Pleura

Protocol applies to malignant pleural mesothelioma.

Procedures

• Cytology

• Incisional Biopsy

• Resection

 

This protocol is intended to assist pathologists in providing clinically useful and relevant information as a result of the examination of surgical specimens. Use of this protocol is intended to be entirely voluntary. If equally valid protocols or similar documents are applicable, the pathologist is, of course, free to follow those authorities. Indeed, the ultimate judgment regarding the propriety of any specific procedure must be made by the physician in light of the individual circumstances presented by a specific patient or specimen.

It should be understood that adherence to this protocol will not guarantee a successful result. Nevertheless, pathologists are urged to familiarize themselves with the document. Where a physician chooses to deviate from the protocol based on the circumstances of a particular patient or specimen, the physician is advised to make a contemporaneous written notation of the reason for the procedure followed.

The College recognizes that this document may be used by hospitals, attorneys, managed care organizations, insurance carriers, and other payers. However, the document was developed solely as a tool to assist pathologists in the diagnostic process by providing information that reflects the state of relevant medical knowledge at the time the protocol was first published. It was not developed for credentialing, litigation, or reimbursement purposes. The College cautions that any uses of the protocol for these purposes involve considerations that are beyond the scope of this document.

 

I. Cytologic material                  back     Top     Main Page

      A.  CLINICAL INFORMATION

            1.   Patient identification

                  a.   Name

                  b.   Identification number

                  c.   Age (birth date)

                  d.   Gender

            2.   Responsible physician(s)

            3.   Date of procedure

            4.   Other clinical information

                  a.   Relevant history

                        (1)  present/past occupation

                        (2)  asbestos exposure

                        (3)  radiation exposure

                        (4)  previous diagnosis of cancer or active infection

                        (5)  previous treatment

                  b.   Relevant findings

                        (1)  pleural effusion(s) (duration)

                        (2)  pleural plaque(s) or thickening

                        (3)  imaging studies

                  c.   Clinical diagnosis

                  d.   Procedure (e.g. thoracentesis, percutaneous fine needle aspiration, thoracoscopy)

                  e.   Operative findings

                  f.    Anatomic site of specimen (e.g. pleural space including laterality, pericardial space)

                  g.   Type of specimen (e.g. pleural fluid, pleural-based mass)

 

      B.   MACROSCOPIC EXAMINATION

            1.   Specimen

                  a.   Unfixed/fixed (specify fixative)

                  b.   Number of slides received, if appropriate

                  c.   Quantity and appearance of fluid specimen, if appropriate (including viscosity)

                  d.   Other (e.g. cytologic preparation from tissue)

                  e.   Results of intraprocedural consultation

            2.   Material prepared for microscopic evaluation (e.g. smear, cytocentrifuge, thin preparation of fluid, cell block)

            3.   Special studies (specify) (e.g. immuno-histochemistry, electron microscopy) (Note A)

      C.  MICROSCOPIC EVALUATION

            1.   Adequacy of specimen (if unsatisfactory for evaluation, specify reasons)

            2.   Tumor, if present

                  a.   Histologic type, if possible (Note B)

                  b.   Other features (e.g. nuclear grade, necrosis)

            3.   Additional pathologic findings (if present) (e.g. ferruginous bodies)

            4.   Results/status of special studies (specify) (e.g. immunohistochemistry, electron microscopy) (Note A)

            5.   Comments

                  a.   Correlation with intraprocedural consultation, as appropriate

                  b.   Correlation with other specimens, as appropriate

                  c.   Correlation with clinical information, as appropriate

II. Incisional Biopsy            back     Top     Main Page

      A.  CLINICAL INFORMATION

            1.   Patient identification

                  a.   Name

                  b.   Identification number

                  c.   Age (birth date)

                  d.   Gender

            2.   Responsible physician(s)

            3.   Date of procedure

            4.   Other clinical information

                  a.   Relevant history

                        (1)  present/past occupation

                        (2)  asbestos exposure

                        (3)  radiation exposure

                        (4)  previous diagnosis of cancer or active infection

                        (5)  previous treatment

                  b.   Relevant findings

                        (1)  pleural effusion(s) (duration)

