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 (ii) Severity (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.

Special stains:

- 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.