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10 Things Dependable Trading System Does

2010-03-10T17:10:00.001-08:00

Trading markets profitably is no longer rocket science; in fact you don't have to be a mathematical genius. All it needs is just having one sensible head sitting on your shoulders and ability to follow simple directions given by a well chosen dependable forex trading system. Whether you're trying to take it as a hobby or you want to earn extra cash and be able to quit your daily job. The task is far simpler than you've ever believed using an automated trading system.
A good trading system will:
1. Remove emotions: Handling ones emotion is one of the biggest challenges individual investors have. Inability to cope with losses make investors second guess their decisions and end up losing money. System traders can forget about making emotional and sometimes-reckless decisions by strictly following a pre-developed system. Lowering the rate of human inefficiencies, system traders can boost profits.
2. Save time: Once a reliable system is developed and optimized, next to nothing effort is required by the trader. Automated the signal generation is done by a computer so the trader is freed from spending time on analysis.
3. Remove the brain tasking exercise. The Development, programming and analysis have been done and made ready for instant use as soon as launched by user.
4. Stop bothering about analysis. A good trading system reads information input from the market and makes trade analysis without bothering the user.
5. Start another business: System trading has the potential to free you from your burdensome day-job by supplementing and sometimes replacing your full-time income. This is not to say every trader is billionaire-which would be crazy! What I am saying is that if done properly, and given the 'right' set of tools - there's just NO reason why you can't be successful trading forex.
6. Perfect trading skills. A dependable trading system will provide the trader with an understanding of what goes on -the when and why of every trade.
7. Build confidence and control: Careful observation and imitation of the way the system executes its trade and the results the systems gets helps the trader psychologically to develop confidence and learn to be in control.
8. Helps improve discipline: Since an automated system does not take owner inputs at the point of trading, indiscipline on the part of user can be avoided. Trading with discipline will put more money in your pocket and take less money out. The one constant truth concerning the markets is that discipline = increased profits.
9. Avoid trial and error: With system trading, you can learn the rules and trade profitably WITHOUT the costly and time-consuming act of 'trial and error. You can the basics without biting your finger.
10. Accurate Real-time decisions: Good trading systems use clear and concise rules that give you precise entries and exits - making the right choice ensures 90% of the work is done for you! All you need to do is learn the rules, watch for a setup (the system identifies this for you) and place and manage your trade to target. That's it!

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Article Source: http://EzineArticles.com/?expert=Ilori_Olalekan

How to Earn Money With Google Adsense

2010-02-10T17:07:00.000-08:00

Do you want to make money quick? In this article we are going to talk about one of the quickest ways you can make money. Making money quick is not only possible there are people doing it everyday with Google Adsense.

Google AdSense delivers text and image ads that match the content on your website. These are very targeted ads that you can choose the size and color of and they come across to your customer as helpful more than an ad itself.

Google Ads require virtually no maintenance and they help you put advertising on your website without actually having to deal with advertisers yourself. If you can copy and paste a small code you can have targeted advertising on your website in minutes.

Adsense is simple to join and it is free to join. Whether you are an internet newbie or a veteran you can profit quickly by placing Google Adsense ads on your web pages.
Since Google does all of the work by finding the most profitable ads for your pages you can do what you do best....provide good content and lots of it. The more web pages you create the quicker you will be making money. You can learn more here:
https://www.google.com/adsense/
Once you have joined Google Adsense you will want to combine Google search with AdSense to monetize more of your web pages. You can do this by placing a Google search box on your pages. Google AdSense combines Google's search technology with
thousands of keyword advertisers to deliver targeted text-based ads to search result pages. People find these ads useful and click on them, and when they do, Google pays you.

You can see an example of how this works right here on this web page. In fact we combine Google search and Google Adsense on almost every website and web pages we create. We have found it a very easy way to make money quick and to make money over and over. It's great.

The internet offers many ways to make money quick. The nice thing about Google Adsense is you have the largest search engine in the world doing your advertising for you. This truely allows you to make money quickly and you can do it over and over with as many products as you want.
About the Author
Kaushik Das is a full-time Internet Marketer. Learn about a new keyword generation and analysis tool that all of the gurus are secretly using to quadruple their Adwords and Adsense earnings... http://manomanju.com/keyword-elite
Article Source: www.Ezine-Article.com

Mesothelioma

2010-02-01T04:13:00.001-08:00

Mesotheliomas form a spectrum of tumors that usually arise in the pleura or in the abdominal cavity. The malignant tumors arising within the pleura are strongly associated with prior asbestos exposure in up to 90% of cases. The time period from initial exposure to development of the cancer may range from 25-45 years and the lifetime risk of developing mesothelioma following heavy exposure ranges from 7-10%. It diffusely spreads through the pleural space, directly invading other thoracic structures and associated with pleural effusion. The underlying lung is usually encased within the tumor.

