Cardiac Path Online
Histopathology reporting of the Specimens of Pericardium
Specimens of pericardium includes full thickness biopsies, pericardiectomy specimens for tuberculosis,
sarcoidosis and other inflammatory conditions, and excisions for
rare neoplasms such as teratoma and mesothelioma.
The diagnosis of malignant mesothelioma should be made with caution because it is a rare lesion and reactive mesothelial proliferation can be very florid in inflammatory conditions of the pericardium.
Clinical details of the patient:
Age and sex of the patient ; Presenting features and their duration ; History of exposure to asbestos, previous or current tuberculosis, sarcoidosis, systemic malignancy, uraemia, collagen vascular disease;
History of previous surgery, trauma, radiotherapy ;
Investigation : Radiological features and diagnosis , results of microbiological investigations and tuberculin test if relevant.
The pathologist should comment on the following features in the histopathology report:
- Mesothelial proliferation and hyperplasia : Which in severe cases can be mistaken for neoplasia ;
- Inflammation :
(i) Nature: acute, purulent, fibrinous, chronic non- specific, granulomatous, eosinophilic.
(iii) whether organisms are found ;
- Fibrosis : With or without calcification ;
- Neoplasia :
- Primary : Mesothelioma, whether monophasic or biphasic;
- Metastatic : Usually from carcinoma of breast and lung, and less commonly melanoma and lymphoma.
- van-Gieson for fibrosis;
- Mucin stain in cases of suspected mesothelioma, metastatic adenocarcinoma ;
- Stains for organisms as appropriate (Ziehl-Neelsen, Gram, PAS, Grocott )
- Immunostains to distinguish mesothelioma from metastatic adenocarcinoma.
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