                        (2)  pleural plaque(s) or thickening

                        (3)  imaging studies

                  c.   Clinical diagnosis

                  d.   Procedure (e.g. percutaneous needle biopsy, thoracoscopic biopsy of  pleura and/or lung, open thoracotomy biopsy of pleura and/or lung, lymph
                        node biopsy)

                  e.   Operative findings

                  f.    Anatomic site(s) of specimen (e.g.parietal/visceral pleura, lung indicating lobe and laterality, mediastinal node, diaphragm, pericardium)

                  g.   Type(s) of specimen (e.g. pleura, lung, lymph node, tumor nodule)

 

      B.   MACROSCOPIC EXAMINATION

            1.   Specimen

                  a.   Unfixed/fixed (specify fixative)

                  b.   Size (three dimensions)

                  c.   Descriptive features (color, hemorrhage, necrosis)

                  d.   Results of intraoperative consultation

            2.   Tissue submitted for microscopic evaluation

                  a.   Submit entire specimen (if possible)

                  b.   Frozen section tissue fragment(s) (unless saved for special studies)

            3.   Special studies, (specify) (e.g. immuno-histochemistry, electron microscopy) (Note A)

      C.  MICROSCOPIC EVALUATION

            1.   Tumor

                  a.   Histologic type (Note B)

                  b.   Histologic grade (Note C)

                  c.   Extent of invasion (Note D)

            2.   Additional pathologic findings, if present

                  a.   Ferruginous bodies

                  b.   Pleural plaque

                  c.   Pulmonary interstitial fibrosis

                  d.   Other(s)

            3.   Other tissue(s) present

            4.   Results/status of special studies (specify)

            5.   Comments

                  a.   Correlation with intraoperative consultation, as appropriate

                  b.   Correlation with other specimens, as appropriate

                  c.   Correlation with clinical information, as appropriate

III. Resection          back     Top     Main Page

      A.  CLINICAL INFORMATION

            1.   Patient identification

                  a.   Name

                  b.   Identification number

                  c.   Age (birth date)

                  d.   Gender

            2.   Responsible physician(s)

            3.   Date of procedure

            4.   Other clinical information

                  a.   Relevant history

                        (1)  present/past occupation

                        (2)  asbestos exposure

                        (3)  radiation exposure

                        (4)  previous diagnosis of cancer or active infection

                        (5)  previous treatment

                  b.   Relevant findings

                        (1)  pleural effusion(s) (duration)

                        (2)  pleural plaque(s) or thickening

                        (3)  imaging studies

                  c.   Clinical diagnosis

                  d.   Procedure

                  e.   Operative findings

                  f.    Anatomic site(s) of specimen

 

      b.   MACROSCOPIC EXAMINATION

            1.   Specimens

                  a.   Organ(s)/tissue(s) included

                  b.   Unfixed/fixed (specify fixative)

                  c.   Size (three dimensions)

                  d.   Weight

                  e.   External aspect (extent of resection)

                  f.    Visceral pleura (as appropriate)

                  g.   Attached tissue (as appropriate) (e.g. pleura/pericardium/diaphragm)

                  h.   Orientation (if designated by surgeon)

                  i.    Results of intraoperative consultation

            2.   Tumor

                  a.   Location

                  b.   Size (three dimensions and minimum/maximum thickness of involved pleura)

                  c.   Descriptive features (e.g. color, diffuse/ localized/circumscribed, consistency, other)

                  d.   Extent of invasion, as appropriate (Note D)

            3.   Margins (resections performed for surgical cure)

                  a.   Bronchus

                  b.   Pulmonary vessels

                  c.   Parietal pleura

                        (1)  chest wall

                        (2)  mediastinal (including pericardium/great vessels/esophagus/trachea/vertebral bodies)

                  d.   Diaphragm

                  e.   Extra-pleural chest wall (including excised thoracoscopic site and old scars)

                  f.    Note areas designated by surgeon

            4.   Other pleura/lung

                  a.   Normal

                  b.   Abnormal (specify)

