Written By: Devin Golden

Mesothelioma Histology

Mesothelioma histology is a pathology process used to diagnose this rare and aggressive cancer. Doctors look at tissue samples under a microscope to determine if cells have mutated and formed into mesothelioma.

Karen Ritter, RN BSN

Medically Reviewed By

Karen Ritter, RN BSN

Registered Nurse

Karen Ritter, RN BSN

Medically Reviewed By

Karen Ritter, RN BSN

Registered Nurse


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What Is Mesothelioma Histology?

Mesothelioma histology, or mesothelioma histopathology, is the study of tissue for the presence of mesothelioma. This process is part of mesothelioma pathology, which involves examining either tissue or fluid to determine if this cancer exists.

The medical term “histology” refers to the microscopic study of tissue. “Histopathology” is the inspection of tissue for diseased cells. These two terms are interchangeable when referring to the process used for diagnosing mesothelioma.

The most notable characteristics of mesothelioma histology are:

  • Most definitive method to diagnose mesothelioma
  • More reliable than studying fluid samples (mesothelioma cytology)
  • Can be accomplished with a large or small incision
  • More invasive process needed than cytology
  • Larger number of cells to analyze compared to cytology


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How Is Mesothelioma Histology Performed?

Mesothelioma histology is one of the final steps in the diagnostic process. Histology starts with extracting tissue from the body during a mesothelioma biopsy.

Doctors remove tissue samples from patients due to:

  • Experiencing mesothelioma symptoms
  • Imaging tests showing signs of the cancer
  • Blood tests indicating mesothelioma

How Are Tissue Samples Collected?

Doctors collect tissue samples through biopsy procedures. One option is a surgical biopsy, which involves a large incision and possibly anesthesia. Due to improvements in medical technology and practices, most doctors use a camera-assisted needle biopsy. This method uses a smaller incision.

There are multiple types of mesothelioma biopsy procedures. The tissue biopsy you’ll undergo depends on where doctors believe your mesothelioma originated. The mesothelioma biopsies are:

Thoracotomy Icon

Thoracotomy - Involves opening the chest cavity and removing tissue from the thorax, specifically the pleura, to diagnose pleural mesothelioma

Laparotomy Icon

Laparotomy - Involves opening the abdominal cavity and removing tissue from the abdomen, specifically the peritoneum, to diagnose peritoneal mesothelioma

Thoracoscopy Icon

Thoracoscopy - A camera-assisted needle biopsy used to remove tissue from the pleura and diagnose pleural mesothelioma in a less-invasive manner than a thoracotomy

Laparoscopy Icon

Laparoscopy - A camera-assisted needle biopsy used to remove tissue from the peritoneum and diagnose peritoneal mesothelioma in a less-invasive manner than a laparotomy

Mediastinoscopy Icon

Mediastinoscopy - nvolves opening the chest to remove lymph-node tissue from the mediastinum, which is the small space between your lungs, if doctors believe tumors have spread there

After your doctor takes a tissue biopsy, they’ll request a pathology report to declare a definitive mesothelioma diagnosis.

Pathology reports are the results of mesothelioma histology tests. These tests involve microscopic observation of the tissue samples. They are the most important and conclusive factor in determining a patient’s diagnosis.

How Do Doctors Test Tissue Samples?

After collecting the samples, pathologists study the tissue under a microscope to determine if mesothelioma is present. They’ll also examine the tissue for specific characteristics that reveal the mesothelioma cell type, among other traits.

In determining cell type, pathologists look for:

  • Cellular behavior
  • Cell size and shape
  • Cell nuclei
  • Cell pattern of the sample

Each cell type — epithelioid and sarcomatoid — has unique characteristics. Epithelioid mesothelioma cells are well-defined. They have a visible nuclei and clump together. They also grow quickly but metastasize slowly.

Sarcomatoid mesothelioma cells are less defined and tough to identify. They have an irregular shape and elongated structure. Sarcomatoid cells spread faster and don’t appear clumped together.

