Qap (Anatomical Pathology) 

QAP Peer Review

AP146
Case History: M/26,persistent ascites. Laparoscopy showed multiple peritoneal nodules.
Intended diagnosis: Malignant mesothelioma with deciduoid features. Contributed by:MST
Code Diagnosis Comment Score
anonymous Malignant Mesothelioma (90%) Metastatic carcinoma (10%) Immunostain for mesothelial marker (eg. Calretinin) and true epithelial marker (eg. BerEP4 and monoclonal CEA) +/- electron microscopic examination is advised.  100
anonymous Malignant tumour (100%), favour mesothelioma. Differential diagnoses are poorly differentiated carcinoma, germ cell tumour. Immunohistochemical study for confirmation. Mesothelioma is positive for calretinin, negative for BerEP4, MOC-31 and CEA. Germ cell tumour may be positive for AFP, PLAP.  100
anonymous Mesothelioma. 90% Adenocarcinoma. 10% Perform a panel of immuohistochemical stains and EM to reach a conclusive diagnosis. Clinical history of asbestoes exposure relevant.  95
anonymous Malignant tumor, favor malignant mesothelioma (90%)Ddx carcinoma (5%), melanoma (5%) Immunostaining for CK5/6, calretinin (+ in mesothelioma), BerEP4, MOC31 (+ in carcinoma, - in mesothelioma & melanoma) and S100 (+ in melanoma)  100
anonymous Malignant mesothelioma with deciduoid features. 100 % nil  100
anonymous Malignant mesothelioma. (100%) nil  100
anonymous Peritoneum nodules - Malignant mesothelioma (100%) Tumour cells are almost exclusively epithelioid and deciduoid. Immunostains calretinin, CK5/6(+ve) and BerEP4 (-ve) can help to confirm the diagnosis.  100
anonymous Malignant mesothelioma, 90% Metastatic adenocarcinoma, 10% Need to confirm the mesothelial nature by calretinin immunohistochemically or/and electon microscopy to look for the presence of very long microvilli with length/width > 10/1. If negative, try to establish the primary source by cytokeratin profile (CK7 and CK20).  100
anonymous Malignant mesothelioma 70% metastatic carcinoma 30% Suggest immunohistochemical staining for calretinin, Ber-EP4, CEA to confirm the diagnosis.  100
anonymous Malignant neoplasm, favor mesothelioma. (100%) To be confirmed by immunohistochemical and ultrastructural studies. Differential diagnoses include other types of malignant tumors like metastatic carcinoma, sarcoma and melanoma etc.  95
anonymous Malignant mesothelioma, epithelial type (100%) nil  100
anonymous Favour mesothelioma. Confirm with calretinin (+ve) and Ber-EP4 (-ve), also exclude hepatoid tumor, e.g. carcinoma of liver, stomach and germ cell tumor. Probability: 100% nil  100
anonymous Favour mesothelioma. Confirm with calretinin (+ve) and Ber-EP4 (-ve), also exclude hepatoid tumor, e.g. carcinoma of liver, stomach and germ cell tumor. Probability: 100% Probability: 100% nil  100
anonymous Malignant tumour (100%); differential diagnoses include mesothelioma (80%), metastatic carcinoma (15%) and metastatic melanoma (5%). Perform panel of immunostains including: CK5/6, calretinin and HBME-1 for mesothelioma; cytokeratin, CEA, BerEP4 and LeuM1 for carcinoma; and HMB45 for melanoma. Ultrastructural studies for microvilli as in mesothelioma.  100
anonymous Deciduoid mesothelioma panel of mesothelial and carcinoma marker will be performed which incl EMA, CK5/6, thromobomodulin , calretinin for mesothelioma and EP4, AUA1 and CEA for carcinoma.  100
anonymous Mesothelioma nil  100