The abdominal peritoneal variant is also related to asbestos exposure and 50% of these patients may have pulmonary fibrosis. Although 50% of these cases may be limited to the abdominal cavity, intestinal obstruction is common frequently leading to death.
The classic histopathology of the mesothelioma is a biphasic tumor with both an epithelioid and sarcomatoid or spindle cell component. From this description, it can be readily appreciated how the diagnosis may be very difficult to confirm. The table below lists the major histologic variants of the tumor. The task of the pathologist is to separate the mesothelioma from its many mimics including adenocarcinoma from the lung (in pleural cases) and soft tissue sarcomas such as malignant fibrous histiocytoma (in peritoneal cases). Immunoperoxidase studies and electron microscopy may aid in this distinction.
Unfortunately, the disease has a progressively downhill course. The importance in making the correct diagnosis is more of a medicolegal issue, because of the association of asbestos exposure, rather than a therapeutic one.
OUTLINE

Epidemiology

Disease Associations

Pathogenesis

Laboratory/Radiologic/Other Diagnostic Testing

Gross Appearance and Clinical Variants

Histopathological Features and Variants

Special Stains/
Immunohistochemistry/
Electron Microscopy

Differential Diagnosis

Prognosis

Treatment

Commonly Used Terms

Internet Links

EPIDEMIOLOGY

Malignant Peritoneal Mesothelioma in Women

A Study of 75 Cases With Emphasis on Their Morphologic Spectrum and Differential Diagnosis

Patricia M. Baker, MD, etal.

Am J Clin Pathol 2005;123:724-737 Abstract quote

Seventy-five malignant mesotheliomas of the peritoneum in women were reviewed to highlight their morphologic spectrum. The patients ranged from 17 to 92 (mean, 47.4) years of age. The clinical presentation was usually abdominal or pelvic pain, abdominal swelling (sometimes due to ascites), or a pelvic mass.

On microscopic examination, the majority of the tumors had only an epithelial morphology, but 4 were biphasic and 1 was sarcomatoid. The most common epithelial patterns were tubular and papillary (which often coexisted), but 5 tumors were purely diffuse; 2 had cells with abundant glassy eosinophilic cytoplasm (so-called deciduoid mesothelioma). The cells in the tubular and papillary patterns were generally cuboidal with scant to moderate amounts of eosinophilic cytoplasm. Nuclear atypia was usually only mild, although a minority of cases had moderate or even, occasionally, severe atypia. Many tumors had foci that, viewed in isolation, resembled so-called well-differentiated papillary mesothelioma, and accordingly that diagnosis should be made cautiously.

Unusual features were lymphoid follicles (13 cases), striking myxoid stroma (5 cases), prominent foamy histiocytes (5 cases), and a striking vascular proliferation (1 case). The varied morphology of peritoneal malignant mesotheliomas may raise a broad differential diagnosis, but in most cases the resemblance to other tumors is limited.

Histochemistry, immunohistochemistry, and electron microscopy may provide important aid, particularly when tissue is limited, but should be needed only occasionally.

PATHOGENESIS CHARACTERIZATION

ASBESTOSIS

Current controversies regarding the role of asbestos exposure in the causation of malignant mesothelioma: The need for an evidence-based approach to develop medicolegal guidelines.

Marchevsky AM, Wick MR.

