One interesting study is called, Diffuse malignant mesothelioma of pleura: diagnostic criteria based on an autopsy study. By Adams VI, Unni KK. - Am J Clin Pathol. 1984 Jul;82(1):15-23. Here is an excerpt: Abstract - Sixteen unequivocal, diffuse malignant mesotheliomas ( DMM ) of pleura and eight diffuse pleural tumors simulating DMM , all from autopsied cases, were studied with hematoxylin and eosin, mucicarmine, diastase-periodic acid-Schiff ( DPAS ), colloidal iron, carcinoembryonic antigen, and keratin immunoperoxidase stains. Collagen production by tumor cells when identifiable was diagnostic of DMM and was found not only in sarcomatous and "biphasic" mesotheliomas but also focally in "epithelial" variants. In "epithelial" areas, a constant nuclear/cytoplasmic (N/C) ratio with variable cell size often imparted a distinctive appearance of regularity, and mucin-negative DPAS -negative vacuoles or ground-glass cytoplasmic zones always could be found. Most metastatic carcinomas featured a high N/C ratio; some but not all had mucicarmine-positive or DPAS -positive vacuoles. Stains for carcinoembryonic antigen and keratin did not discriminate between DMM and metastatic carcinoma. Distant metastases were present in 12 of the 16 DMM cases but were clinically occult in 11 cases.
One interesting study is called, Integrated computed tomography-positron emission tomography in patients with potentially resectable malignant pleural mesothelioma: Staging implications - Volume 129, Issue 6, Pages 1364-1370 (June 2005) Journal of Thoracic and Cardiovascular Surgery by Jeremy J. Erasmus, MD, Mylene T. Truong, MD, W. Roy Smythe, MD, Reginald F. Munden, DMD, MD, Edith M. Marom, MD, David C. Rice, MD, Ara A. Vaporciyan, MD, Garrett L. Walsh, MD, Bradley S. Sabloff, MD, Lyle D. Broemeling, PhD, Craig W. Stevens, MD, PhD, Katherine M. Pisters, MD, Donald A. Podoloff, MD, Homer A. Macapinlac, MD Here is an excerpt: Background - Integrated computed tomography-positron emission tomography imaging with coregistration of anatomic and functional imaging data may improve the accuracy of malignant pleural mesothelioma staging. We evaluate the use of integrated computed tomography-positron emission tomography in patients with malignant pleural mesothelioma who are being considered for extrapleural pneumonectomy. Methods - Twenty-nine patients with malignant pleural mesothelioma who were judged to be candidates for extrapleural pneumonectomy after clinical and conventional radiologic evaluation underwent whole-body integrated computed tomography-positron emission tomography and pathologic staging. Two reviewers blinded to the results of clinical and pathologic staging retrospectively evaluated computed tomography, positron emission tomography, and coregistered computed tomography-positron emission tomography images. Staging was performed according to the International Mesothelioma Interest Group TNM staging system. Histopathology and/or results of further radiologic evaluation or follow-up served as the reference standard. Results - Integrated computed tomography-positron emission tomography provided additional information in 11 of 29 patients that precluded extrapleural pneumonectomy. The overall tumor stage was correctly classified in 21 of 29 patients. The tumor stage was correctly determined in 15 of 24 patients, 6 of whom had T4 (nonresectable) disease. The node stage was accurately determined in 6 of 17 patients. Extrathoracic metastases not identified by routine clinical and conventional radiologic evaluation were detected in 7 of 29 patients and were found to be diffuse (n = 2) or solitary (n = 5).
Conclusions - Integrated computed tomography-positron emission tomography increases the accuracy of malignant pleural mesothelioma staging and is important in determining the appropriate therapy in patients being considered for extrapleural pneumonectomy.