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Fortarezza F, Pezzuto F, Maniglio S, Marzullo A, d'Amati A, Cavone D, Romano DE, Pentimone F, De Palma A, Marulli G, Lettini T, Caporusso C, Barbarino M, Salzillo C, Quaranta A, Calabrese F, Serio G, Vimercati L. Adverse Prognostic Impact of Transitional and Pleomorphic Patterns in Pleural Nonepithelioid Mesothelioma: Insights From Comprehensive Analysis and Reticulin Stain. Arch Pathol Lab Med 2025; 149:347-353. [PMID: 38952294 DOI: 10.5858/arpa.2023-0523-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2024] [Indexed: 07/03/2024]
Abstract
CONTEXT.— Mesothelioma subtyping into epithelioid and nonepithelioid categories plays a crucial role in prognosis and treatment selection, with emerging recognition of the impact of various histologic patterns. OBJECTIVE.— To investigate the prognostic implications of transitional and pleomorphic patterns in sarcomatoid mesothelioma. DESIGN.— A total of 132 mesothelioma cases (87 biphasic, 45 sarcomatoid) were analyzed. Histologic slides were assessed, treatment data collected, and cases categorized into predominant epithelioid or sarcomatoid patterns. The sarcomatoid mesotheliomas were classified into usual, pleomorphic, and transitional patterns, with reticulin staining for the latter. Statistical analysis included Cox regression and Kaplan-Meier methods. RESULTS.— Younger age (P = .02) and receiving therapy (P < .001) correlated with improved survival for both histotypes. Advanced stage was associated with shorter survival in sarcomatoid cases (P = .02). Predominant epithelioid pattern in biphasic cases led to longer survival (P < .001). Transitional and pleomorphic patterns were indicative of worse prognosis, with significantly lower survival in cases with both patterns than in cases with the usual sarcomatoid pattern (P = .046). Multivariate analysis identified independent survival factors, including predominant epithelioid component in biphasic mesothelioma (P = .001) and chemotherapy (P < .001). CONCLUSIONS.— Histologic subtyping in mesothelioma plays a pivotal role in prognosis. Transitional and pleomorphic patterns, even in low percentages, indicate poorer outcomes. This study highlights the need for standardized diagnostic support and suggests the potential utility of histochemical staining in identifying more aggressive morphologic aspects. Recognizing the significance of these patterns can guide treatment decisions and patient care strategies.
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Affiliation(s)
| | - Federica Pezzuto
- the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Pathology Unit, University of Padova, Padova, Italy (Pezzuto, Calabrese)
| | - Sonia Maniglio
- the Department of Precision and Regenerative Medicine and Ionian Area, Pathology Unit, University of Bari "Aldo Moro," Bari, Italy (Maniglio, Marzullo, D'amati, Lettini, Caporusso, Salzillo, Quaranta, Serio)
| | - Andrea Marzullo
- the Department of Precision and Regenerative Medicine and Ionian Area, Pathology Unit, University of Bari "Aldo Moro," Bari, Italy (Maniglio, Marzullo, D'amati, Lettini, Caporusso, Salzillo, Quaranta, Serio)
| | - Antonio d'Amati
- the Department of Precision and Regenerative Medicine and Ionian Area, Pathology Unit, University of Bari "Aldo Moro," Bari, Italy (Maniglio, Marzullo, D'amati, Lettini, Caporusso, Salzillo, Quaranta, Serio)
| | - Domenica Cavone
- the Department of Interdisciplinary Medicine, Occupational Health Unit, University of Bari "Aldo Moro," Bari, Italy (Cavone, Romano, Pentimone, Vimercati)
| | - Daniele Egidio Romano
- the Department of Interdisciplinary Medicine, Occupational Health Unit, University of Bari "Aldo Moro," Bari, Italy (Cavone, Romano, Pentimone, Vimercati)
| | - Floriana Pentimone
