Series Overview v
Contributors ix
Preface xi
SECTION I. Epidemiologic, Clinical, and Radiologic Features 1 The Diagnosis of Mesothelioma

Timothy Craig Allen and Richard L. Attanoos 2 WHO Classification

Richard L. Attanoos 3 Staging

Jason Lester 4 Imaging

Jason Lester
5 Non–Asbestos-Related Diffuse Malignant Mesothelioma

Allen R. Gibbs and Richard L. Attanoos
6 Spontaneous/Idiopathic Diffuse Malignant Mesothelioma

Allen R. Gibbs
7 SV40 Virus, Vaccines, and Disease

Richard L. Attanoos
8 Medicolegal Considerations

Timothy Craig Allen and Richard L. Attanoos SECTION II. Histopathology
9 Approach to the Serosal Biopsy

Richard L. Attanoos
10 Morphologic Variants and Their Mimics

Richard L. Attanoos and Allen R. Gibbs
11 Mucin Histochemistry and Electron Microscopy

Richard L. Attanoos
12 Immunohistochemistry

Richard L. Attanoos
13 Atypical Mesothelial Proliferations

Timothy Craig Allen
SECTION III. Molecular Features 14 Molecular Mechanisms of Pathogenesis

15 Molecular Prognostic Markers

Jason Lester
16 Targeted Gene Therapy

Jason Lester
17 Immunotherapy

Jason Lester
18 Molecular Diagnostics

Richard L. Attanoos
19 Cancer Stem Cells

Timothy Craig Allen Index 185

diffuse malignant mesothelioma’s wide variety of histologic appearances are mimicked not only by other primary and metastatic neoplasms, but also very common reactive conditions involving the serosal surfaces can be so histologically robust as to mimic diffuse malignant mesothelioma as well. The diagnosis of diffuse malignant mesothelioma is therefore fre- quently far from straightforward.
In addition, given the dismal outcome of almost all patients with diffuse malignant mesothelioma, as well as the dearth of successful therapeutic options, the diagnosis of diffuse malignant mesothelioma, once rendered, carries with it enormous prognostic weight. Legal considerations add another level of complexity, and they often arise as soon as the diagnosis of diffuse malignant mesothelioma is clinically considered, much less pathologically ren- dered. Unfortunately, these legal considerations may intentionally or unintentionally influ- ence, or attempt to influence, the pathologist examining the case.
Even as the incidence and mortality of diffuse malignant mesothelioma are expected to increase, desperately needed molecular-based therapies that have shown benefit in patients with cancers such as breast and lung have yet to provide any therapeutic benefit in patients with diffuse malignant mesothelioma. Nonetheless, researchers are carefully studying the molecular mechanisms involved in asbestos-caused diffuse malignant mesothelioma in an attempt to identify molecular diagnostic, prognostic, and therapeutic biomarkers for which new, promising therapies may be based.
Also, besides diffuse malignant mesothelioma, there are other, even rarer, mesotheliomas which have not been shown to be caused by asbestos exposure, and which have differing prognoses and treatments. It is imperative that these be accurately diagnosed as well.
This book is meant to address the diagnostic aspects of mesothelioma as well as the ongoing molecular research surrounding diffuse malignant mesothelioma. It is meant to assist the pathologist in diagnosing diffuse malignant mesothelioma and other mesothelio- mas, as well as to differentiate the much more common lesions that mimic diffuse malig- nant mesothelioma, with particular attention to reactive mesothelial hyperplasia and fibrous pleuritis.
The editors wish to gratefully acknowledge our esteemed predecessors and colleagues whose expertise in mesothelioma has added much to our understanding of this devastating disease.
Richard L. Attanoos, MBBS, FRCPath Timothy Craig Allen, MD, JD