Mixed Deck — All Mesothelioma Diagnosis Topics Flashcards
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Read the first 20 Mixed Deck — All Mesothelioma Diagnosis Topics flashcards as text
Which mesothelial lesion is classified as a precursor to mesothelioma and shows malignant cells confined to the mesothelial surface?
Answer: Mesothelioma in situ
Mesothelioma in situ (MIS) is a newly recognized WHO entity where malignant mesothelial cells are confined to the surface without stromal invasion, detected by BAP1 loss or CDKN2A deletion.
In the US, approximately how many new mesothelioma cases are diagnosed each year?
Answer: About 3,000
Approximately 3,000 new mesothelioma cases are diagnosed annually in the United States.
Which IHC marker is typically negative in mesothelioma but positive in metastatic breast carcinoma to the pleura?
Answer: GATA3
GATA3 is expressed in breast and urothelial carcinoma but is absent in mesothelioma, making it useful in distinguishing pleural metastases from primary mesothelioma.
What does an elevated serum CRP (C-reactive protein) indicate in the context of mesothelioma?
Answer: Active systemic inflammation associated with worse prognosis
Elevated CRP reflects tumor-driven systemic inflammation in mesothelioma and is an independent predictor of poor prognosis.
CT scan of the chest in pleural mesothelioma most characteristically shows which finding?
Answer: Circumferential pleural thickening
CT imaging typically reveals circumferential or nodular pleural thickening, often encasing the lung, which is highly characteristic of malignant pleural mesothelioma.
FISH (fluorescence in situ hybridization) for CDKN2A (p16) deletion is used in mesothelioma pathology to:
Answer: Distinguish malignant mesothelioma from benign mesothelial hyperplasia
Homozygous deletion of CDKN2A detected by FISH is a reliable molecular marker of malignancy in mesothelioma, distinguishing it from benign reactive proliferations.
What is the role of next-generation sequencing (NGS) in mesothelioma diagnosis?
Answer: Identifying actionable mutations and confirming malignancy
NGS identifies somatic mutations (e.g., BAP1, NF2, CDKN2A) that confirm malignancy and may reveal targetable alterations for clinical trials.
Immunohistochemistry (IHC) is essential in mesothelioma pathology primarily to:
Answer: Distinguish mesothelioma from adenocarcinoma
IHC panels are used to differentiate mesothelioma from metastatic adenocarcinoma, which can be morphologically identical on routine staining.
Serum SMRP testing has FDA approval as an aid for which clinical purpose in mesothelioma?
Answer: Monitoring previously diagnosed mesothelioma patients
The FDA approved SMRP (Mesomark assay) as an aid for monitoring patients with epithelioid or biphasic mesothelioma, not for primary diagnosis or screening.
MicroRNA-625-3p in pleural effusion has been studied as a mesothelioma biomarker because:
Answer: It is elevated in malignant effusions and may improve cytological diagnosis
MicroRNA-625-3p levels are elevated in pleural fluid from mesothelioma patients and may augment cytological diagnosis in indeterminate cases.
Megakaryocyte potentiating factor (MPF) is a biomarker for mesothelioma that is related to which protein?
Answer: Mesothelin
MPF is a precursor of mesothelin and is shed into the blood; it has been studied as a complementary biomarker alongside SMRP for mesothelioma detection.
In mesothelioma imaging, contralateral pleural disease or pericardial extension indicates which TNM stage?
Answer: Stage IV
Extension to contralateral pleura or pericardium indicates advanced T4 disease, placing the patient in Stage IV of the IMIG staging system.
Which inflammatory marker ratio is used as a prognostic tool in mesothelioma?
Answer: Neutrophil-to-lymphocyte ratio (NLR)
An elevated neutrophil-to-lymphocyte ratio (NLR) reflects systemic inflammation and immune suppression and is an independent prognostic marker in mesothelioma.
Which type of mesothelioma affects the lining of the lungs?
Answer: Pleural mesothelioma
Pleural mesothelioma arises from the pleura, the thin membrane surrounding the lungs, and is the most common form.
Which staging system is most widely used for malignant pleural mesothelioma in the US?
Answer: IMIG/IASLC TNM staging system
The IMIG/IASLC TNM-based staging system is the standard for malignant pleural mesothelioma, incorporated into the AJCC Cancer Staging Manual.
Electron microscopy in mesothelioma diagnosis is used to identify which ultrastructural feature?
Answer: Long, slender microvilli on tumor cell surface
Mesothelioma cells characteristically show long, slender microvilli on electron microscopy, in contrast to the short, stubby microvilli of adenocarcinoma.
Which CT finding helps differentiate malignant pleural mesothelioma from a benign pleural effusion?
Answer: Pleural nodularity and thickening >1 cm
Pleural nodularity and pleural thickening greater than 1 cm are CT features that strongly suggest malignancy rather than benign effusion.
Which gender is more commonly diagnosed with mesothelioma in the US?
Answer: Men
Men are diagnosed with mesothelioma far more often than women due to historical occupational asbestos exposure in male-dominated industries.
In peritoneal mesothelioma, which CT feature best predicts completeness of cytoreductive surgery?
Answer: Peritoneal cancer index (PCI) score
A low PCI score on preoperative CT predicts that complete cytoreduction is achievable, which is the strongest predictor of long-term survival.
Which imaging finding on CT is used to calculate the peritoneal cancer index (PCI) in peritoneal mesothelioma?
Answer: Distribution and size of peritoneal tumor deposits
The PCI is calculated by scoring the size and distribution of tumor deposits across 13 abdominal regions on CT to guide surgical planning.