- the Department of Interdisciplinary Medicine, Occupational Health Unit, University of Bari "Aldo Moro," Bari, Italy (Cavone, Romano, Pentimone, Vimercati)
| | - Angela De Palma
- the Department of Precision and Regenerative Medicine and Ionian Area, Unit of Thoracic Surgery, University of Bari "Aldo Moro," Bari, Italy (De Palma)
| | - Giuseppe Marulli
- the Department of Biomedical Sciences, Thoracic Surgery Unit, Humanitas University, Milano, Italy (Marulli)
| | - Teresa Lettini
- the Department of Precision and Regenerative Medicine and Ionian Area, Pathology Unit, University of Bari "Aldo Moro," Bari, Italy (Maniglio, Marzullo, D'amati, Lettini, Caporusso, Salzillo, Quaranta, Serio)
| | - Concetta Caporusso
- the Department of Precision and Regenerative Medicine and Ionian Area, Pathology Unit, University of Bari "Aldo Moro," Bari, Italy (Maniglio, Marzullo, D'amati, Lettini, Caporusso, Salzillo, Quaranta, Serio)
| | - Marcella Barbarino
- the Department of Medical Biotechnologies, University of Siena, Siena, Italy (Barbarino)
| | - Cecilia Salzillo
- the Department of Precision and Regenerative Medicine and Ionian Area, Pathology Unit, University of Bari "Aldo Moro," Bari, Italy (Maniglio, Marzullo, D'amati, Lettini, Caporusso, Salzillo, Quaranta, Serio)
| | - Andrea Quaranta
- the Department of Precision and Regenerative Medicine and Ionian Area, Pathology Unit, University of Bari "Aldo Moro," Bari, Italy (Maniglio, Marzullo, D'amati, Lettini, Caporusso, Salzillo, Quaranta, Serio)
| | - Fiorella Calabrese
- the Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Pathology Unit, University of Padova, Padova, Italy (Pezzuto, Calabrese)
| | - Gabriella Serio
- the Department of Precision and Regenerative Medicine and Ionian Area, Pathology Unit, University of Bari "Aldo Moro," Bari, Italy (Maniglio, Marzullo, D'amati, Lettini, Caporusso, Salzillo, Quaranta, Serio)
| | - Luigi Vimercati
- the Department of Interdisciplinary Medicine, Occupational Health Unit, University of Bari "Aldo Moro," Bari, Italy (Cavone, Romano, Pentimone, Vimercati)
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Lucà S, Pignata G, Cioce A, Salzillo C, De Cecio R, Ferrara G, Della Corte CM, Morgillo F, Fiorelli A, Montella M, Franco R. Diagnostic Challenges in the Pathological Approach to Pleural Mesothelioma. Cancers (Basel) 2025; 17:481. [PMID: 39941848 PMCID: PMC11816244 DOI: 10.3390/cancers17030481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2025] [Revised: 01/26/2025] [Accepted: 01/28/2025] [Indexed: 02/16/2025] Open
Abstract
Malignant pleural mesothelioma (MPM) still represents a complex diagnostic challenge for pathologists in routine practice. This diagnosis requires a multidisciplinary approach, and pathological evaluation is mandatory. The histopathological diagnosis is stepwise and should be based on morphological and immunohistochemical assessment, sometimes associated with molecular tests, and supported by clinical and radiological findings. A correct morphological approach aims to exclude pleural metastasis or benign mesothelial proliferations, which are the main differential diagnoses. While certain histological features are diagnostic of MPM, others are highly suggestive but not definitive. Immunohistochemistry plays a pivotal role, with a panel of both traditional and newer markers being used to assess mesothelial differentiation and to differentiate malignant from benign proliferations. In more challenging cases, molecular tests, such as fluorescent in situ hybridization (FISH) to detect CDKN2A deletion, can be helpful in distinguishing malignant from benign pleural lesions. This review summarizes the key morphological, immunohistochemical, and molecular features that should be considered when pleural biopsy samples are examined, with the aim of improving diagnostic accuracy in this complex area.
