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Presented by Division of Cytopathology and prepared by Natasha Rekhtman, M.D., Ph.D.
Case 1: 56 year-old woman with persistent pleural effusion.
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1. Question
Week 259: Case 1
56 year-old woman with persistent pleural effusion. Cytospin slides of thoracentesis fluid./images/c04-10493a.jpg
/images/c04-10493b.jpg
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/images/c04-10493d.jpgCorrect
Answer: Most consistent with malignant mesothelioma
Histology: Mixed within an inflammatory cell background are numerous fragments of large cells with a bosselated “knobby” outline. Occasional “windows” between cells (images 3 and 4) and “skirts” at the cytoplasmic edge (image 4) are seen. The nuclei are large with macronucleoli and irregular nuclear membranes. Immunocytochemistry shows that these large cells are positive for CK7 and calretinin, and focally positive for p53, while immunostains for CK20, TTF-1, monoclonal CEA and CD15 are negative.
Discussion: The morphologic features and immunostains are most consistent with malignant mesothelioma. Adenocarcinoma tends to have fragments with smooth borders as opposed to the “flower-like” edges seen in mesothelioma. While the morphologic features of metastatic ovarian papillary serous carcinoma often can be difficult to distinguish from mesothelioma, immunoreactivity to calretinin favors mesothelioma as ovarian epithelial tumors seldom are positive for calretinin (Am J Surg Pathol 26:1477, 2002). Pneumonectomy confirmed the diagnosis of malignant mesothelioma, epithelioid type.
Incorrect
Answer: Most consistent with malignant mesothelioma
Histology: Mixed within an inflammatory cell background are numerous fragments of large cells with a bosselated “knobby” outline. Occasional “windows” between cells (images 3 and 4) and “skirts” at the cytoplasmic edge (image 4) are seen. The nuclei are large with macronucleoli and irregular nuclear membranes. Immunocytochemistry shows that these large cells are positive for CK7 and calretinin, and focally positive for p53, while immunostains for CK20, TTF-1, monoclonal CEA and CD15 are negative.
Discussion: The morphologic features and immunostains are most consistent with malignant mesothelioma. Adenocarcinoma tends to have fragments with smooth borders as opposed to the “flower-like” edges seen in mesothelioma. While the morphologic features of metastatic ovarian papillary serous carcinoma often can be difficult to distinguish from mesothelioma, immunoreactivity to calretinin favors mesothelioma as ovarian epithelial tumors seldom are positive for calretinin (Am J Surg Pathol 26:1477, 2002). Pneumonectomy confirmed the diagnosis of malignant mesothelioma, epithelioid type.