Ann Diagn Pathol. 2003 Oct;7(5):321-32. Abstract quote

Asbestos is a group of fibrous silicate minerals that includes two mineralogic groups: amphiboles and serpentines. While the carcinogenic role of amphiboles (eg, crocidolite and amosite) is well established, medical "experts" that tend to strongly advocate their views currently argue in medicolegal cases multiple specific issues regarding the carcinogenicity of asbestos fibers.
For example, it is controversial whether chrysotile causes malignant mesothelioma (MM); what are the specific carcinogenic thresholds for amphiboles and chrysotile; what occupations are truly at risk to develop MM as a result of asbestos exposure; what is the role of chrysotile in the development of peritoneal MM; how to assign causation in individuals exposed to multiple industrial products containing variable concentrations of various asbestos fibers; and, what criteria should be used to accept causation in household exposure cases and others. The causation criteria currently acceptable in U.S. courts are surprisingly flexible and subject to variable interpretation by medical "experts." At a time where thousands of individuals are claiming causation of MM by asbestos exposure, there is a need to develop more specific causation guidelines based on scientific evidence. Evidence-based medicine has been proposed as a new approach to the study, teaching, and the practice of medicine and has been used as a process of systematically reviewing the relevant studies in the literature to assess their scientific validity and development of guidelines.
This article summarizes some of the current controversies regarding the role of asbestos exposure in the causation of MM and suggests the need for future evidence-based medicine-type studies to develop causation guidelines that could be used consistently during litigation.

c-KIT

c-Kit is not expressed in malignant mesothelioma.
Horvai AE, Li L, Xu Z, Kramer MJ, Jablons DM, Treseler PA.
Department of Pathology, University of California, San Francisco, California 94143, USA.
Mod Pathol. 2003 Aug;16(8):818-22. Abstract quote Overexpression of KIT protein (CD117), the product of the c-kit gene, has been shown to have important prognostic and therapeutic implications for a number of malignant neoplasms. Previous studies have shown conflicting results regarding the expression of c-kit in malignant mesothelioma.

To determine whether malignant mesothelioma expresses KIT, immunohistochemistry and RT-PCR were used to analyze archived tissue from 37 cases of mesothelioma. Although a subset of mesotheliomas demonstrated specific staining with the DAKO anti-KIT antibody, in each case staining was nuclear. We could not detect c-kit mRNA by a sensitive RT-PCR assay, even in cases with strong nuclear staining. Furthermore, a second anti-KIT antibody (Cell-Marque) only demonstrated staining in a single mesothelioma case and in none of the cases that demonstrated nuclear staining.

We conclude that immunoreactivity for KIT in mesothelioma does not represent expression of the c-kit gene and may represent antibody cross-reaction with nuclear proteins. Our results raise doubt about previously reported expression of KIT in mesothelioma and consequently, the applicability of therapeutic agents that target the kinase activity of KIT.

GAMMA GCS

Overexpression of gamma-glutamylcysteine synthetase in human malignant mesothelioma.
Jarvinen K, Soini Y, Kahlos K, Kinnula VL.
Department of Internal Medicine, University of Oulu, Helsinki, Finland.
Hum Pathol 2002 Jul;33(7):748-55 Abstract quote Mesothelioma is a fatal tumor resistant to all treatment modalities for reasons that are still unresolved. Glutathione (GSH)-associated pathways are induced by oxidants and cytotoxic drugs, and they are also involved in the progression and resistance of some tumor cells in vitro. The rate-limiting enzyme in GSH biosynthesis is gamma-glutamylcysteine synthetase (gamma GCS). However, the expression of this enzyme has not been systematically investigated in malignant tumors, and there are no studies of gamma GCS in biopsy specimens of malignant mesothelioma.
We investigated the immunohistochemical distribution and expression of both subunits of gamma GCS in healthy pleural mesothelium, pleural mesothelioma tumor biopsy samples (34 cases), and mesothelioma cells in culture (7 cell lines). Nonmalignant mesothelium showed no immunoreactivity for either subunit in any of the cases. The heavy (catalytic) subunit of gamma GCS was highly immunostained in 29 and weakly positive in 5 cases. High-moderate and weak immunoreactivity of the light (regulatory) subunit of gamma GCS was found in 15 and 7 tumors, respectively, whereas 12 cases showed no reactivity. There was no correlation with either catalytic or regulatory subunit expression and patient survival. There was, however, a significant correlation between the heavy chain and multidrug resistance protein (MRP) 2 (P =.048), whereas no correlation was observed between the light chain and MRP1 or MRP2. Treatment of cultured mesothelioma cells with buthionine sulfoximine (BSO), to inhibit gamma GCS, significantly potentiated cisplatin-induced cytotoxicity mainly by nonapoptotic mechanism when assessed by counting the living cells, TUNEL (terminal deoxytransferase-mediated dUTP nick-end labeling) assay, and caspase-3 cleavage.
In conclusion, gamma GCS is highly positive in most cases of malignant mesothelioma and may play an important role in the primary drug resistance of this tumor in vivo.

