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Farkas et al. J Cancer Metastasis Treat 2022;8:37 Journal of Cancer
DOI: 10.20517/2394-4722.2022.89
Metastasis and Treatment

Review Open Access

Updates on the pathologic diagnosis and
classification of mesothelioma

Julia R. Farkas, Mark Sharobim, Jefree J. Schulte

Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI 53792, USA.
Correspondence to: Jefree J. Schulte, Department of Pathology and Laboratory Medicine, University of Wisconsin, 600 Highland
Ave, Madison, WI 53792, USA. E-mail: jschulte2@wisc.edu

How to cite this article: Farkas JR, Sharobim M, Schulte JJ. Updates on the pathologic diagnosis and classification of
mesothelioma. J Cancer Metastasis Treat 2022;8:37. https://dx.doi.org/10.20517/2394-4722.2022.89

Received: 19 Jul 2022 First Decision: 17 Aug 2022 Revised: 19 Aug 2022 Accepted: 26 Aug 2022 Published: 9 Sep 2022

Academic Editor: Robert Arthur Kratzke Copy Editor: Fangling Lan Production Editor: Fangling Lan

Abstract
Mesothelioma is a rare malignant tumor of the serosal membranes that can be challenging to diagnose, especially
on small biopsy specimens. There are updated guidelines on the diagnosis and classification of mesothelioma,
which incorporate advancements in understanding mesothelioma biology published in the literature over recent
years. This review will discuss marked developments and/or improvements that have been made, including: (1) to
the histologic classifications of mesothelioma; (2) the use of such classifications and nuclear grading in prognosis;
(3) the indispensability of ancillary studies in the diagnosis of mesothelioma; (4) the application of these pleural
based classifications and diagnostic schemes in peritoneal mesothelioma; and (5) the potential for diagnosis of
mesothelioma in situ.

Keywords: Mesothelioma, BRCA associated peptide 1 (BAP1), methylthioadenosine phosphorylase (MTAP),
nuclear grading, mesothelioma in situ

INTRODUCTION
Mesothelioma is a neoplasm that most commonly arises in the pleura, but can also be found in peritoneum,
pericardium, or tunica vaginalis of the testes . It is a rare tumor with an annual estimated incidence of
[1,2]
3000 cases per year in the United States; it affects men more than women [1,3,4] . All mesotheliomas are
clinically aggressive and carry a poor prognosis, with studies estimating a median survival of 9-29 months

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
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