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We present the case of a 74\u2010year\u2010old male who presented with clinical features of MPM but from whom pleural fluid and biopsies initially suggested benign pathology. He later developed diffuse bony metastases and re\u2010examination of pleural biopsies using modern immunohistochemistry and molecular testing revealed a diagnosis of sarcomatoid and desmoplastic MPM with heterologous osteosarcomatous differentiation. This case not only demonstrates the rare potential of skeletal metastasis of MPM, but also highlights the importance of recognizing the utility of modern diagnostic tests and their potential to prevent the need for unnecessary invasive procedures. To our knowledge this is the first description of this rare histological sub\u2010type presenting with skeletal metastases.<\/jats:p>","DOI":"10.1002\/rcr2.664","type":"journal-article","created":{"date-parts":[[2020,9,20]],"date-time":"2020-09-20T00:59:20Z","timestamp":1600563560000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A challenging diagnosis of malignant mesothelioma with osteosarcomatous differentiation metastasizing to bone"],"prefix":"10.1002","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6678-1407","authenticated-orcid":false,"given":"Michael","family":"Brown","sequence":"first","affiliation":[{"name":"Department of Thoracic Medicine Royal Adelaide Hospital  Adelaide Australia"},{"name":"Faculty of Health and Medical Sciences, Adelaide Medical School University of Adelaide  Adelaide Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hubertus","family":"Jersmann","sequence":"additional","affiliation":[{"name":"Department of Thoracic Medicine Royal Adelaide Hospital  Adelaide Australia"},{"name":"Faculty of Health and Medical Sciences, Adelaide Medical School University of Adelaide  Adelaide Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4873-5439","authenticated-orcid":false,"given":"Thomas","family":"Crowhurst","sequence":"additional","affiliation":[{"name":"Department of Thoracic Medicine Royal Adelaide Hospital  Adelaide Australia"},{"name":"Faculty of Health and Medical Sciences, Adelaide Medical School University of Adelaide  Adelaide Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chris","family":"Van Vliet","sequence":"additional","affiliation":[{"name":"Department of Anatomical Pathology PathWest Laboratory Medicine, QEII Medical Centre  Nedlands Western Australia Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gareth","family":"Crouch","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery Royal Adelaide Hospital  Adelaide Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arash","family":"Badiei","sequence":"additional","affiliation":[{"name":"Department of Thoracic Medicine Royal Adelaide Hospital  Adelaide Australia"},{"name":"Faculty of Health and Medical Sciences, Adelaide Medical School University of Adelaide  Adelaide Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,9,19]]},"reference":[{"key":"e_1_2_4_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/10937404.2016.1194254"},{"key":"e_1_2_4_3_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.96.09091932"},{"key":"e_1_2_4_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0000000000000630"},{"key":"e_1_2_4_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0b013e31826915f1"},{"key":"e_1_2_4_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2009.180"},{"key":"e_1_2_4_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-198204000-00003"},{"key":"e_1_2_4_8_1","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1038\/bjc.2017.20","article-title":"Comparison of outcomes following a cytological or histological diagnosis of malignant mesothelioma","volume":"116","author":"Sanjeevan M","year":"2017","journal-title":"Br. 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