Mesothelioma Cells

Fact Checked

There are three main mesothelioma cells types that characterize how tumors form. Epithelioid cells are the most common and make up 50 percent of all mesothelioma cases. Sarcomatoid cells are more aggressive and represent only 10 percent of cases. If epithelioid and sarcomatoid cells are present, mesothelioma is considered biphasic.

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Dr. Fontaine explains how the mesothelioma cell type affects a patient's treatment options.
Dr. Fontaine explains how the mesothelioma cell type affects a patient's treatment options.

What Is Mesothelioma Histology?

Histology is a branch of biology that involves the study of cells and tissues.

Histology technicians use microscopes to view tissues and cells up close. They prepare samples of tissue with chemical stains. The stains make the cells’ features stand out to help with identification.

Mesothelioma histology involves the study of cancerous mesothelial cells. It is considered a branch of histopathology, the study of diseased cells. Histopathology falls within the larger field of pathology.

It takes special training to identify cancer cells. Board-certified pathologists often become specialized in identifying different types of cancer. A small number of pathologists specialize in identifying mesothelioma cells.

Facts About Mesothelioma Cells

  • Tumors are classified into three main cell types
  • Epithelial cells are more common and easier to treat
  • Sarcomatoid cells are rare and harder to treat
  • Doctors identify the cell type by studying tissue samples of the cancer

There are several types of mesothelioma cancer cells. Each cell type responds to treatment differently and affects the individual patient’s prognosis.

Accurate mesothelioma testing of the cell type is essential to developing an effective treatment plan.

Histology also helps prevent mesothelioma misdiagnosis. For example, peritoneal mesothelioma and ovarian cancer can be difficult to differentiate. Analyzing the cell type helps doctors tell the difference.

Cell Types of Malignant Mesothelioma

Pathologists look for three different types of cells when mesothelioma is suspected. These cell types are called epithelial, sarcomatoid and biphasic.

Epithelial Mesothelioma Cells

Epithelial Cells

Epithelial cells are uniform and sharply defined. They feature prominent nuclei and often form complex branching patterns. They divide quickly but tend to stick together, which means it takes longer for them to spread throughout the body. This cell type makes up 50 percent of all mesothelioma cases.

Sarcomatoid Meosthelioma Cells

Sarcomatoid Cells

Spindle-shaped sarcomatoid cells typically lack strong characteristics. They spread more easily than epithelial cells because they don’t stick together the way epithelial cells do. This rare cell type characterizes 10 percent of cases.

Biphasic Mesothelioma Cells

Biphasic Cells

Malignant mesothelioma is considered biphasic when both epithelial and sarcomatoid cells are present. Each type accounts for at least 10 percent of the tumor mass. The biphasic (mixed) cell type accounts for 30 to 40 percent of mesothelioma cases.

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Each cell type has different visible characteristics. For example, sarcomatoid cells have elongated nuclei. Epithelial cells have microvilli (microscopic protrusions of a cell) or cell organelles.

Doctors use these histological classifications to confirm the diagnosis. Along with staging information, they can later develop a prognosis and treatment plan.

Each cell type responds differently to treatment.

  • Epithelial cells are typically the most responsive to treatment, which often leads to a better prognosis.
  • Sarcomatoid cells are the least responsive to treatment. Some mesothelioma specialists do not consider sarcomatoid tumors eligible for surgical removal.
  • The biphasic cell type is also considered less responsive to treatment than the epithelial cell type. But, the exact prognosis depends on the ratio of epithelial cells to sarcomatoid cells.

The appearance of the different cell types is subtle. This fact can make the diagnostic process quite challenging. For example, distinguishing mesothelioma cells from adenocarcinoma cells can be a serious challenge. Only the most experienced mesothelioma pathologists can easily tell the difference.

Dr. David Sugarbaker explains the three mesothelioma cell types: Epithelial, Sarcomatoid and Biphasic.