            5.   Regional lymph nodes (Note E)

                  a.   Total number*

                        * All nodes included in a pulmonary specimen are designated N1 (Note E) unless otherwise specified by surgeon

                  b.   Number involved by tumor

                        (1)  extra-capsular extension

                        (2)  distinguish metastasis from nodal involvement by direct extension, as appropriate

            6.   Separately submitted lymph nodes (report each node station separately) (Note E)

                  a.   Location (station) specified by surgeon

                  b.   Total number

                  c.   Number involved by tumor

                        (1)  extra-capsular extension

                        (2)  distinguish metastasis from nodal involvement by direct extension, as appropriate

            7.   Tissues submitted for microscopic evaluation

                  a.   Tumor relation to pleura

                  b.   Tumor relation to adjacent lung

                  c.   Tumor relation to extrapleural tissues

                        (1)  chest wall

                        (2)  diaphragm

                        (3)  pericardium

                        (4)  mediastinal tissues

                  d.   Margins (as appropriate)

                        (1)  bronchus

                        (2)  pulmonary vessels

                        (3)  parietal pleura

                              i.    chest wall

                              ii.    mediastinal (pericardium, great vessels, esophagus, trachea, vertebral bodies)

                        (4)  diaphragm

                        (5)  extra-pleural chest wall

                        (6)  areas marked by surgeon

                  e.   Non-neoplastic pleura/lung

                        (1)  normal

                        (2)  abnormal

                  f.    Attached tissue

                  g.   All lymph nodes

                  h.   Frozen section tissue fragment(s) (unless saved for special studies)

                  i.    Other(s) (specify)

            8.   Special studies (specify) (e.g. immuno-histochemistry, electron microscopy) (Note A)

 

      C.  MICROSCOPIC EVALUATION

            1.   Tumor

                  a.   Histologic type (Note B)

                  b.   Histologic grade (Note C)

                  c.   Site (laterality, visceral/parietal pleura, pericardium)

                  d.   Size (from gross description, diffuse/localized)

                  e.   Extent of invasion  (Note D)

            2.   Regional lymph nodes (Note D)

                  a.   Site(s)

                        (1)  included in pulmonary specimen

                        (2)  separately submitted (report each node station separately, as specified)

                  b.   Number

                        (1)  total number

                        (2)  number with metastasis (note extra-capsular invasion, if present)

            3.   Margins

                  a.   Bronchus

                  b.   Pulmonary vessels

                  c.   Parietal pleura

                        (1)  chest wall

                        (2)  mediastinal

                              i.    pericardium

                              ii.    great vessels

                              iii.   esophagus

                              iv.   trachea

                              v.   vertebral bodies

                  d.   Diaphragm

                  e.   Extra-pleural chest wall (including excised thoracoscopic site and old scars)

                  f.    Areas marked by surgeon

            4.   Additional pathologic findings, if present

                  a.   Non-neoplastic lung

                  b.   Ferruginous bodies

                  c.   Pleural plaque

                  d.   Interstitial fibrosis

                  e.   Other(s)

            5.   Distant metastasis, specify site(s) (Note D)

            6.   Other tissue(s)/organ(s)

            7.   Results/status of special studies (specify)

            8.   Comments

                  a.   Correlation with intraoperative consultation, as appropriate

                  b.   Correlation with other specimens, as appropriate

                  c.   Correlation with clinical information, as appropriate

 

EXPLANATORY NOTES

A.  Special Studies       back     Top     Main Page

Immunohistochemistry and electron microscopy have become important adjuncts to routine microscopic evaluation in the diagnosis and classification of malignant mesothelioma.(1-7)

 

B.   Histologic Type      back     Top     Main Page    

For consistency in reporting, the histologic classification published by the World Health Organization (WHO) is recommended.(8) However, other classifications may be used. The more detailed histologic classification of malignant mesothelioma by Hammar recognizes histologic variations which might be confused with other neoplasms and points out light microscopic similarities to benign pleural cells including the surface mesothelial cell and the multipotential subserosal spindle cell.(9)

 

