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Mesothelioma IHC — SCE Medical Oncology MCQ

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HardGI CancersMesothelioma IHCSCE Medical Oncology

A pleural biopsy shows a bland mesothelial proliferation in dense fibrosis. BAP1 nuclear staining is retained and MTAP expression is retained. Which pathology statement is most accurate?

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Correct answer: E — Retention does not exclude mesothelioma; loss of BAP1 or MTAP supports malignancy

Loss of BAP1 nuclear expression or demonstration of CDKN2A deletion, often supported by MTAP loss, strongly supports malignant mesothelial proliferation against a reactive process. Sensitivity is incomplete, so retention does not exclude mesothelioma. Morphological invasion and clinicopathological correlation remain decisive; exposure history alone is not diagnostic.

Reference: ASCO guideline: treatment of malignant pleural mesothelioma. https://pmc.ncbi.nlm.nih.gov/articles/PMC8058628/