Rare Variances in Histological Mesothelioma Types

In this variant of epithelial mesothelioma the cells line small, gland-like structures. This type is also called glandular or microglandular mesothelioma.
Benign mesothelioma is not cancerous and is not the result of asbestos exposure.
This type has smooth, thin-walled cysts held together by fragile fibrovascular tissue. It is a subtype of epithelial mesothelioma.
This variant of epithelial mesothelioma has been diagnosed in just a few dozen cases. Some doctors suspect it may be caused by a hormonal imbalance.
In this form of sarcomatoid mesothelioma, more than 50 percent of the tumor is made up of dense, fibrous tissue.
This type contains bodily tissues different from the tissues in which they form.
This subtype of sarcomatoid mesothelioma is often misdiagnosed. It is made up of a dense bundle of inflammatory and immune cells.
This variant of epithelial mesothelioma resembles healthy cells that grow and multiply at a slow rate. It does not typically spread to other parts of the body.
Small Cell
Occurs when a large proportion of a mesothelioma tumor is made up of small cells that grow in a pattern similar to small-cell carcinoma.

The Histology Process

It takes a team to diagnose mesothelioma. The team includes surgeons, histotechnicians, histopathologists and other professionals. They work together to provide the patient’s oncologist with information.

Histology Process

A surgeon removes a sample of tumor tissue through a biopsy procedure. The sample is prepared by a histotechnician. This scientist preserves and stains the sample with a number of special chemicals. These chemicals reveal the microscopic appearance of the cells.

The histotechnician works closely with a pathologist to identify a cancer’s cell type.

How Histotechnicians Prepare a Tissue Sample for Staining

1. Fixing
The tissue is preserved with a chemical such as formaldehyde.
2. Embedding
The tissue is embedded in a block of paraffin or plastic resin to make the material easy to cut.
3. Sectioning
A machine called a microtome slices extremely thin pieces of the sample.
4. Mounting
The slices of embedded tissue are smoothed out in a water bath and then placed on slides and baked.
Quick Fact:

“Frozen section fixation” is used to diagnose cancer during surgery. A surgically removed tumor is quickly frozen while the patient is still in surgery. A slice of the frozen tissue is then stained and placed on a slide for a rapid assessment by a pathologist to determine if a tumor is malignant.

After the cancerous tissue is mounted and stained on a slide, the sample is now ready to view under a microscope. They observe the size, shape and anatomical structure of the cells to identify the tumor’s cell type.

Other techniques are used by pathologists to learn more about cells. These techniques include in situ hybridization and immunohistochemistry.

In situ hybridization uses fluorescent or radioactive probes to bind DNA and RNA. Using this method, scientists can analyze the genes of a cell. They can also detect genetic abnormalities.

Immunohistochemistry is based on the principle that antibodies bind to specific antigens. Antibodies also bind to proteins called oncoproteins.

Different antibodies are applied to tissues on a microscope slide depending on what type of cancer is suspected. Visual patterns are created by the interaction of antibodies and oncoproteins. These patterns help pathologists diagnose mesothelioma.

Common Immunohistochemical Markers for Mesothelioma

  • Cytokeratin 5 and 6
  • Calretinin
  • WT-1 protein
  • Podoplanin (D2-40)

Immunohistochemistry is regularly used in the diagnosis of mesothelioma. This technique improves the accuracy of diagnosis when used in context with other diagnostic data.

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Registered Nurse and Patient Advocate

Karen Selby joined in 2009. She is a registered nurse with a background in oncology and thoracic surgery and was the regional director of a tissue bank before becoming a Patient Advocate at The Mesothelioma Center. Karen has assisted surgeons with thoracic surgeries such as lung resections, lung transplants, pneumonectomies, pleurectomies and wedge resections. She is also a member of the Academy of Oncology Nurse & Patient Navigators.

Walter Pacheco, Managing Editor at
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9 Cited Article Sources

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  6. Rice University Institute of Biosciences and Bioengineering. (2005, April 13). Histology and Immunohistochemistry. Retrieved from:
  7. Pass, H., Vogelzang, N., and Carbone, M. (2005). Malignant Mesothelioma: Advances in Pathogenesis, Diagnosis, and Transitional Therapies. New York: Springer.
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Last Modified July 9, 2019

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