Overview

Epithelioid cells grow more slowly than other types and tend to cluster together rather than spreading rapidly. This makes treatment more effective. Patients with epithelioid mesothelioma have the best prognosis of all cell types.

Characteristics

  • Uniform, cube-shaped or oval cells
  • Well-defined cell boundaries
  • Cells tend to stick together in clusters
  • Slower growth rate compared to other types
  • Less likely to metastasize quickly
  • Most responsive to standard treatments

Subtypes

Tubulopapillary

Forms tube-like structures; associated with better prognosis

Acinar

Forms gland-like clusters; moderate prognosis

Solid

Dense sheets of cells; less favorable than other epithelioid subtypes

Trabecular

Cells arranged in cords or ribbons

Micropapillary

Small papillary structures; may indicate poorer prognosis

Diagnosis

Accurate cell type identification is critical for treatment planning. Diagnosis typically involves:

  • Tissue biopsy analyzed by pathologist
  • Immunohistochemistry staining (calretinin, WT1, D2-40 positive)
  • Distinguished from adenocarcinoma using marker panels
  • May require second opinion from specialized pathologist
Learn more about mesothelioma diagnosis →

Treatment Options

Treatment for epithelioid mesothelioma may include:

  • Surgery often recommended (pleurectomy or EPP)
  • Best response to chemotherapy (pemetrexed + cisplatin)
  • Immunotherapy effective (CheckMate 743 trial)
  • Multimodal therapy typically offers best outcomes
  • Clinical trials widely available
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Prognosis

Patients with epithelioid mesothelioma who undergo surgery may survive 2-4 years or longer. The slower growth and localized tumors make aggressive treatment worthwhile for many patients.

Learn about mesothelioma prognosis factors →

Getting a Second Opinion

Because cell type significantly affects treatment options and prognosis, obtaining a second opinion on your pathology results from a mesothelioma specialist is often recommended. Pathologists with mesothelioma experience are more likely to accurately identify cell type, subtypes, and any unusual features that may affect your treatment plan.