This page is for pleural mesothelioma. For peritoneal mesothelioma, refer here.

Auto text: “Insert Pleura Biopsy” or “Insert Pleura Resection”


  1. Pleural specimens may come with or without lung.
  2. Weigh and measure in 3 dimensions.
  3. Measure volume (for pleura-only specimens): There is a graduated cylinder in the gross room, that can be filled with water to a designated volume. Submerge the specimen, and record the amount of water displacement.
  4. Photograph each case.
  5. Orient the specimen.  The requisition and/or specimen container often mention sutures and what site(s) they mark.
  6. Measure attached diaphragm and, if present, peritoneum attached to abdominal surface of diaphragm.
  7. Measure attached pericardium, if present.
  8. If lung is present, take bronchial/resection margin, vascular margins, and hilar lymph nodes.
  9. Ink as follows: pericardial surface – blue, abdominal surface of diaphragm – black, chest wall surface-violet.
  10. If lung is present, ink outer surface of lung another color and slice sagitally into ~3 slices. Take gross photographs of each slice. Print these out so that you can map where you take your sections.
  11. In all cases, measure thickness of pleura (range) and any discrete nodules (state maximum thickness measurement), and estimate what percent of pleura is involved (is the tumor a discrete focus or diffuse entity).
  12. If unfused, measure thickness of visceral and parietal pleura separately. If fused, measure thickness together.
  13. Measure thickness of pericardium and abdominal peritoneum, if present.
  14. Fix in formalin overnight.


  1. Describe tumor extent:
    • Involvement of parietal and visceral pleura.
    • Extension into or through diaphragm.
    • Extension into or through pericardium.
    • If lung is present,tracking of tumor down interlobar fissures and extension into lung parenchyma.
  2. If oriented, take sections of pleura where the tumor is closest to the:
    • Apex
    • Anterior surface
    • Posterior surface
    • Lateral surface
    • Medial surface
  3. Take sections of tumor (no more than a total of 20 cassettes per case) to show invasion into:
    • Pericardium
    • Diaphragm
    • Lung parenchyma
    • Bronchi
    • Mediastinal fat
    • Interlobar fissure
    • Chest wall soft tissue
    • Submit ALL lymph nodes
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