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Affiliation(s)
- Stefano Lucà
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (S.L.); (A.C.); (M.M.)
- Department of Experimental Medicine, PhD Course in Public Health, University of Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Giovanna Pignata
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy; (G.P.); (R.D.C.); (G.F.)
| | - Alessandro Cioce
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (S.L.); (A.C.); (M.M.)
- Department of Experimental Medicine, PhD Course in Public Health, University of Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Cecilia Salzillo
- Department of Experimental Medicine, PhD Course in Public Health, University of Campania Luigi Vanvitelli, 80138 Naples, Italy;
- Department of Precision and Regenerative Medicine and Ionian Area, Pathology Unit, University of Bari Aldo Moro, 70121 Bari, Italy
| | - Rossella De Cecio
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy; (G.P.); (R.D.C.); (G.F.)
| | - Gerardo Ferrara
- Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, 80131 Naples, Italy; (G.P.); (R.D.C.); (G.F.)
| | - Carminia Maria Della Corte
- Department of Precision Medicine, Medical Oncology, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.M.D.C.); (F.M.)
| | - Floriana Morgillo
- Department of Precision Medicine, Medical Oncology, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (C.M.D.C.); (F.M.)
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Department of Translational Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Marco Montella
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (S.L.); (A.C.); (M.M.)
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (S.L.); (A.C.); (M.M.)
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Mirra L, Beretta GL, Lisini D, Marcianti A, Spampinato E, Corno C, Costantino M, Corsico A, Stella GM, Perego P. Therapeutic Strategies to Improve the Treatment of Pleural Mesothelioma. Curr Med Chem 2025; 32:2093-2114. [PMID: 38629360 DOI: 10.2174/0109298673268206240405084558] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 05/20/2025]
Abstract
Pleural mesothelioma is a rare neoplastic disease with aggressive features. Patient survival is poor due to the lack of early symptoms and the absence of effective therapeutic strategies. The development of pleural mesothelioma is mainly associated to asbestos exposure and related chronic inflammation. From a molecular-based perspective, this disease is a heterogeneous tumor lacking actionable alterations. The median overall survival of patients affected by this tumor does not exceed 16 months from diagnosis. Molecular and biochemical approaches have shown that this disease is characterized by resistance to drug-induced apoptosis associated with the activation of cell survival pathways and expression of anti-apoptotic proteins. Thus, there is an urgent need to develop efficient and safe therapeutic strategies. Here, we review the pharmacological options available for the treatment of this disease with specific reference to the antitumor agents used in systemic therapies. In addition, novel pharmacological approaches, such as drug delivery tools, to improve pleural mesothelioma treatment are discussed.
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Affiliation(s)
- Luca Mirra
- Molecular Pharmacology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Luca Beretta
- Molecular Pharmacology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Daniela Lisini
- Cell Therapy Production Unit, Scientific Direction, IRCCS Neurological Institute Carlo Besta Foundation, Milan, 20133, Italy
| | - Angela Marcianti
- Cell Therapy Production Unit, Scientific Direction, IRCCS Neurological Institute Carlo Besta Foundation, Milan, 20133, Italy
| | - Eleonora Spampinato
- Cell Therapy Production Unit, Scientific Direction, IRCCS Neurological Institute Carlo Besta Foundation, Milan, 20133, Italy
| | - Cristina Corno
