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Differences Between Mesothelioma and Adenocarcinoma |
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Uploaded: 2007-08-18, Updated: 2007-08-18 |
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Mesothelioma |
Adenocarcinoma |
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Radiology Findings |
Diffuse nodular pleural thickening | Diffuse nodular pleural masses | |
| Often unilateral | Often bilateral | ||
| Nodular thickening of fissures | Intra-parenchymal lung nodules | ||
| Encasement, invasion of bone, decreased lung volume | Encasement unusual, but can occur | ||
| Can metastasize | Often associated with hilar adenopathy | ||
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Gross Features
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Yellow fluid, can be bloody |
Variable, may be bloody |
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| Viscous to gelatinous | Less thick or gelatinous | ||
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Patterns |
Continuum, morphologic kinship | Foreign cells or groups | |
| Larger, more complex groups, cell-in-cell, long chains | Less complex, smooth community borders | ||
| More irregular knobby, flower, papillary outlines | Glandular, acinar patterns | ||
| Often collagen cores | Rare collagen core | ||
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Cells |
Larger and more pleomorphic than benign cells | Columnar | |
| Relatively constant N/C ratio | Increased N/C ratio | ||
| Common multinucleated giant cells | Rare multinucleated giant cells | ||
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Border |
Often windows, blebs, lacy skirts (microvilli) | Unusual windows or microvilli | |
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Cytoplasm |
Denser center, paler and lacy edge | Delicate, homogenous, pale to foamy | |
| Two tone staining | Uniform staining | ||
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Vacuoles |
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| Location | Perinuclear | Periphery | Eccentric or random |
| Size/Shape | Small, uniform | Small, slightly variable | Large, marked variation or irregular |
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Content |
Lipid |
Glycogen |
Secretory epithelial mucin |
| Rare degenerative or mesenchymal mucin (HA) vacuoles | May form large balloon or signet ring vacuoles | ||
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Nucleus |
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| Location |
Central or paracentral |
Often eccentric | |
| Shape | Often less pleomorphic, not bizarre, binucleation | Often pleomorphic, occasionally bizarre | |
| Chromatin | Less hyperchromatic | More hyperchromatic | |
| Nuclear Membrane | Thick, irregular | Thick, irregular | |
| Nucleoli | Enlarged, multiple or macro-nucleoli | Prominent | |
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Background
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Combined epithelial and spindle cells | Not common | |
| Epithelial mucin not present | Epithelial mucin often present | ||
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Special Stains |
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| PAS, undigested | (+), abundant, peripheral, finely | May be (+), droplet, diffuse | |
| PAS, digested | Usually (-) | Often (+) | |
| Mucicarmine | Usually (-) | Often (+) | |
| Alcian Blue | Usually (+), but (-) after hyaluronidae digestion | Often (+) and remains (+) after hyaluronidae digestion | |
| Oil Red O | Fine, centrally located in most cases | Large, eccentric in 10% cases | |
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Electron Microscopy |
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| True Glands | No | Yes | |
| Intermediate Filaments | Abundant, peri-nuclear | Sparse | |
| Microvilli | Long, slender, bushy and branching | Short, blunt, stubby rootlets and terminal web | |
| Glycogen | Prominent | Unusual | |
| Epithelial Mucin | Not present | Common | |
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Immunostaining |
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| CEA | (-) | (+) | |
| Keratins | (+)HMW and LMW | (+) LMW | |
| Vimentin | (+) | (-) | |
| EMA | (+) | (+) | |
| CD15/Leu-M1 | (-) | (+) | |
| Secretory Component | (-) | (+) | |
| Calretinin | (+) | (-) | |
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Reference | |
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| Summarized by Zenggang Pan, MD, PhD | |