NO ASBESTOS

Mesothelioma in patients with nonoccupational asbestos exposure An evidence-based approach to causation assessment. Marchevsky AM, Harber P, Crawford L, Wick MR. Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.

Ann Diagn Pathol. 2006 Aug;10(4):241-50. Abstract quote

The specific parameters of nonoccupational asbestos exposures (NOAE) that can distinguish an idiopathic from an asbestos-caused malignant mesothelioma (MM) are controversial. A systematic literature review yielded 1028 cases with this putative association. Only 287 of those reports had a defined single exposure to a household, building occupant, or neighborhood/community asbestos source. The available "evidence" was used to develop semiarbitrary evidence-based causation guideline rules for the assessment of putative associations between MM and NOAE.

The rules are classified into class A (tissue burden analysis shows asbestos body counts or fiber counts in lung tissues comparable to MM caused by occupational exposure to asbestos) and classes B to D based on whether certain combinations of NOAE features and MM (evidence) have been described in over 15% (class B), 5% to 15% (class C), and less than 5% (class D) of the patients reviewed. The proposed 4 classes of evidence-based causation guidelines provide a semiarbitrary framework to evaluate the causation of individual MM patients by NOAE based on decreasing levels of currently available evidence. The neoplasms in classes A to C patients are probably caused by NOAE, with decreasing weight of evidence in the 3 groups. There is minimal evidence to support the causation of MM by NOAE in class D patients.

There is no evidence or only anecdotal evidence to support a causal association between MM and NOAE in individuals who cannot be classified into any of the 4 classes. Future studies are needed to provide more comprehensive data regarding the association between MM and NOAE.

CLINICAL VARIANTS CHARACTERIZATION

GENERAL Adapted from Am J Clin Pathol 2000;113:619-622

BENIGN Adenomatoid tumor

HYPERPLASTIC VS. BORDERLINE NEOPLASTIC Multicystic mesothelioma
Localized or diffuse "well-differentiated papillary mesothelioma"

OVERTLY MALIGNANT

Localized or diffuse epithelioid mesothelioma
Large polygonal-cell tube
Tubulopapillary type
Mucin-containing polyhedral-cell type
Small cell type
Clear cell type
Oncocytoid or granular-cell types

Localized or diffuse sarcomatoid types
Fibrosarcoma or malignant fibrous histiocytoma-like
With divergent differentiation (eg osteochondroid, myogenous)
Lymphohistiocytoid (lymphoma-like)
Desmoplastic

Localized or diffuse biphasic mesothelioma

INFLAMMATORY PROCESS

Malignant mesothelioma of the peritoneum presenting as an inflammatory lesion: a report of four cases.
Kerrigan SA, Cagle P, Churg A.
Am J Surg Pathol 2003 Feb;27(2):248-53 Abstract quote Most cases of malignant mesothelioma present with obvious diffuse tumor, and the presence of grossly visible diffuse tumor is usually cited as an important criterion for making the diagnosis.
We report four cases of unsuspected malignant mesothelioma of the peritoneum presenting as localized acute inflammatory lesions. The clinical diagnoses were acute appendicitis in two cases, acute cholecystitis in the third case, and incarcerated umbilical hernia in the fourth case. In all cases tumor was not evident at initial surgical exploration or on gross pathologic examination, and the diagnosis was only made on microscopic examination of the resected specimens. All cases showed a tubulopapillary form of epithelial mesothelioma with obvious tissue invasion, but the foci of tumor were too small to be seen grossly or were present deep in fibrous tissue.
On follow-up all patients developed grossly evident tumor, and one of these patients is alive without evidence of disease 5 years after presentation.
We conclude that peritoneal mesotheliomas may occasionally present as inflammatory processes without grossly evident tumor and can be diagnosed by microscopic findings alone.

LOCALIZED

Localized malignant mesothelioma.

Allen TC, Cagle PT, Churg AM, Colby TV, Gibbs AR, Hammar SP, Corson JM, Grimes MM, Ordonez NG, Roggli V, Travis WD, Wick MR.

Department of Pathology, Baylor College of Medicine, Houston, TX, USA.

Am J Surg Pathol. 2005 Jul;29(7):866-73. Abstract quote

Localized malignant mesotheliomas are uncommon sharply circumscribed tumors of the serosal membranes with the microscopic appearance of diffuse malignant mesothelioma but without any evidence of diffuse spread. Little is known about their behavior.

