Pathology of human mesothelioma. Etiologic and diagnostic considerations
Roggli, V.L.; Kolbeck, J.; Sanfilippo, F.; Shelburne, J.D.
Pathology Annual 22(Part 2): 91-131
1987
ISSN/ISBN: 0079-0184 PMID: 2825103 Document Number: 297240
Since the description by Wagner et al of the occurrence of malignant mesothelioma in asbestos workers of the Northwestern Cape Province of South Africa in 1960, there have been numerous reports in the literature dealing with mesothelioma. Epidemiologic studies have shown increasing rates of mesothelioma in a number of industrialized nations, and the current trend is expected to continue until the year 2000 and beyond. In parallel with this increasing incidence, pathologists have directed attention toward determining the diagnostic features of mesothelioma which permit its distinction from other neoplastic processes with which it can be confused. In spite of a proliferation of papers on the diagnosis of mesothelioma, there remains considerable controversy regarding the utility of various diagnostic techniques. Very few of the reported studies, however, have evaluated the diagnostic modalities of routine histology, histochemistry, immunohistochemistry, and electron microscopy in a single series of cases. Mesothelium consists of a single layer of flattened to cuboidal cells forming an epithelium that lines the serous cavities of the body. The membrane forming the lining of the pleural, peritoneal, and pericardial cavities includes both the mesothelium proper as well as a thin underlying layer of mesenchymal connective tissue. Mesothelial cells possess a complex cytoskeletal network of intermediate filaments, synthesize hyaluronic acid, and express long surface microvilli which project into the serous cavities. The surfaces of these cells also have numerous pinocytotic vesicles. Although the mesothelium has been studied rather intensively, it is still uncertain whether neoplasms of the serous cavities arise from mesothelial cells or from the underlying mesenchymal connective tissues (or both). The purpose of this review is to summarize the literature concerning the pathologic diagnosis of human mesotheliomas, and to suggest a systematic approach towards making a diagnosis. The role of various etiologic factors and the results of mineralogic analysis of lung tissue in cases of mesothelioma will also be considered, with emphasis on the literature published since the review of Kannerstein et al.
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