The 2015 World Health Organization Classification of Tumors of the Pleura: Advances since the 2004 Classification Francoise Galateau-Salle, MD, Andrew.

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Presentation transcript:

The 2015 World Health Organization Classification of Tumors of the Pleura: Advances since the 2004 Classification Francoise Galateau-Salle, MD, Andrew Churg, MD, Victor Roggli, MD, William D. Travis, MD Journal of Thoracic Oncology Volume 11, Issue 2, Pages 142-154 (February 2016) DOI: 10.1016/j.jtho.2015.11.005 Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

Figure 1 Diffuse malignant mesothelioma, epithelioid type. (A) The pleomorphic pattern consists of large atypical and multinucleated tumor cells, some with prominent nucleoli. (B) The solid pattern, with sheets of epithelioid tumor cells. (C) The micropapillary pattern, with a nest of tumor cells growing in papillae lacking fibrovascular cores. (Reprinted from Travis et al.1, with permission from Dr. William D. Travis.) (D) Staining with calretinin shows positive nuclear and cytoplasmic reactivity. (Reprinted from Travis et al.1, with permission from Dr. Francoise Galateau-Salle.) Journal of Thoracic Oncology 2016 11, 142-154DOI: (10.1016/j.jtho.2015.11.005) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

Figure 2 Organizing pleuritis. (A) The pleural cavity is on the left, and the chest wall fat (not sampled) would appear on the right. The biopsy specimen reveals zonation—that is, it is more cellular adjacent to the pleural cavity and less cellular away from the pleural cavity. In addition, there is layering of mesothelial cells immediately adjacent to the pleural space; this is a sign of a benign process. This particular example shows fake fat located deep in the pleura near the junction with the chest wall; note the characteristic pattern of fat-like spaces parallel to the pleura surface (right). (B) Keratin staining of an area of fake fat from another case. Keratin-positive mesothelial cells run between the spaces (highlighted by arrows), suggesting the invasion of fat. However, all of the mesothelial cells are aligned parallel to the pleural surface and do not invade down (i.e., away from the pleural surface), the diagnostic finding that would be seen in desmoplastic mesothelioma. Journal of Thoracic Oncology 2016 11, 142-154DOI: (10.1016/j.jtho.2015.11.005) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

Figure 3 Diffuse malignant mesothelioma, sarcomatoid type with heterologous elements. (A) Malignant bone and cartilage represent osteosarcomatous and chrondrosarcomatous differentiation in this malignant mesothelioma. (B) Rhabdomyosarcomatous differentiation in this mesothelioma shows highly atypical tumor cell cytology with prominent epithelioid cytoplasm, suggesting rhabdomyoblasts. (C) Immunohistochemistry of the tumor in part B shows positive staining for myogenin, confirming rhabdomyosarcomatous differentiation. (B and C, Reprinted from Travis et al.1, with permission from Dr. William D. Travis.) Journal of Thoracic Oncology 2016 11, 142-154DOI: (10.1016/j.jtho.2015.11.005) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

Figure 4 Well differentiated papillary mesothelioma. (A) This tumor consists of exophytic surface growth on the pleural surface, consisting of papillary fronds with broad fibrovascular cores. No downward invasive growth was seen. (Reprinted from Travis et al.1, with permission from Dr. Francoise Galateau-Salle.) (B) These papillae have broad fibrovascular cores with a myxoid stroma. The surface of the papillae is lined by cuboidal mesothelial cells with bland cytology. Journal of Thoracic Oncology 2016 11, 142-154DOI: (10.1016/j.jtho.2015.11.005) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

Figure 5 Utility of p16 fluorescence in situ hybridization (FISH) to separate benign from malignant mesothelial proliferations. This patient was thought to have a mesothelioma, but the biopsy specimen was equivocal with vague stromal nodules (marked with an asterisk), suggestive of a desmoplastic mesothelioma. FISH (inset) reveals a complete loss of red p16 signals, indicating that the process is in fact malignant. Green signals represent centromere 9. Journal of Thoracic Oncology 2016 11, 142-154DOI: (10.1016/j.jtho.2015.11.005) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

Figure 6 BRCA1-associated protein 1 (BAP1) immunostaining in mesothelioma. These examples of mesotheliomas show the (A) retention and (B) loss of BAP1 from a tissue microarray. Arrows point out positive stromal cells and lymphocytes that serve as internal staining controls. Journal of Thoracic Oncology 2016 11, 142-154DOI: (10.1016/j.jtho.2015.11.005) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

Figure 7 Solitary fibrous tumor. (A) This neoplasm consists of spindle cells in a storiform pattern with a stroma showing prominent ropy collagen. (B) Immunohistochemistry for STAT6 shows diffuse strong nuclear staining. Journal of Thoracic Oncology 2016 11, 142-154DOI: (10.1016/j.jtho.2015.11.005) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

Figure 8 Epithelioid hemangioendothelioma. (A) The pleura is markedly thickened and infiltrated by a cellular neoplasm. There is extensive infiltration of parietal pleural fat. (B) The tumor has a hyaline stroma infiltrated by cytologically bland epithelioid cells with some intracytoplasmic lumens (center). (C) CD31 shows diffuse strong staining. (D and E) Fluorescence in situ hybridization analysis using custom BAC probes shows break-apart signals (arrows in CAMTA1 [D] and WWTR1 [E]). Red, centromeric; green, telomeric. (D and E, Courtesy of Dr. Cristina Antonescu.) Journal of Thoracic Oncology 2016 11, 142-154DOI: (10.1016/j.jtho.2015.11.005) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions

Figure 9 Desmoid tumor. (A) This tumor consists of bland spindle cells with sharply tapered nuclei growing within a fibrous stroma. (B) Immunohistochemistry for β-catenin shows positive nuclear staining. Journal of Thoracic Oncology 2016 11, 142-154DOI: (10.1016/j.jtho.2015.11.005) Copyright © 2015 International Association for the Study of Lung Cancer Terms and Conditions