We report 23 new cases. The mean age at presentation was 63 years, and the sex ratio was approximately 2:1 (male/female). Twenty-one tumors were pleural and 2 were peritoneal. Sixteen tumors reproduced microscopic patterns of diffuse epithelial mesotheliomas, 6 had mixed epithelial and sarcomatous patterns, and 1 was purely sarcomatous. After surgical excision of the tumor, 10 of 21 patients with follow-up data were alive without evidence of disease from 18 months to 11 years after diagnosis. Patients who died had developed local recurrences and metastases, but none had diffuse pleural spread.

Localized malignant mesotheliomas should be separated from diffuse malignant mesotheliomas because of their localized presentation, quite different biologic behavior, and far better prognosis.

MILIARY LUNG METASTASIS

Miliary pulmonary metastases from a clinically occult pleural mesothelioma.
Livasy CA, Tishko DJ, Maygarden SJ.
Ann Diagn Pathol. 2003 Aug;7(4):249-53. Abstract quote Mesothelioma is a rare neoplasm of the serosal membranes. Signs and symptoms of a pleural effusion typically herald discovery of the tumor.

We report a case of miliary metastatic mesothelioma involving both lungs in a 54-year-old man who presented with right-sided chest discomfort, numerous pulmonary nodules detected by computed tomography of the chest, and absent pleural effusion.

Immunohistochemical and electron microscopy studies performed on wedge biopsies of parenchymal pulmonary nodules led to the diagnosis of metastatic mesothelioma. Subsequent pleural evaluation and biopsy of pleural thickening noted at a site of prior chest wall trauma identified the primary neoplasm and confirmed the diagnosis as malignant epithelioid mesothelioma. The histologic appearance of discohesive epithelioid cells in a distinctly myxoid background was the clue in this case leading to the consideration of metastatic mesothelioma and a thorough immunohistochemical evaluation of the tumor.

This case shows that mesothelioma may metastasize throughout the lungs in a miliary pattern and the metastases may be clinically detected before the primary pleural tumor. Metastatic mesothelioma is a consideration for metastatic pulmonary tumors of unknown origin.

PARATESTICULAR

Paratesticular papillary mesothelioma: a case with borderline features.

Cabay RJ, Siddiqui NH, Alam S.

Department of Pathology, College of Medicine, University of Illinois, Chicago, IL 60612-7335, USA.

Arch Pathol Lab Med. 2006 Jan;130(1):90-2. Abstract quote

Most often, mesotheliomas involve the serosal (serous) membranes of the pleura and peritoneum. Sometimes, mesothelial proliferations are identified in other locations. On very rare occasions, a mesothelioma is found within the tunica vaginalis of the paratesticular region.

We report a case of papillary mesothelioma of the tunica vaginalis in a 52-year-old man. Although this lesion had papillary structures lined by a single layer of mesothelial cells with predominantly bland nuclear and cytologic features, there was evidence of a minimal presence of mesothelial cells in the underlying stroma. This combination of benign and semimalignant characteristics can make the diagnosis of such a lesion problematic.

We think that a diagnosis of "borderline papillary mesothelioma" can be considered for similar mesothelial proliferations to allow for a possible increase in diagnostic accuracy and provide an enhanced informational platform from which patients and clinicians can benefit.

SKIN METASTASIS

Widespread cutaneous and perioral metastases of mesothelioma.

Cassarino DS, Xue W, Shannon KJ.

Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, and Greenbelt, MD, USA.

J Cutan Pathol. 2003 Oct;30(9):582-5 Abstract quote.

BACKGROUND: Cutaneous involvement by mesothelioma represents a rare occurrence from an uncommon neoplasm. Most cases have resulted from local extension of an underlying body cavity mesothelioma or from surgical site contamination. We could only find six previously reported cases of distant cutaneous metastases of mesothelioma.

METHODS: We describe a case of metastatic mesothelioma involving multiple skin sites and the lip in a 64-year-old man with an underlying primary pleural mesothelioma.

RESULTS: A 64-year-old man presented with a lip lesion clinically diagnosed as keratoacanthoma vs. squamous cell carcinoma. Evaluation of the lip biopsy revealed tubulo-glandular and acinar-like arrangements of plump epithelioid cells with a hobnailed appearance, vesicular nuclei, and prominent nucleoli. The initial impression of metastatic carcinoma was revised to probable mesothelioma upon discovery of a previous history of pleural mesothelioma. Positive immunohistochemical stains for anti-cytokeratin, anti-calretinin, and HBME-1 and negative stains for anti-CEA, Leu-M1, B72.3, and Ber-Ep4 confirmed the diagnosis.

