Document dY3ZBOQv5vaM6qMw9YELpXJxG

Mayo Clinic Scottsdale 13400 East Shea Boulevard Scottsdale, Arizona 85259 480-301-8000 May 2, 2001 Donald Heinig, M.D. Exempts Lutheran Medical Center Department of Pathology 8300 West 38th Avenue Wheat Ridge, CO 80033 RE: Trainor, James L. YOUR#: LS01-2780 OUR#: OS01-1164 Dear Dr. Heimg: At Dr. Larry Repscher's request, I have reviewed the sections from a pleural mass from the above-named patient and agree with your diagnosis of epithelioid malignant mesothelioma. Whether or not this lesion represents extension from a peritoneal mesothelioma, or primary in the pleura, (but perhaps at an early stage), is impossible to say for sure. I do see evidence for hyaline pleural plaque compatible with asbestos exposure. I also agree that your immunohistochemical stains certainly don't argue against mesothelioma. It would be helpful to have cytokeratin 5/6 and calretmm stains on this tumor to ensure it's mesothelial origins. My diagnosis reads as follows: Pleural based mass: Histologic changes most consistent with epithelioid malignant mesothelioma. Stromal invasion by epithelioid cells and necrosis are present. Hyaline pleural plaque compatible with asbestos exposure is seen in separate biopsies. Thank you for sharing this interesting case with us in consultation and allowing us to participate in the care of this patient. Since^bly, ^-------- - V i Kevin O. Leslie, M.D. KDL:tdb Co '* T)r ^ U\