Mesothelioma pathology is the study of a type of cancer related to asbestos exposure. Mesothelioma develops in the tissue lining around the lungs. Doctors use specific details in the pathology report of your tissue samples to determine a diagnosis and develop the right treatment plan for you.
Written by Dr. Daniel Landau, MD | Edited by Amy Edel | Last Update: August 21, 2025
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There are 2 main types of mesothelioma pathology tests: cytopathology and histopathology. Cytology studies cell samples from bodily fluids and secretions. Histology examines body tissue samples.
Cytology for mesothelioma is less invasive, quicker and often a less expensive test. However, it offers more limited information and less conclusive results.
How Pathologists Help Diagnose Mesothelioma
Learn about your diagnosis, top doctors and how to pay for treatment in our free mesothelioma guide.
Get Your GuideHistology for mesothelioma involves biopsies or samples collected during surgery. While these tests can be more invasive and expensive, they also provide more comprehensive and accurate information.
Mesothelioma cytology involves studying blood tests and taking samples of body fluids from the chest cavity. A sterile fine-needle aspiration is a minimally invasive procedure using a thin syringe to collect fluid and a skin-numbing medicine or topical anesthetic. This sterile procedure reduces the risk of infection.
The pleural cavity is the space between 2 layers of the pleura, or lining around the chest cavity. The fluid that cushions that space can contain cancer cells and other markers that suggest cancer is present. The fluid sample from the pleural space is taken from the side or back of your chest cavity to prevent injuring your lung.
Cytology for mesothelioma isn’t enough to diagnose the disease on its own. However, an experienced pathologist’s cytologic evaluation combined with imaging and/or blood testing can help with an initial diagnosis.
A tissue biopsy with histology testing remains the best way to confirm a mesothelioma diagnosis. Staining samples during histology allows pathologists to see markers that can help distinguish mesothelioma from other cancers.
Pathologists also use histology to identify the specific type of cell causing your mesothelioma. There are 3 cell types of mesothelioma: epithelioid, sarcomatoid and biphasic. These are classified based on how a tissue sample looks under the microscope. It’s important to identify which mesothelioma cell type you have because each responds to treatment differently.
“Most of the time, patients aren’t aware of their cell type and have to review their pathology report to find it,” Snehal Smart, M.D., Patient Advocate at The Mesothelioma Center shares. “I review the cell types with them and explain how this also helps the doctor determine the best treatment plan for them.”
After the mesothelioma pathology report is complete, the treatment plan can begin. Patients work closely with their doctors to select the therapies that offer the best chance for a positive outcome.
“What we know is that the pathology makes a difference in your expectations, from treatment,” says Dr. Tirrell Johnson, a medical oncologist at the University of Florida Health Cancer Center-Orlando Health. A mesothelioma treatment plan may include surgery, immunotherapy, chemo, radiation therapy and supportive care.
Epithelioid mesothelioma is usually treated with a combination or multimodal treatments, often involving surgery. This cell type typically responds better to chemo than others. Sarcomatoid mesothelioma can be treated with several options, but surgery is less common because it tends to come back quickly. Biphasic mesothelioma contains both epithelioid and sarcomatoid types. Treatment depends on which cell type is most dominant and where the disease is found.
Jim McWhorter
Navy Veteran Pursues Mesothelioma Immunotherapy Trials
After an initial misdiagnosis from multiple doctors, Jim McWhorter and his wife, Pam, then saw his CT scan notes had said, “suspect for mesothelioma.” He was finally able to have a pathologist study his tumor samples and confirm a diagnosis of epithelioid pleural mesothelioma. This allowed him to pursue the best treatment plan for him.
Your mesothelioma pathology report describes the results from your sample. For people with mesothelioma, the specimen description section of the pathology report will include details about cell type and markers identified with special staining.
Markers of mesothelioma are antigens, which are proteins that immune cells make in response to foreign substances invading the body, signaling that “this cell doesn’t belong here.” Having these details noted in your pathology report helps your doctor confirm your diagnosis.
Elements of Your Pathology Report
The pathologist will send his written report to your doctor. You can request to receive your mesothelioma pathology report from your doctor.
Patient Advocate Danielle DiPietro notes, “When speaking with people about their mesothelioma diagnosis and they don’t know their cell type, for example, I explain that it can be found on their pathology report.” Finding these details in your pathology report can help empower you when speaking with your doctor and making decisions about your treatment plan.
Learn about your diagnosis, top doctors and how to pay for treatment in our updated 2025 guide.