- Molecular Pharmacology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Matteo Costantino
- Molecular Pharmacology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Angelo Corsico
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, 27100 , Italy
- Unit of Respiratory Diseases, Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Matteo Foundation, Pavia, 27100, Italy
| | - Giulia Maria Stella
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, 27100 , Italy
- Unit of Respiratory Diseases, Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Matteo Foundation, Pavia, 27100, Italy
| | - Paola Perego
- Molecular Pharmacology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Husain AN, Chapel DB, Attanoos R, Beasley MB, Brcic L, Butnor K, Chirieac LR, Churg A, Dacic S, Galateau-Salle F, Hiroshima K, Hung YP, Klebe S, Krausz T, Khoor A, Litzky L, Marchevsky A, Nabeshima K, Nicholson AG, Pavlisko EN, Roden AC, Roggli V, Sauter JL, Schulte JJ, Sheaff M, Travis WD, Tsao MS, Walts AE, Colby TV. Guidelines for Pathologic Diagnosis of Mesothelioma: 2023 Update of the Consensus Statement From the International Mesothelioma Interest Group. Arch Pathol Lab Med 2024; 148:1251-1271. [PMID: 38586983 DOI: 10.5858/arpa.2023-0304-ra] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2024] [Indexed: 04/09/2024]
Abstract
CONTEXT.— Mesothelioma is an uncommon tumor that can be difficult to diagnose. OBJECTIVE.— To provide updated, practical guidelines for the pathologic diagnosis of mesothelioma. DATA SOURCES.— Pathologists involved in the International Mesothelioma Interest Group and others with expertise in mesothelioma contributed to this update. Reference material includes peer-reviewed publications and textbooks. CONCLUSIONS.— There was consensus opinion regarding guidelines for (1) histomorphologic diagnosis of mesothelial tumors, including distinction of epithelioid, biphasic, and sarcomatoid mesothelioma; recognition of morphologic variants and patterns; and recognition of common morphologic pitfalls; (2) molecular pathogenesis of mesothelioma; (3) application of immunohistochemical markers to establish mesothelial lineage and distinguish mesothelioma from common morphologic differentials; (4) application of ancillary studies to distinguish benign from malignant mesothelial proliferations, including BAP1 and MTAP immunostains; novel immunomarkers such as Merlin and p53; fluorescence in situ hybridization (FISH) for homozygous deletion of CDKN2A; and novel molecular assays; (5) practical recommendations for routine reporting of mesothelioma, including grading epithelioid mesothelioma and other prognostic parameters; (6) diagnosis of mesothelioma in situ; (7) cytologic diagnosis of mesothelioma, including use of immunostains and molecular assays; and (8) features of nonmalignant peritoneal mesothelial lesions.
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Affiliation(s)
- Aliya N Husain
- From the Department of Pathology, University of Chicago, Chicago, Illinois (Husain, Krausz)
| | - David B Chapel
- the Department of Pathology, University of Michigan, Ann Arbor (Chapel)
| | - Richard Attanoos
- the Department of Cellular Pathology and School of Medicine, University Hospital of Wales and Cardiff University, Cardiff, United Kingdom (Attanoos)
| | - Mary Beth Beasley
- the Department of Pathology, Mount Sinai Hospital, New York, New York (Beasley)
| | - Luka Brcic
- Diagnostic and Research Institute of Pathology Medical University of Graz, Graz, Austria (Brcic)
| | - Kelly Butnor
- the Department of Pathology & Laboratory Medicine, University of Vermont College of Medicine, Burlington (Butnor)
| | - Lucian R Chirieac
- the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Chirieac)
| | - Andrew Churg
- the Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada (Churg)
| | - Sanja Dacic
- the Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Dacic)
| | | | - Kenzo Hiroshima
- the Department of Biochemistry and Genetics, Chiba University Graduate School of Medicine, Chiba, Japan (Hiroshima)