The localized fibrous tumor of the pleura (previously referred to as localized fibrous mesothelioma) is not included in this protocol since it is generally regarded as a benign tumor arising from the subserosal fibrous tissue rather than to the mesothelium.(10)

 

WHO Classification of Malignant Mesothelioma of the Pleura(8)

•     Epithelial

•     Fibrous (spindle-cell)

•     Biphasic

 

Hammar Classification of Malignant Mesothelioma of the Pleura(9)

•     Epithelial

      -     Tubulopapillary

      -     Epithelioid

      -     Glandular

      -     Large cell-giant cell

      -     Small cell

      -     Adenoid-cystic

      -     Signet-ring

•     Sarcomatoid (fibrous, sarcomatous, mesenchymal)

•     Mixed epithelial-sarcomatoid (biphasic)

•     Transitional

•     Desmoplastic

 

C. Histologic Grade           back     Top     Main Page

There is no specific recommended histologic grading system for malignant mesothelioma of the pleura.

 

D.        Staging             back     Top     Main Page

The protocol recommends the American Joint Committee (AJCC) and International Union Against Cancer (UICC) TNM Staging System shown below.(11,12) However, the protocol does not preclude the use of other staging systems such as the staging system of the International Mesothelioma Interest Group Staging System which is also shown below.(13)

 

TNM and Stage Groupings

By AJCC/UICC convention, the designation “T” refers to a primary tumor that has not been previously treated. The symbol “p” refers to the pathologic classification of the TNM, as opposed to the clinical classification and is based on gross and microscopic examination.  pT entails a resection of the primary tumor or biopsy adequate to evaluate the highest pT category; pN entails removal of nodes adequate to validate lymph node metastasis; and pM implies microscopic examination of distant lesions.  Clinical classification (cTNM) is usually carried out by the referring physician before treatment during initial evaluation of the patient or when pathologic classification is not possible.

 

Tumor Remaining in the Patient

Tumor remaining in a patient after therapy with curative intent (e.g., surgical resection for cure) is categorized by a system known as R classification, shown below. 

 

RX                   Presence of residual tumor cannot be assessed

R0                    No residual tumor

R1                    Microscopic residual tumor

R2                    Macroscopic residual tumor.

 

For the surgeon, the R classification may be useful to indicate the known or assumed status of the completeness of a surgical excision.  For the pathologist, the R classification is relevant to the status of the margins of a surgical resection specimen.  That is, tumor involving the resection margin on pathologic examination may be assumed to correspond to residual tumor in the patient and may be classified as macroscopic or microscopic according to the findings at the specimen margin(s).

 

Tumor Remaining in a Specimen

In contrast, tumor remaining in a resection specimen from a patient who has undergone previous (neoadjuvant) treatment of any type (radiation therapy alone, chemotherapy therapy alone, or any combined modality treatment) is codified by the TNM using a prescript “y” (e.g., ypT1).  Thus, yTNM indicates the post-treatment status of the tumor.  For many neoadjuvant therapies, the classification of residual disease may be a strong predictor of postoperative outcome.  In addition, the ypTNM classification provides a standardized framework for the collection of data needed to accurately evaluate new neoadjuvant therapies.

 

Locally Recurrent Tumor

In contrast to “residual” tumor, classification of a tumor as “recurrent” requires a documented disease-free interval after definitive therapy.  Recurrent tumor may also be classified according to the TNM categories, but the prefix “r” (e.g., rpT1) is used to indicate the recurrent status of the tumor. 

