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From Ohio University College of Osteopathic Medicine, Northeastern Ohio Universities College of Medicine, Pulmonary and Critical Care Division of St Elizabeth Hospital (Dr Barreiro) in Youngstown, and the Division of Pathology and Laboratory Medicine of Strong Memorial Hospital at the University of Rochester School of Medicine and Dentistry (Dr Katzman) in New York..

Address correspondence to Timothy J. Barreiro, DO, Pulmonary and Critical Care Division, St Elizabeth Health Center, 1044 Belmont Ave, Youngstown, OH 44501-1006. E-mail: tbarreir{at}neoucom.edu.

Diffuse malignant mesothelioma is the most common primary tumor involving the pleura. Unfortunately, it also poses the most difficulty for physicians to diagnose and treat. Latency from the time of initial asbestos exposure, clinical features of chest pain and dyspnea, and radiographic findings of pleural effusion or pleural thickening are the characteristic features. Pathologic verification remains challenging. The primary distinctions to be made are between reactive and neoplastic mesothelial processes and between malignant mesothelioma and metastatic adenocarcinoma. Adequate tissue sampling is important to help diagnose malignant mesothelioma. This article describes a rare subtype of mesothelioma and illustrates the difficulty in establishing the diagnosis. Also included is a discussion of the clinical features, diagnostic dilemmas, and unsatisfactory outcome associated with this disease.