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Mesothelial Hyperplasia in Cytology Specimens MODIF
Mesothelial Hyperplasia in Cytology Specimens MODIF
Mesothelial Hyperplasia in Cytology Specimens MODIF
Specimens
Philip T Cagle and Andrew Churg. Arch Pathol Lab Med. 2005:
129:1421-1427
1. Cytopathologists are
frequently reluctant in
making the diagnosis
of malignant
mesothelioma
particularly in the
absence of radiological
findings
2. When malignancy is
recognized, it is
sometimes
1. Recognizing
mesothelial origin
2. Distinguishing reactive
from malignant
mesothelial cells
3. Distinguishing
mesothelioma from
non-mesothelial
malignancies
PLEURAL FLUID
MESOTHELIUM
MESOTHELIAL CELLS
CHARACTERISTIC
Uniform cell population
Monotonous , oval to round nuclei
Mononucleated cells with mostly centrally
placed nuclei
Evenly distributed fine powdery chromatin
Inconspicuous to prominent nucleoli
Multinucleation with anisonucleosis
Moderate amount of translucent cytoplasms
Two-zone cytoplasms
MESOTHELIAL CELLS
CHARACTERISTIC
A faint staining thin halo along the edge
(microvilli)
Fuzzy cell border (due to microvilli )
Peripheral blebs in Diff-Quick stained smears
Monolayer cell aggregates
Doublets or triplets with clasp-like articulation
Mesothelial windows between the cells
Occasional papillary groups
Balloning of cytoplasm with signet ring-like
MESOTHELIUM
monolayer of cells with:
Distinct cell borders
(mimicking the
appearance of
cobblestones),
A moderate amount of
cytoplasm, and
A central nucleus
Intracellular windowing.
Nuclear inclusions.
Cytoplasmic blebbing.
MESOTHELIAL CELLS
FLAT MESOTHEL
PERIPHERAL ECTOPLASMA
INNER ENDOPLASM
CENTRAL TO SLIGHTLY
ECCENTRIC NUCLEUS
HYPERTROPHY
Heart failure
Infection
Infarction
Liver disease
Collagen disease
Renal disease/dialysis
Pancreatic disease
Radiation and
chemotherapy
Traumatic
irritation(surgery)
Chronic inflammation
Underlying
neoplasm(causing
irritation
Foreign substance(talc)
Reactive/Hyperplastic Mesothelium
Cytology of Pleural Fluid. Claire W Michael, M.D. The University
of Michigan
Reactive/Hyperplastic Mesothelium
o Nuclei are round to oval with slight variation in
size and chromatin distribution
o Cell size vary slightly, only few cells are out of
proportion in size
o Nucleoli may become prominent
o Multinucleated cells increase
o Occasional intranuclear inclusions are noted
Mesothelioma
IMMUNO-CYTO/HISTO-CHEMISTRY OF
MESOTHELIAL CELLS
1. The distinction between reactive mesothelial hyperplasia
(MH) and malignant mesothelioma (MM) may be very
difficult based only on histologic and morphologic
findings
2. Frank invasion is regarded as the most important
diagnostic feature of malignancy in surgical excision
specimensspecimens; however, this is not applicable to
cytologic examination of effusions
3. The cytologic features commonly used to identify
malignancy, including nuclear pleomorphism,
macronucleoli, large cellular aggregates, papillary-like tissue
fragments, and cell-in-cell engulfment, are helpful features
but have limited use in effusion, because they may also be
Mesothelioma:
markedly
cellular with
large cell balls
Mesotheliom
a with
papillary
groups
Mesotheliom
a
Nuclear atypia
Normal
mesothelia cell
Mesothelio
ma
Reactive
mesothelial
cells
Mesothelio
ma
Mesothelio
ma cell
block
MH
ALV
Pancytoker AE1/3
3+
3+
3+
Pancytoker CAM5.2
3+
3+
3+
Calretinin
3+
3+
D2-40
2+
3+
CK5/6
1+
2+
CK7
1+
2+
3+
CK8
2+
3+
EMA
3+
Vimentin
Desmin
3+
1+
MH: mesothelial hyperplasia, M: mesothelium, ALV: alveolar cell.
- Int J Clin Exp Pathol. 2011,
Modified from: T Terada.
4(6): 631-638
Antibody
Keratin AE1/AE3
EMA
p53
Desmin
Benign Atypical
Mesothelial
Proliferations
Malignant
Mesothelioma
+/+/+/+++
+++
+++
+++
+/-
MH
ALV
Pancytoker
AE1/3
3+
3+
3+
EMA
3+
Desmin
10%
20%
1%
1%
p53
Ki-67
Summary
1/2
Summary
2/2