramount importance and must be routinely used for a definite diagnosis. Till date, very few studies on morphology and detailed IHC markers of mesothelioma have been reported from India.
To analyze the histomorphological findings of malignant mesothelioma, study the utility and role of the various immunohistochemical markers.
A total of 76 cases of mesotheliomas diagnosed at a tertiary cancer center in Udaipur were analyzed retrospectively from January 2015 to January 2020. Comprehensive data were analyzed including demographic, clinical, radiological, histopathological features along with a wide panel of IHC markers.
Mesothelioma occurs over a wide age range from 40 to 70 years. It most commonly involved pleura in 68 cases (89.47%) with very few cases from the peritoneum. On computed tomography (CT) scan, nodular pleural or peritoneal thickening was present. On microscopy, the most common histopathological type was epithelioid mesothelioma (58 cases, 74.3%) followed by sarcomatous (9 cases, 12.8%), deciduoid (6 cases, 8.6%), and 3 cases of biphasic (4.3%). On IHC, WT1, mesothelin, and calretinin markers were positive in 85.91%, 80%, and 93.33% cases of mesothelioma, respectively. Other markers were helpful to rule out differential diagnosis in difficult scenarios.
Therefore, the correlation of histopathology with clinico-radiological findings and judicious use of a panel of IHC markers is required for routine evaluation and definite diagnosis. IHC is also useful in situations with similar morphological spectrum in specific locations.
恶性间皮瘤是一种起源于浆膜衬里的侵袭性肿瘤，预后不良。明确诊断需要通过活检确认；然而，仅通过显微镜评估有时很困难，需要广泛使用免疫组织化学标志物。因此，免疫组织化学（IHC）至关重要，必须常规用于明确诊断。迄今为止，来自印度的关于间皮瘤形态学和详细 IHC 标志物的研究很少。
分析恶性间皮瘤的组织形态学发现，研究各种免疫组织化学标志物的用途和作用。
回顾性分析 2015 年 1 月至 2020 年 1 月在乌代浦的一家三级癌症中心诊断的 76 例间皮瘤病例。分析了全面的数据，包括人口统计学、临床、影像学、组织病理学特征以及广泛的 IHC 标志物。
间皮瘤发生在 40 至 70 岁的广泛年龄段。最常见的是胸膜受累 68 例（89.47%），极少数来自腹膜。在计算机断层扫描（CT）扫描上，存在结节性胸膜或腹膜增厚。显微镜下，最常见的组织病理学类型是上皮样间皮瘤（58 例，74.3%），其次是肉瘤样（9 例，12.8%）、蜕膜样（6 例，8.6%）和 3 例双相（4.3%）。在免疫组织化学中，WT1、间皮素和钙卫蛋白标志物在 85.91%、80%和 93.33%的间皮瘤病例中呈阳性。在困难情况下，其他标志物有助于排除鉴别诊断。
因此，需要将组织病理学与临床放射学发现相关联，并明智地使用免疫组织化学标志物组进行常规评估和明确诊断。免疫组织化学在特定部位具有相似形态学谱的情况下也很有用。
