TY - JOUR
T1 - The differential diagnosis between pleural sarcomatoid mesothelioma and spindle cell/pleomorphic (sarcomatoid) carcinomas of the lung
T2 - evidence-based guidelines from the International Mesothelioma Panel and the MESOPATH National Reference Center
AU - Marchevsky, Alberto M.
AU - LeStang, Nolwenn
AU - Hiroshima, Kenzo
AU - Pelosi, Giuseppe
AU - Attanoos, Richard
AU - Churg, Andrew
AU - Chirieac, Lucian
AU - Dacic, Sanja
AU - Husain, Aliya
AU - Khoor, Andras
AU - Klebe, Sonja
AU - Lantuejoul, Silvie
AU - Roggli, Victor
AU - Vignaud, Jean Michel
AU - Weynard, Birgit
AU - Sauter, Jennifer
AU - Henderson, Douglas
AU - Nabeshima, Kasuzi
AU - Galateau-Salle, Francoise
N1 - Publisher Copyright:
© 2017
PY - 2017/9
Y1 - 2017/9
N2 - 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.
AB - 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.
KW - Differential diagnosis
KW - Guidelines
KW - Pleomorphic carcinoma
KW - Sarcomatoid mesothelioma
KW - Spindle cell carcinoma
UR - http://www.scopus.com/inward/record.url?scp=85028813468&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85028813468&partnerID=8YFLogxK
U2 - 10.1016/j.humpath.2017.07.015
DO - 10.1016/j.humpath.2017.07.015
M3 - Article
C2 - 28782639
AN - SCOPUS:85028813468
SN - 0046-8177
VL - 67
SP - 160
EP - 168
JO - Human Pathology
JF - Human Pathology
ER -