| | - Yin P Hung
- the Department of Pathology, Massachusetts General Hospital, Boston (Hung)
| | - Sonja Klebe
- the Department of Anatomical Pathology, SA Pathology and Flinders University, Bedford Park SA, Australia (Klebe)
| | - Thomas Krausz
- From the Department of Pathology, University of Chicago, Chicago, Illinois (Husain, Krausz)
| | - Andras Khoor
- the Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida (Khoor)
| | - Leslie Litzky
- the Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia (Litzky)
| | - Alberto Marchevsky
- the Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California (Marchevsky, Walts)
| | - Kazuki Nabeshima
- the Department of Clinical Pathology, Fukuoka Tokushukai Hospital, Kasuga City, Fukuoka Prefecture, Japan (Nabeshima)
| | - Andrew G Nicholson
- the Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom (Nicholson)
| | - Elizabeth N Pavlisko
- the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Pavlisko, Roggli)
| | - Anja C Roden
- the Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, Minnesota (Roden)
| | - Victor Roggli
- the Department of Pathology, Duke University Medical Center, Durham, North Carolina (Pavlisko, Roggli)
| | - Jennifer L Sauter
- the Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York (Sauter, Travis)
| | - Jefree J Schulte
- the Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison (Schulte)
| | - Michael Sheaff
- the Department of Cellular Pathology, Barts Health NHS Trust, London, United Kingdom (Sheaff)
| | - William D Travis
- the Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York (Sauter, Travis)
| | - Ming-Sound Tsao
- the Department of Laboratory Medicine and Pathobiology, University of Health Network and University of Toronto, Toronto, Ontario, Canada (Tsao)
| | - Ann E Walts
- the Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California (Marchevsky, Walts)
| | - Thomas V Colby
- and Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale (Emeritus) (Colby)
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5
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Hung YP, Chirieac LR. Molecular and Immunohistochemical Testing in Mesothelioma and Other Mesothelial Lesions. Arch Pathol Lab Med 2024; 148:e77-e89. [PMID: 38190277 DOI: 10.5858/arpa.2023-0213-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 01/10/2024]
Abstract
CONTEXT.— Molecular testing has increasingly been utilized in the evaluation of mesothelioma. Diffuse mesothelioma comprises multiple distinct genetic subgroups. While most diffuse mesotheliomas lack oncogenic kinase mutations and instead harbor alterations involving tumor suppressors and chromatin regulators, a minor subset of tumors is characterized by uncommon alterations such as germline mutations, genomic near-haploidization, ALK rearrangement, ATF1 rearrangement, or EWSR1::YY1 fusion. OBJECTIVE.— To provide updates on the salient molecular features of diffuse mesothelioma, mesothelioma in situ, and other mesothelial lesions: well-differentiated papillary mesothelial tumor, adenomatoid tumor, peritoneal inclusion cyst, and others. We consider the diagnostic, prognostic, and predictive utility of molecular testing in mesothelial lesions. DATA SOURCES.— We performed a literature review of recently described genetic features, molecular approaches, and immunohistochemical tools, including BAP1, MTAP, and merlin in mesothelioma and other mesothelial lesions. CONCLUSIONS.— Our evolving understanding of the molecular diversity of diffuse mesothelioma and other mesothelial lesions has led to considerable changes in pathology diagnostic practice, including the application of immunohistochemical markers such as BAP1, MTAP, and merlin (NF2), which are surrogates of mutation status. In young patients and/or those without significant asbestos exposure, unusual mesothelioma genetics such as germline mutations, ALK rearrangement, and ATF1 rearrangement should be considered.
