Introduction to Continuing Special Series

The following articles represent the next special section in a continuing series of special sections or special issues entitled “Insights and Controversies in Pathology.” Each special section consists of a group of articles providing the most current knowledge, recent advances, and areas of controversy for a subspeciality field in pathology.This special section focuses on serosal pathology. Françoise Galateau-Salle, MD, PhD, and Allen Gibbs, MBChB, FRCPath, served as guest editors and invited authors to submit their work focusing on different aspects of serosal pathology.Sisko Anttila, MD, PhD, focuses on “Epithelioid Lesions of the Serosa.” In her article, she reviews the epithelial/epithelioid lesions of the pleura, and discusses the differential diagnosis of epithelioid mesothelioma versus metastasis, including immunohistochemical markers. She also focuses on the more problematic area of malignant versus benign proliferations of the mesothelial cells. Finally, she discusses some of the rare epithelioid lesions of the pleura and peritoneum.Pier-Giacomo Betta, MD, and colleagues provide a comprehensive overview on “Immunohistochemistry and Molecular Diagnostics of Pleural Malignant Mesothelioma.” This article not only assists in selecting which protein markers to use in difficult mesothelioma cases in daily practice, but also provides some insight into genetics and proteomics of these malignant tumors.Despite the ban on asbestos in many countries, in others, such as India, asbestos exposure is still common in several places, especially in ship salvaging, such as in the port of Mumbai. And even in industrialized countries, the story seems to be never ending, as illustrated by the debate in Canada about reopening of asbestos mines.In the last decade an increase of mesothelioma cases appeared in our daily practice for which no asbestos exposure can be proven, creating new challenges in asbestos litigation. Bharat Jasani, PhD, MBChB, FRCPath, and Allen Gibbs, MBChB, FRCPath, provide us with new information about “Mesothelioma Not Associated With Asbestos Exposure.” This article assists in understanding what other mechanisms might underlie the development of these malignant tumors. In addition, this article highlights important information for the litigation setting.Although primary lymphoproliferative conditions of the pleura are uncommon, they usually give rise to many difficult diagnostic problems. The article by Richard Attanoos, MD, MBBS, FRCPath, sheds some light on these rarely seen entities and provides clues on how to properly diagnose them.Finally, Didier Jean, PhD, et al discuss “Molecular Changes in Mesothelioma With an Impact on Prognosis and Treatment.” Despite many investigations dealing with genetics, proteomics, and posttranslational modifications, we still have not identified targets for improved treatment of these malignancies, and only a few biomarkers have been introduced as prognostic factors. The authors have reviewed the current literature and provide an extensive overview of investigations in this field. Many of these studies are controversial. The major problem in most studies is that genetic alterations in mesotheliomas have not been investigated as driver versus bystander mutations/alterations. It is our hope that, in the near future, further investigations might identify driver genes, which subsequently might be targeted by new drugs. Recently, a gene (BAP1) has been identified in familial mesothelioma and in another investigation was also found in sporadic mesotheliomas. This might give rise to new hope in this deadly disease.

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