 

Primary Tumor (T)

TX                   Primary tumor cannot be assessed

T0                    No evidence of primary tumor

T1                    Tumor limited to ipsilateral parietal and/or visceral pleura

T2                    Tumor invades any of the following: ipsilateral lung, endothoracic fascia, diaphragm, or pericardium

T3                    Tumor invades any of the following: ipsilateral chest wall muscle, ribs, or mediastinal organs or tissues

T4                    Tumor directly extends to any of the following: contralateral pleura, contralateral lung, peritoneum, intra-abdominal organs, cervical tissues

 

Regional Lymph Nodes (N)

NX                  Regional lymph nodes cannot be assessed

N0                   No regional lymph node metastasis

N1                   Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes, including intrapulmonary nodes involved by direct extension of the primary tumor

N2                   Metastasis in ipsilateral mediastinal and/or subcarinal lymph node(s)

N3                   Metastasis in contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph node(s)

 

Distant Metastasis (M)

MX                  Presence of distant metastasis cannot be assessed

M0                   No evidence of distant metastasis

M1                   Distant metastasis

 

Stage Groupings

Stage I: T1                    N0                   M0      

                        T2                    N0                   M0

Stage II:           T1                    N1                   M0

                        T2                    N1                   M0

Stage III:          T1                    N2                   M0

                        T2                    N2                   M0

                        T3                    N0,1,2             M0

Stage IV:          Any T               N3                   M0

                        T4                    Any N              M0

                        Any T               Any N              M1

 

International Mesothelioma Interest Group Staging System (13)

 

Primary Tumor (T)

T1:

            T1a:                 Tumor limited to the ipsilateral parietal pleura, including mediastinal and diaphragmatic pleura. No involvement of the visceral pleura.

T1b:                 Tumor involving the ispilateral parietal pleura, including mediastinal and diaphragmatic pleura. Scattered foci of tumor also involving the visceral pleura.

T2:                               Tumor involving each of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with

                                    at least one of the following features:

                                    -           involvement of diaphragmatic muscle

                                    -           confluent visceral pleural tumor  (including the fissures) or extension of tumor from visceral pleura into

                                                the underlying pulmonary parenchyma

T3*:                             Tumor involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with

                                    at least one of the following features:

                                    -           involvement of the endothoracic fascia

                                    -           extension into the mediastinal fat

                                    -           solitary, completely resectable focus of tumor extending into the soft tissues of the chest wall

                                    -           nontransmural involvement of the pericardium

 

* T3 describes locally advanced but potentially resectable tumor.

 

T4**:                           Tumor involving all of the ipsilateral pleural surfaces (parietal, mediastinal, diaphragmatic, and visceral pleura) with

                                    at least one of the following features:

                                    -           diffuse extension or multifocal masses of  tumor in the chest wall with or without associated rib destruction

                                    -           direct transdiaphragmatic extension of tumor to the peritoneum

                                    -           direct extension of tumor to the contralateral pleura

                                    -           direct extension of tumor to one or more mediastinal organs

                                    -           direct extension of tumor into the spine

                                    -           tumor extending through to the internal surface of the pericardium with or without a pericardial effusion; or tumor involving the

                                                myocardium

 

** T4 describes locally advanced technically unresectable tumor.

 

Regional Lymph Nodes (N)

NX                  Regional lymph nodes cannot be assessed

N0                   No regional lymph node metastasis

N1                   Metastasis in the ipsilateral bronchopulmonary or hilar lymph nodes

N2                   Metastasis in the subcarinal or the ipsilateral mediastinal lymph nodes, including the ipsilateral internal mammary nodes

N3                   Metastasis in the contralateral mediastinal, contralateral internal mammary, ipsilateral, or contralateral supraclavicular lymph nodes

 

Distant Metastasis (M)

MX                  Distant metastasis cannot be assessed

M0                   No distant metastasis

M1                   Distant metastasis present

 

Stage Groupings

Stage I

            Ia         T1a                  N0                   M0

            Ib         T1b                  N0                   M0

Stage II            T2                    N0                   M0

Stage III           T3                    N0                   M0

                        Any T               N1                   M0

                        Any T               N2                   M0

Stage IV           T4                    N3                   M1

                        Any T               Any N              M1

 

E.   Regional Lymph Node Classification           back     Top     Main Page                

A classification of regional lymph nodes adapted from Naruke and recommended by the AJCC is shown below.(11) This anatomic classification of nodal groups is not to be confused with N categories of regional lymph node metastasis of the TNM Staging System detailed in Note D above.