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MESH Headings
- Humans
- Mesothelioma/diagnosis
- Mesothelioma/genetics
- Mesothelioma/metabolism
- Mesothelioma/pathology
- Immunohistochemistry
- Biomarkers, Tumor/genetics
- Biomarkers, Tumor/metabolism
- Biomarkers, Tumor/analysis
- Neoplasms, Mesothelial/diagnosis
- Neoplasms, Mesothelial/genetics
- Neoplasms, Mesothelial/metabolism
- Neoplasms, Mesothelial/pathology
- Mesothelioma, Malignant/diagnosis
- Mesothelioma, Malignant/genetics
- Mesothelioma, Malignant/pathology
- Mesothelioma, Malignant/metabolism
- Mutation
- Tumor Suppressor Proteins
- Ubiquitin Thiolesterase
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Affiliation(s)
- Yin P Hung
- From the Department of Pathology, Massachusetts General Hospital. Boston (Hung)
- the Department of Pathology, Harvard Medical School, Boston, Massachusetts (Hung, Chirieac)
| | - Lucian R Chirieac
- the Department of Pathology, Harvard Medical School, Boston, Massachusetts (Hung, Chirieac)
- the Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Chirieac)
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Chapel DB, Hornick JL, Barlow J, Bueno R, Sholl LM. Clinical and molecular validation of BAP1, MTAP, P53, and Merlin immunohistochemistry in diagnosis of pleural mesothelioma. Mod Pathol 2022; 35:1383-1397. [PMID: 35459788 PMCID: PMC9529776 DOI: 10.1038/s41379-022-01081-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/16/2022] [Accepted: 03/28/2022] [Indexed: 12/28/2022]
Abstract
BAP1 and MTAP immunostains play an important role in diagnosis of mesothelioma, but additional markers are needed to increase sensitivity. We analyzed 84 pleural mesotheliomas (51 epithelioid, 27 biphasic, 6 sarcomatoid) by a hybrid-capture next-generation sequencing (NGS) panel including complete coverage of coding and splicing regions for BAP1, CDKN2A/MTAP, NF2, and TP53 and correlated molecular findings with diagnostic immunostains for BAP1, MTAP, Merlin, and p53, respectively. Fifty-seven reactive mesothelial proliferations served as benign comparators. Loss of BAP1, MTAP, and Merlin protein expression were, respectively, 54%, 46%, and 52% sensitive and 100% specific for mesothelioma. Two-marker immunopanels of BAP1 + MTAP, BAP1 + Merlin, and MTAP + Merlin were 79%, 85%, and 71% sensitive for mesothelioma, while a three-marker immunopanel of BAP1 + MTAP + Merlin was 90% sensitive. Diffuse (mutant-pattern) p53 immunostaining was seen in only 6 (7%) tumors but represented the only immunohistochemical abnormality in 2 cases. Null-pattern p53 was not specific for malignancy. An immunopanel of BAP1 + MTAP + Merlin + p53 was 93% sensitive for mesothelioma, and panel NGS detected a pathogenic alteration in BAP1, MTAP, NF2, and/or TP53 in 95%. Together, 83 (99%) of 84 tumors showed a diagnostic alteration by either immunohistochemistry or panel NGS. Adding Merlin to the standard BAP1 + MTAP immunopanel increases sensitivity for mesothelioma without sacrificing specificity. p53 immunohistochemistry and panel NGS with complete coverage of BAP1, CDKN2A/MTAP, TP53, and NF2 may be useful in diagnostically challenging cases.
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Affiliation(s)
- David B Chapel
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA.
- Department of Pathology, University of Michigan - Michigan Medicine, Ann Arbor, MI, 48109, USA.
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Julianne Barlow
- Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Raphael Bueno
- Department of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Center for Advanced Molecular Diagnostics, Brigham and Women's Hospital, Boston, MA, 02115, USA
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Koul A, Bawa RK, Kumar Y. Artificial Intelligence Techniques to Predict the Airway Disorders Illness: A Systematic Review. ARCHIVES OF COMPUTATIONAL METHODS IN ENGINEERING : STATE OF THE ART REVIEWS 2022; 30:831-864. [PMID: 36189431 PMCID: PMC9516534 DOI: 10.1007/s11831-022-09818-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/04/2022] [Indexed: 06/16/2023]
Abstract
Airway disease is a major healthcare issue that causes at least 3 million fatalities every year. It is also considered one of the foremost causes of death all around the globe by 2030. Numerous studies have been undertaken to demonstrate the latest advances in artificial intelligence algorithms to assist in identifying and classifying these diseases. This comprehensive review aims to summarise the state-of-the-art machine and deep learning-based systems for detecting airway disorders, envisage the trends of the recent work in this domain, and analyze the difficulties and potential future paths. This systematic literature review includes the study of one hundred fifty-five articles on airway diseases such as cystic fibrosis, emphysema, lung cancer, Mesothelioma, covid-19, pneumoconiosis, asthma, pulmonary edema, tuberculosis, pulmonary embolism as well as highlights the automated learning techniques to predict them. The study concludes with a discussion and challenges about expanding the efficiency and machine and deep learning-assisted airway disease detection applications.
