{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T22:18:39Z","timestamp":1775513919166,"version":"3.50.1"},"reference-count":23,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2020,6,29]],"date-time":"2020-06-29T00:00:00Z","timestamp":1593388800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Histopathology"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>Nuclear grade has been recently validated as a powerful prognostic tool in epithelioid malignant pleural mesothelioma (E\u2010MPM). In other studies histological parameters including pleomorphic features and growth patterns were also shown to exert prognostic impact. The primary aims of our study are (i) externally validate the prognostic role of pleomorphic features in E\u2010MPM and (ii) investigate if evaluating growth pattern in addition to 2\u2010tier nuclear grade improves prognostication.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>614 consecutive cases of E\u2010MPM from our institution over a period of 15\u00a0years were retrospectively reviewed, of which 51 showed pleomorphic features. E\u2010MPM with pleomorphic features showed significantly worse overall survival compared to those without (5.4 versus 14.7\u00a0months). Tumours with predominantly micropapillary pattern showed the worst survival (6.2\u00a0months) followed by solid (10.5\u00a0months), microcystic (15.3\u00a0months), discohesive (16.1\u00a0months), trabecular (17.6\u00a0months) and tubulo\u2010papillary (18.6\u00a0months). Sub\u2010classification of growth patterns into high grade (solid, micropapillary) and low grade (all others) led to good separation of overall survival (10.5 versus 18.0\u00a0months) but did not predict survival independent of 2\u2010tier nuclear grade. A composite score comprised of growth pattern and 2\u2010tier nuclear grade did not improve prognostication compared with nuclear grade alone. Intra\u2010tumoural heterogeneity in growth patterns is ubiquitous.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our findings support the incorporation of E\u2010MPM with pleomorphic features in the epithelioid subtype as a highly aggressive variant distinct from 2\u2010tier nuclear grade. E\u2010MPM demonstrates extensive heterogeneity in growth pattern but its evaluation does not offer additional prognostic utility to 2\u2010tier nuclear grade.<\/jats:p><\/jats:sec>","DOI":"10.1111\/his.14127","type":"journal-article","created":{"date-parts":[[2020,4,25]],"date-time":"2020-04-25T20:50:31Z","timestamp":1587847831000},"page":"423-436","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Presence of pleomorphic features but not growth patterns improves prognostic stratification of epithelioid malignant pleural mesothelioma by 2\u2010tier nuclear grade"],"prefix":"10.1111","volume":"77","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6134-980X","authenticated-orcid":false,"given":"Yu Z","family":"Zhang","sequence":"first","affiliation":[{"name":"National Centre for Mesothelioma Research National Heart &amp; Lung Institute Imperial College London London UK"},{"name":"Department of Histopathology Royal Brompton and Harefield NHS Foundation Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cecilia","family":"Brambilla","sequence":"additional","affiliation":[{"name":"Department of Histopathology Royal Brompton and Harefield NHS Foundation Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip L","family":"Molyneaux","sequence":"additional","affiliation":[{"name":"National Heart &amp; Lung Institute Imperial College London London UK"},{"name":"NIHR Respiratory Clinical Research Facility Royal Brompton Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Rice","sequence":"additional","affiliation":[{"name":"Department of Histopathology Royal Brompton and Harefield NHS Foundation Trust London UK"},{"name":"National Heart &amp; Lung Institute Imperial College London London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan L","family":"Robertus","sequence":"additional","affiliation":[{"name":"Department of Histopathology Royal Brompton and Harefield NHS Foundation Trust London UK"},{"name":"National Heart &amp; Lung Institute Imperial College London London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Jordan","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Royal Brompton and Harefield NHS Foundation Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Lim","sequence":"additional","affiliation":[{"name":"National Heart &amp; Lung Institute Imperial College London London UK"},{"name":"Department of Thoracic Surgery Royal Brompton and Harefield NHS Foundation Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Loic","family":"Lang\u2010Lazdunski","sequence":"additional","affiliation":[{"name":"Lung Centre BUPA Cromwell Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sofina","family":"Begum","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Royal Brompton and Harefield NHS Foundation Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Dusmet","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Royal Brompton and Harefield NHS Foundation Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vladimir","family":"Anikin","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Royal Brompton and Harefield NHS Foundation Trust London UK"},{"name":"Department of Oncology and Reconstructive Surgery I.M. Sechenov First Moscow State Medical University Moscow Russia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emma","family":"Beddow","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Royal Brompton and Harefield NHS Foundation Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Finch","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Royal Brompton and Harefield NHS Foundation Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nizar","family":"Asadi","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Royal Brompton and Harefield NHS Foundation Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanjay","family":"Popat","sequence":"additional","affiliation":[{"name":"National Heart &amp; Lung Institute Imperial College London London UK"},{"name":"Department of Medicine Royal Marsden Hospital NHS Foundation Trust London UK"},{"name":"Institute of Cancer Research London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John L","family":"Quesne","sequence":"additional","affiliation":[{"name":"MRC Toxicology Unit University of Cambridge Leicester UK"},{"name":"Leicester Cancer Research Centre University of Leicester Leicester UK"},{"name":"Department of Cellular Pathology University Hospitals Leicester NHS Trust Leicester UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aliya N","family":"Husain","sequence":"additional","affiliation":[{"name":"Department of Pathology University of Chicago Medical Centre Chicago USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William O C M","family":"Cookson","sequence":"additional","affiliation":[{"name":"National Centre for Mesothelioma Research National Heart &amp; Lung Institute Imperial College London London UK"},{"name":"National Heart &amp; Lung Institute Imperial College London London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miriam F","family":"Moffatt","sequence":"additional","affiliation":[{"name":"National Centre for Mesothelioma Research National Heart &amp; Lung Institute Imperial College London London UK"},{"name":"National Heart &amp; Lung Institute Imperial College London London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3257-102X","authenticated-orcid":false,"given":"Andrew G","family":"Nicholson","sequence":"additional","affiliation":[{"name":"Department of Histopathology Royal Brompton and Harefield NHS Foundation Trust London UK"},{"name":"National Heart &amp; Lung Institute Imperial College London London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2020,6,29]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2019.08.2506"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.5858\/arpa.2017-0124-RA"},{"key":"e_1_2_8_4_1","volume-title":"World Health Organization classification of tumours. pathology and genetics. 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