Get Your Free GuideYour pathology report is a key tool to help guide discussions about treatment options. If you receive the report before your doctor appointment, take time to review it carefully and write down any questions or concerns. Being prepared will help you have a more productive conversation with your doctor about your diagnosis and next steps.
What to Do Next
In addition to these steps, talk with a Patient Advocate or your doctor to explore clinical trial options. As of July 2025, there are 47 ongoing and 100 recruiting clinical trials for mesothelioma treatment in the United States. Participating in a trial can provide access to promising new therapies and potentially ease some medical expenses.
If managing your diagnosis feels overwhelming at any point, remember that you are not alone. Your health care team and Patient Advocates are available to answer questions, provide support and help connect you with mesothelioma specialists and cancer centers for second opinions and tailored treatment plans.
Mesothelioma pathology is the study of tissue samples from people with a type of malignant cancer, or cancer with uncontrolled cell growth. When imaging or blood tests suggest someone may have mesothelioma, doctors order a biopsy to collect cells, pieces of a tumor or both for a special examination. The experts who perform this examination and testing are called pathologists.
Pathologists examine the sample under a microscope and perform special tests for mesothelioma diagnosis. Doctors then use the pathology results to accurately confirm a diagnosis.
Pathology allows doctors and scientists to better understand how mesothelioma develops and spreads, which can lead to improved treatment.
Your doctor will use the details from your individual mesothelioma pathology report to determine the right treatment plan for you. This will account for factors such as the particular mesothelioma cells in your sample and how those cells respond to different therapies.
What are the primary cell types of mesothelioma and how do they impact a patients prognosis?
[MUSIC PLAYING] The two main cell types, meaning the types of cells the mesothelium could be made up of, when we look at it under the microscope, are epithelial and sarcomatoid. And these are jargon-like terms, but they become important in terms of the prognosis of the patient and how we treat the disease. So the epithelial cell type is a little more common, and the patients with that disease have a better prognosis. The sarcomatoid cell type is a little more difficult to treat, and that disease behaves a little differently. It tends to progress locally, meaning it doesn’t tend to metastasize or go to other places, but it can go through the chest wall and cause pain or go under the diaphragm and affect the abdomen. Now if somebody has more than 90% of either of those cell types, we consider their disease that cell type. If they have more than 10% of both, we call it mixed or biphasic. And generally speaking, we tend to divide groups when we look at information about patients with mesothelioma as epithelial and non-epithelial, with the non-epithelial including sarcomatoid, mixed subtype, and a few other very rare ones. Even though patients with non-epithelial disease do have, overall, a worse prognosis, that doesn’t impair long-term survival. I published a paper about 11 years ago showing that patients with non-epithelial disease can still live three years or more. People shouldn’t take the prognosis associated with their cell type as a hard and fast rule about how long they’re going to live. [MUSIC PLAYING]
Mesothelioma pathology, if caught in an early stage, can identify malignant mesothelioma. Early detection of the disease found in body tissue can influence a patient’s prognosis or the best outcome after treatment. The more accurate the pathology results, the better a treatment plan can be created.
Yes. If a patient has a known asbestos exposure history, they can talk to their doctor about the importance of finding a pathologist with experience in mesothelioma. There are several pathologists across the U.S. who practice this specialty. A Patient Advocate can also work with you to help you find a pathologist with mesothelioma experience.
Speak with a Patient Advocate about getting second opinions for pathology and treatment options. They can assist with finding a consultant pathology doctor in your area for more clarity of the pathology report.
Patient Advocates have the knowledge to help guide you through reading your report. They can also suggest questions to ask your doctor or mesothelioma specialist. Understanding your specific pathology report can help allow you to actively be part of developing your treatment plan with your doctor.
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Asbestos.com. (2025, August 21). Mesothelioma Pathology. Retrieved December 9, 2025, from https://www.asbestos.com/mesothelioma/diagnosis/pathology/
"Mesothelioma Pathology." Asbestos.com, 21 Aug 2025, https://www.asbestos.com/mesothelioma/diagnosis/pathology/.
Asbestos.com. "Mesothelioma Pathology." Last modified August 21, 2025. https://www.asbestos.com/mesothelioma/diagnosis/pathology/.
Dr. Landau is the Medical Director of Virtual Hematology at the Medical University of South Carolina, where he leads programs that expand access to cancer care through telehealth. With more than 18 years of experience in oncology and hematology, he specializes in hematologic and genitourinary cancers, including bladder, prostate and kidney cancers. He has held multiple leadership roles in cancer program development and previously served as section chief of hematology and oncology at Orlando Health UF Health Cancer Center, where he founded its telehealth program.
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