Immunohistochemistry in Mesothelioma Histology

Doctors test tissue samples to detect mesothelioma through the process of immunohistochemistry. This is an integral part of mesothelioma histology. This method can provide evidence of mesothelioma tumors that supplements the pathologist’s microscopic examination of the cells.

Immunohistochemistry requires immunohistochemical staining, which involves introducing a foreign substance to the tissue samples. The foreign substance is an antibody that reacts with mesothelioma cells. The reaction reveals the presence of cancer.

There isn’t one particular antibody that always presents a positive immunohistochemical stain for mesothelioma. Therefore, pathologists must conduct multiple tests with various antibodies.

Staining also helps pathologists determine which cell type comprises the patient’s disease. Some mesothelioma cell types respond to specific antibodies used in staining. The most common positive stains for pleural mesothelioma are:

  • Calretinin — Indicated in close to all cases of epithelioid mesothelioma
  • Cytokeratin 5 or 5/6 — Shown in between 75% and 100% of diagnoses
  • Wilms’ tumor-I antigen (WT1) — Expressed in between 70% and 95% of cases
  • Podoplanin (D2-40) — Exhibited in between 90% and 100% of diagnoses

Other positive stains used to detect sarcomatoid mesothelioma cells include AE1/AE3 and CAM5.2.

Mesothelioma Histology Accuracy and Seeking the Help of a Specialist

Mesothelioma histology is more trusted than cytology for diagnosing this disease. This fact is due to tissue samples being more reliable than fluid samples.

One study published on UpToDate compared the accuracy of tissue biopsies and fluid samples:

  • Camera-assisted tissue biopsies were 98% accurate in diagnosing mesothelioma.
  • Fluid biopsies were only 26% accurate in diagnosing mesothelioma.

Mesothelioma misdiagnosis is common due to this cancer being so aggressive and expressing symptoms common with other illnesses. Mesothelioma is also rare, and many pathologists do not have experience identifying mesothelioma cells under a microscope.

If you believe you may have mesothelioma, you should see a specialist. They work with pathologists who have experience detecting this cancer and performing mesothelioma histology. We can help you connect with some of the top mesothelioma specialists to begin the diagnostic process.

Sources & Author

  1. What Is Histopathology? VeryWellHealth. Retrieved from: https://www.verywellhealth.com/histopathology-2252152. Accessed: 05/06/2020.
  2. Tests for Malignant Mesothelioma. American Cancer Society. Retrieved from: https://www.cancer.org/cancer/malignant-mesothelioma/detection-diagnosis-staging/how-diagnosed.html. Accessed: 05/05/2020.
  3. Types of biopsies used to look for cancer. American Cancer Society. Retrieved from: https://www.cancer.org/treatment/understanding-your-diagnosis/tests/testing-biopsy-and-cytology-specimens-for-cancer/biopsy-types.html. Accessed: 05/05/2020.
  4. Diffuse Malignant Mesothelioma. Pathology Outlines. Retrieved from: http://www.pathologyoutlines.com/topic/pleuramesothelioma.html/. Accessed: 09/4/18.
  5. Guidelines for Pathologic Diagnosis of Malignant Mesothelioma. International Mesothelioma Interest Group. Retrieved from: https://www.archivesofpathology.org/doi/pdf/10.5858/arpa.2017-0124-RA. Accessed: 10/04/19.
  6. Presentation, initial evaluation, and prognosis of malignant pleural mesothelioma. UpToDate. Retrieved from: https://www.uptodate.com/contents/presentation-initial-evaluation-and-prognosis-of-malignant-pleural-mesothelioma?topicRef=4625&source=see_link. Accessed: 03/19/19.
  7. The immunohistochemical characterization of sarcomatoid malignant mesothelioma of the pleura. American Journal of Cancer Research. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3180102/. Accessed: 06/01/2020.
Devin Golden

About the Writer, Devin Golden

Devin Golden is a content writer for Mesothelioma Guide. He produces mesothelioma-related content on various mediums, including the Mesothelioma Guide website and social media channels. Devin's objective is to translate complex information regarding mesothelioma into informative, easily absorbable content to help patients and their loved ones.