Factors predictive of progression in lesions categorised as well-differentiated papillary mesothelial tumour of the pleura, tunica vaginalis and peritoneum: a scoping review

Purpose: This scoping review examines the literature on factors predictive of progression of well-differentiated papillary mesothelial tumours (WDPMT) to identify features relevant to their prognosis.

Methods:  A comprehensive search was conducted across six databases to identify English-language case reports and case series published between 2000 and 2024 that described progression of WDPMT to diffuse mesothelioma. Ten studies met inclusion criteria. Data were extracted and synthesised using thematic analysis, and critical appraisal was undertaken using the JBI checklists to assess reporting quality.

Results: Quality appraisal rendered the 10 studies satisfactory for inclusion. Multifocality, and BAP1 loss on immunohistochemistry were consistently associated with progression of WDPMT to diffuse mesothelioma.

Discussion: This scoping review provides insights into the current understanding of WDPMTs and highlights the paucity of published literature on disease progression, with only 10 relevant articles identified over a two-decade period. WDMPT and papillary mesothelioma in situ (MIS) morphologically are indistinguishable but biologically distinct entities. BAP1 loss on immunohistochemistry (IHC), and multifocality are factors associated with risk of progression to diffuse mesothelioma. Testing for BAP1 and MTAP is mandatory for diagnosis. We suggest that WDPMT-like lesions with BAP1 and/or MTAP loss should be classified as papillary MIS.