 

N2 Nodes

      Superior Mediastinal Nodes

            Highest mediastinal

            Upper peritracheal

            Pre-tracheal and retro-tracheal

            Lower peritracheal (including azygos nodes)

      Aortic Nodes

            Subaortic (aortic window)

            Peri-aortic (ascending aorta or phrenic)

      Inferior Mediastinal Nodes

            Subcarinal

            Peri-esophageal (below carina)

            Pulmonary ligament

N1 Nodes

      Hilar

      Interlobar

      Lobar

      Segmental

Classification of lymph nodes recommended by the American Thoracic Society(14)

 

Definitions of Lymph Node Stations

2R. Right upper peritracheal (suprainnominate) nodes: nodes to the right of the midline of the trachea between the intersection of the caudal margin of the innominate artery with the trachea and the apex of the lung. (Includes highest R mediastinal node.)

2L. Left upper peritracheal (supra-aortic nodes): nodes to the left of the midline of the trachea between the top of the aortic arch and the apex of the lung. (Includes highest mediastinal node.)

4R. Right lower peritracheal nodes: nodes to the right of the midline of the trachea between the cephalic border of the azygos vein and the intersection of the caudal margin of the brachiocephalic artery with the right side of the trachea. (Includes some pretracheal and paracaval nodes.)

4L. Left lower peritracheal nodes: nodes to the left of the midline of the trachea between the top of the aortic arch and the level of the carina, medial to the ligamentum arteriosum. (Includes some pretracheal nodes.)

5.     Aortopulmonary nodes: subaortic and para-aortic nodes, lateral to the ligamentum arteriosum or the aorta or left pulmonary artery, proximal to the first branch of the left pulmonary artery.

6.     Anterior mediastinal nodes: nodes anterior to the ascending aorta or the innominate artery. (Includes some pretracheal and preaortic nodes.)

7.     Subcarinal nodes: nodes arising caudal to the carina of the trachea but not associated with the lower lobe bronchi or arteries within the lung.

8.     Paraesophageal nodes: nodes dorsal to the posterior wall of the trachea and to the right or left of the midline of the esophagus. (Includes retrotracheal but not not subcarinal nodes.)

9.     Right or left pulmonary ligament nodes: nodes within the right or left pulmonary ligament.

10R.     Right tracheobronchial nodes: nodes to the right of the midline of the trachea from the level of the cephalic border of the azygos vein to the origin of the right upper lobe bronchus.

10L.     Left peribronchial nodes: nodes to the left of the midline of the trachea between the carina and the left upper lobe bronchus, medial to the ligamentum arteriosum.

11.   Intrapulmonary nodes: nodes removed in the right or left lung specimen plus those distal to the mainstem bronchi or secondary carina. (Includes interlobar, lobar and segmental nodes.) Post-thoracotomy staging may designate 11 interlobar, 12 lobar, 13 segmental, 14 subsegmental.

 

REFERENCES                        back     Top     Main Page

1.     Frisman D, McCarthy W, Schleiff P, Buckner S, Nocito J, O’Leary T. Immunocytochemistry in the differential diagnosis of effusions: Use of logistic regression to select a panel of antibodies to distinguish adenocarcinomas from mesothelial proliferations. Mod Pathol. 1993;6:179-184.

2.     Gaffey M, Mills S, Swanson P, Zarbo R, Shah A, Wick M. Immunoreactivity for Ber-EP4 in adenocarcinomas, adenomatoid tumors and malignant mesotheliomas. Am J Surg Pathol. 1992;16:593-599.

3.     Otis CN, Carter D, Cole S, Battifora H. Immunohistochemical evaluation of pleural mesothelioma and pulmonary adenocarcinoma. A bi-institutional study of 47 cases. Am J Surg Pathol. 1987;11:445-456.

4.     Sheibani K, Azumi N, Battifora H. Further evidence demonstrating the value of Leu M1 antigen in the differential diagnosis of malignant mesothelioma and adenocarcinoma: An immunohistologic evaluation of 395 cases. Lab Invest. 1988;58:84A.

5.     Sheibani K, Shin S, Kerzirian J, Weiss L. Ber-EP4 antibody as a discriminant in the differential diagnosis of malignant mesothelioma versus adenocarcinoma. Am J Surg Pathol. 1991; 15:779-784.

