Abstract
Mesothelioma is often difficult to diagnose due to its rarity and its unusual histopathological features that could lend to diagnostic pitfalls and misdiagnosis. The WHO histological classification of pleural tumors in 2021 recommended a pathologic grading system for malignant pleural mesothelioma. Architectural aspects and cytological features, with nuclear grading, bent on a neoplastic score with fundamental prognostic and diagnostic value. Unusual features must be correctly assigned in the grading system to avoid misdiagnosis, especially toward metastatic lesions or reactive pleural processes. In this paper, we present two cases as examples of unusual morphological and architectural features with a brief literature review.
Highlights
In 2021, WHO published its latest volume about thoracic tumors
Mesothelioma is often difficult to diagnose due to its rarity and its unusual histopathological features, which could lend to diagnostic pitfalls and misdiagnosis
Mesothelioma in its epithelioid appearance must be distinguished from carcinomas and other epithelioid neoplasms that can infiltrate the pleura in a diffuse way, with a pseudomesotheliomatous appearance
Summary
In the case of epithelioid mesothelioma, architectural patterns are underlined, as in previous editions, as well as cytological features and stromal appearance, due to their prognostic value and to avoid possible diagnostic pitfalls. Such differential diagnosis is in many cases hard, but some architectural features, such as the demonstration of fat infiltrations or molecular alterations (e.g., BAP1 inactivating mutations), help to achieve this goal [4,5].
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