A 60-year-old asbestos-exposed shipyard worker develops a pleural mass. Biopsy shows spindle and epithelioid cells with tubulopapillary architecture; IHC is positive for calretinin, WT-1, and D2-40, and negative for CEA and TTF-1. The diagnosis is:

• A Metastatic adenocarcinoma to the pleura
• B Solitary fibrous tumor of pleura
• C Synovial sarcoma
• D Malignant mesothelioma ✓

Explanation

Malignant pleural mesothelioma is strongly associated with asbestos exposure (often with a 30–40 year latency). The IHC panel — positive calretinin, WT-1, and D2-40 (podoplanin) with negative CEA and TTF-1 — confirms mesothelial rather than carcinomatous origin. The biphasic (epithelioid + sarcomatoid) or purely epithelioid pattern and the pleural location in an asbestos-exposed individual are characteristic.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.