6.     Suzuki Y, Churg J, Kannerstein M. Ultrastructure of human malignant diffuse mesothelioma. Am J Pathol. 1976;85:241-262.

7.     Warhol MJ, Corson JM. An ultrastructural comparison of mesotheliomas with adenocarcinomas of the lung and breast. Hum Pathol. 1985;16:50-55.

8.     World Health Organization. Histologic Typing of Lung Tumours. 2nd ed. Geneva: World Health Organization; 1981.

9.     Hammar S. Pleural Diseases. In: Dail D, Hammer S, eds. Pulmonary Pathology. 2nd ed. New York: Springer-Verlag; 1994:1494.

10.   England DM, Hochholzer L, McCarthy MJ. Localized benign and malignant fibrous tumors of the pleura: A clinicopathologic review of 223 cases. Am J Surg Pathol. 1989;13:640-658.

11.   Fleming ID, Cooper JS, Henson DE, et al. eds. AJCC Manual for Staging of Cancer. 5th ed. Lippincott Raven, Philadelphia,PA: 1997.

12.   Hermanek P, Sobin L. TNM Classification of Malignant Tumours. 4th ed. Berlin: Springer-Verlag; 1992.

13.   Rusch VW. A proposed new international TNM staging system for malignant pleural mesothelioma from the International Mesothelioma Interest Group. Chest. 1995;108:1122-1128.

14.   American Thoracic Society: Clinical staging of primary lung cancer. Am Rev Resp Dis. 1983;127:659-664.

 

BIBLIOGRAPHY

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•      Antman K. Natural history and epidemiology of malignant mesothelioma. Chest. 1993;103(Suppl):373-376.

•      DiBonito L, Falconieri G, Colautti I, Bonifacio Gori D, Dudine S, Giarelli L. Cytopathology of malignant mesothelioma: A study of its patterns and histological bases. Diagn Cytopathol. 1993;9:25-31.

•      Grove A, Paulson SM, Gregersen M. The value of immunohistochemistry of pleural biopsy specimens in the differential diagnosis between malignant mesothelioma and metastatic carcinoma. Pathol Res Pract. 1994;190:1044-1055.

•      Johansson L, Linden CJ. Aspects of histopathologic subtype as a prognostic factor in 85 pleural mesotheliomas. Chest. 1996;109:109-114.

•      Leong AS, Vernon-Roberts E. The immunochemistry of malignant mesothelioma. Pathol Annu. 1994;29(Pt. 2):157-179.

•      Pass H. Contemporary approaches in the investigation and treatment of malignant pleural mesothelioma. Chest Surg Clin of N Am. 1994;4:497-515.

•      Pass H, Pogrebniak H. Malignant Pleural Mesothelioma. In: Wells S, ed. Current Problems in Surgery. Vol. 30. 1993:923-1012.

•      Qua J, Rao U, Takita H. Malignant pleural mesothelioma: A clinicopathologic study. J Surg Oncol. 1993;54:47-50.

•      Sugarbaker D, Strauss G, Lynch T, et al. Node status has prognostic significance in the multimodality therapy of diffuse, malignant mesothelioma. J Clin Oncol. 1993;11:1172-1178.

•      Tammilehto L, Maasilta P, Kostianinen S, et al. Diagnosis and prognostic factors in malignant pleural mesothelioma: A retrospective analysis of 65 patients. Respiration. 1992;59:129-135.

Author:

Gerald Nash, MD

 

©2000. College of American Pathologists (CAP). All rights reserved. None of the contents of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means (electronic, mechanical, photocopying, recording, or otherwise) without prior written permission of the publisher.

 

Expires as CAP policy in May 2001. A year prior, the protocol will be reviewed and updated.

 

Contributors:                back     Top     Main Page

        CAP Cancer Committee; Karen Antman, MD; Samuel P. Hammar, MD; Eugene Mark, MD; Christopher Otis, MD; Harvey I. Pass, MD; Peter B. Schiff, MD, PhD