Mesothelioma Navy Mesothelioma Diagnosis & Treatment 4

Question 1

A Navy veteran's pleural biopsy shows cells staining positive for calretinin, WT-1, and CK5/6, but negative for TTF-1 and CEA. What is the most likely diagnosis?

Accepted Answer

Epithelioid mesothelioma

Answer

The immunoprofile (calretinin+, WT-1+, CK5/6+, TTF-1−, CEA−) is characteristic of epithelioid mesothelioma, not lung carcinoma.

Question 2

What does the term 'malignant pleural effusion' mean in the setting of mesothelioma?

Accepted Answer

Fluid in the pleural space containing malignant cells shed by the tumor

Answer

Malignant pleural effusion contains cancerous cells and is a common presenting feature of pleural mesothelioma, causing dyspnea and chest heaviness.

Question 3

Which genetic mutation, involving a tumor suppressor gene, is the most common somatic alteration found in mesothelioma?

Accepted Answer

BAP1 loss

Answer

BAP1 (BRCA1-associated protein 1) loss is the most frequently identified somatic alteration in mesothelioma and is also linked to hereditary predisposition.

Question 4

During a thoracentesis for mesothelioma diagnosis, the cytology returns 'atypical mesothelial cells.' What should the next diagnostic step typically be?

Accepted Answer

Proceed with image-guided or surgical pleural biopsy for definitive tissue diagnosis

Answer

Atypical cytology is insufficient for a definitive mesothelioma diagnosis; a tissue biopsy providing histologic architecture and immunohistochemistry is required.

Question 5

What is 'hemithoracic radiation' and when is it used in mesothelioma management?

Accepted Answer

High-dose radiation to one entire side of the chest, typically after EPP to reduce local recurrence

Answer

Hemithoracic radiation delivers high doses to the entire affected side of the chest and is used postoperatively after EPP as part of a multimodal approach.

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Mesothelioma Navy Mesothelioma Diagnosis & Treatment 4