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Affiliation(s)
- Apeksha Koul
- Department of Computer Science and Engineering, Punjabi University, Patiala, Punjab India
| | - Rajesh K. Bawa
- Department of Computer Science, Punjabi University, Patiala, Punjab India
| | - Yogesh Kumar
- Department of Computer Science and Engineering, School of Technology, Pandit Deendayal Energy University, Gandhinagar, Gujarat India
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8
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Sauter JL, Dacic S, Galateau-Salle F, Attanoos RL, Butnor KJ, Churg A, Husain AN, Kadota K, Khoor A, Nicholson AG, Roggli V, Schmitt F, Tsao MS, Travis WD. The 2021 World Health Organization Classification of Tumors of the Pleura: Advances since the 2015 Classification. J Thorac Oncol 2022; 17:608-622. [PMID: 35026477 DOI: 10.1016/j.jtho.2021.12.014] [Citation(s) in RCA: 97] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/14/2021] [Accepted: 12/31/2021] [Indexed: 12/01/2022]
Abstract
Significant changes in the 2021 World Health Organization (WHO) Classification of Tumors of the Pleura and Pericardium since the 2015 WHO Classification include: 1) Pleural and pericardial tumors have been combined in one chapter whereas in the 2015 WHO, pericardial tumors were classified with cardiac tumors; 2) Well-differentiated papillary mesothelioma (WDPM) has been renamed well-differentiated papillary mesothelial tumor (WDPMT) given growing evidence that these tumors exhibit relatively indolent behavior; 3) Localized and diffuse mesothelioma no longer include the term "malignant" as a prefix; 4) Mesothelioma in situ (MIS) has been added to the 2021 classification since these lesions can now be recognized by loss of BAP1 and/or MTAP by immunohistochemistry and/or CDKN2A homozygous deletion by FISH; 5) The three main histologic subtypes (i.e. epithelioid, biphasic and sarcomatoid) remain the same but architectural patterns, cytologic and stromal features are more formally incorporated into the 2021 classification based on their prognostic significance; 6) Nuclear grading for epithelioid diffuse mesothelioma is introduced and it is recommended to record this and other histologically prognostic features in pathology reports; 7) BAP1, EZH2 and MTAP immunohistochemistry have been shown to be useful in separating benign mesothelial proliferations from mesothelioma; 8) Biphasic mesothelioma can be diagnosed in small biopsies showing both epithelioid and sarcomatoid components even if the amount of one component is less than 10%; and 9) The most frequently altered genes in diffuse pleural mesothelioma include BAP 1, CDKN2A, NF2, TP53, SETD2 and SETB1.
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Affiliation(s)
- Jennifer L Sauter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, United States.
| | - Sanja Dacic
- Department of Pathology University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States
| | - Francoise Galateau-Salle
- MESOPATH Centre Leon Berard, Lyon, France, Unit of Cancer Research Center INSERM U1052-CNRS5286R, Lyon France
| | - Richard L Attanoos
- Department of Cellular Pathology, University Hospital of Wales and School of Medicine, Cardiff University, Wales, United Kingdom
| | - Kelly J Butnor
- Department of Pathology & Laboratory Medicine, The University of Vermont Medical Center, Burlington, Vermont, United States
| | - Andrew Churg
- Dept of Pathology, Vancouver General Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Aliya N Husain
- Department of Pathology, University of Chicago, Chicago, Illinois, United States
| | - Kyuichi Kadota
- Department of Pathology, Faculty of Medicine, Shimane University
| | - Andras Khoor
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida, United States
| | - Andrew G Nicholson
- Royal Brompton and Harefield Hospitals, and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Victor Roggli
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, United States
| | - Fernando Schmitt
- RISE@Cintesis, Medical Faculty of Porto University, Porto, Portugal; Unit of Molecular Pathology of IPATIMUP, Porto, Portugal
| | - Ming-Sound Tsao
- Department of Pathology, University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, United States
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