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Pathological anatomy and molecular pathology
Michael Krismann1, Klaus-Michael Müller, Malgorzata Jaworska
1Institute of Pathology, University Clinic Bergmannsheil Bochum, Bürkle-de-la-Camp-Platz 1, D-44789, Germany. michael.krismann@ruhr-uni-bochum.de
Abstract:
The incidence of malignant mesotheliomas in Germany has increased since about the mid 1980s, and a further increase is expected until about 2020 due to the peak in asbestos processing in Germany between 1965 and 1980. About 90% of the mesotheliomas recorded in the files of the German Mesothelioma Registry in Bochum are asbestos-related and therefore possibly due to an occupational exposure. In 2003, 717 mesotheliomas were newly diagnosed at the German Mesothelioma Registry. Mesotheliomas are very heterogeneous in terms of histological appearances and of prognosis. At present, the diagnostic gold standard is conventional histology in combination with additional immunohistochemical analysis. We were not able to confirm a promising report that described telomerase reverse transcriptase catalytic subunit (TERT) for the differentiation between reactive and neoplastic mesothelial lesions, which can be extremely difficult. DNA cytometric analysis may also help differentiate between reactive and neoplastic mesothelial lesions. There are some characteristic patterns of chromosomal imbalances as detectable by comparative genomic hybridization (CGH), but at present, specific chromosomal or genetic defects that give rise to a mesothelioma are not known. A reliable pathological diagnosis is the basis for therapeutic, prognostic, and medicolegal consequences. In general, it can be achieved by thoracoscopic inspection with specifically directed biopsy. Furthermore, a description of the peculiarities of each mesothelioma by the pathologist might be the key to a more individual therapy in the future.
Insights
Malignant mesothelioma incidence is rising in Germany due to past asbestos exposure. Reliable diagnosis, crucial for treatment and legal matters, relies on histology, immunohistochemistry, and potentially DNA cytometry, as new markers like TERT showed limited diagnostic value.
Area of Science:
- Oncology
- Pathology
- Occupational Health
Background:
- Malignant mesothelioma incidence in Germany has risen since the mid-1980s, projected to peak around 2020.
- Approximately 90% of mesotheliomas are asbestos-related, often linked to occupational exposure during peak asbestos processing years (1965-1980).
- In 2003, the German Mesothelioma Registry diagnosed 717 new cases, highlighting the disease's public health impact.
Purpose of the Study:
- To evaluate diagnostic markers for malignant mesothelioma.
- To assess the utility of telomerase reverse transcriptase catalytic subunit (TERT) and DNA cytometry in differentiating neoplastic from reactive mesothelial lesions.
- To underscore the importance of accurate pathological diagnosis for patient management.
Main Methods:
- Review of cases from the German Mesothelioma Registry.
- Histopathological and immunohistochemical analysis, the current diagnostic gold standard.
- Investigation of telomerase reverse transcriptase catalytic subunit (TERT) expression.
- DNA cytometric analysis.
- Comparative genomic hybridization (CGH) for chromosomal abnormalities.
Main Results:
- The study could not confirm TERT as a reliable marker for differentiating reactive from neoplastic mesothelial lesions.
- DNA cytometry showed potential in distinguishing between reactive and neoplastic mesothelial lesions.
- Characteristic chromosomal imbalance patterns were observed via CGH, but specific causative genetic defects remain unknown.
- Conventional histology with immunohistochemistry remains the gold standard for diagnosis.
Conclusions:
- Accurate pathological diagnosis of mesothelioma is essential for guiding therapy, prognosis, and medicolegal assessments.
- While TERT was not found to be a definitive diagnostic marker, DNA cytometry and CGH offer potential adjunctive diagnostic tools.
- Thoracoscopic biopsy and detailed pathological descriptions are crucial for individualized patient treatment strategies.