CONCLUSION: We report a rare example of multiple cutaneous metastases of mesothelioma. We also demonstrate the usefulness of relatively new and specific immunomarkers for mesothelioma vs. adenocarcinoma. Metastatic mesothelioma to the skin or lip is a very rare occurrence but should be considered in the differential diagnosis of malignant epithelioid neoplasms.

HISTOLOGICAL TYPES

CHARACTERIZATION

HISTOLOGICAL VARIANTS

BENIGN CYSTIC MESOTHELIOMA

Benign cystic mesothelioma of the peritoneum: A clinicopathologic study of 17 cases and immunohistochemical analysis of estrogen and progesterone receptor status.
Sawh RN, Malpica A, Deavers MT, Liu J, Silva EG.
Division of Pathology and Laboratory Medicine, The University of Texas M.D. Anderson Cancer Center, Houston, TX.

Hum Pathol 2003 Apr;34(4):369-74 Abstract quote Benign cystic mesothelioma (BCM) is an uncommon lesion of the peritoneum occurring predominantly in women of reproductive age. Although most patients are managed by surgical resection, a reported high incidence of cyst recurrence has led to the use of hormonal therapy in isolated cases in an attempt to control cyst size and relieve local symptoms.

To date, the estrogen receptor (ER) and progesterone receptor (PR) status of BCM has not been evaluated. Here we present our experience with 17 cases (13 women, 4 men) of BCM seen over a 19-year period, including an immunohistochemical analysis of ER and PR status in 14 cases. All lesions showed typical morphological features of BCM, and calretinin immunostaining was positive in 14 of 14 cases. Five patients experienced either 1 or 2 tumor recurrences, and no patients died of disease. One case was diffusely positive for ER only, 1 case was focally positive for PR only, and 1 case was focally positive for both ER and PR.

Although immunohistochemical detection of female sex hormone receptors in BCM is uncommon, the focal presence of ER and/or PR in some lesions does provide weak biologic support for the use of hormonal manipulation as a therapeutic option.

CLEAR CELL

Mesothelioma with clear cell features: An ultrastructural and immunohistochemical study of 20 cases. Ordonez NG.

Hum Pathol. 2005 May;36(5):465-73. Abstract quote Summary Mesotheliomas with clear cell morphology are rare and only a few individual case reports have been documented in the literature. The author reports a series of 20 epithelioid mesotheliomas with clear features, 17 of which originated in the pleura and 3 in the peritoneum. Eighteen of the patients were men and 2 were women. Twelve patients had a history of asbestos exposure. Electron microscopy and special histochemical stains demonstrated that the cytoplasmic clearing seen in hematoxylin and eosin-stained sections resulted from multiple factors that can occur either singly or in combination. The most frequent cause of the cytoplasmic clearing was the accumulation of large amounts of intracytoplasmic glycogen. Another but somewhat less common factor was the accumulation of large amounts of lipid, which occurred alone or with glycogen. Other less common causes were marked mitochondrial swelling, the presence of numerous intracytoplasmic vesicles, and a large number of intracytoplasmic lumens. The value of immunohistochemistry in helping to distinguish epithelioid mesotheliomas from some carcinomas with clear cell morphology is emphasized. In addition, it was determined that because electron microscopy was decisive in establishing the cause of the cytoplasmic clearing in most of the cases, tissue for electron microscopy should routinely be procured for ultrastructural studies.

DECIDUOID FEATURES

Malignant deciduoid mesothelioma: a diagnostic challenge. Mourra N, de Chaisemartin C, Goubin-Versini I, Parc R, Flejou JF. Department of Pathology, Hopital St-Antoine, Paris, France.

Arch Pathol Lab Med. 2005 Mar;129(3):403-6. Abstract quote Malignant deciduoid mesothelioma, a rare phenotype of epithelioid mesothelioma, arises more commonly from the peritoneum of young women, but it is also reported in the pleura of elderly people. We report a case of malignant deciduoid mesothelioma that occurred in a 41-year-old woman after cesarean section and was initially misdiagnosed as pseudotumoral deciduosis. Microscopically, the tumor was entirely composed of deciduoid areas, and only scattered tumor cells were positive for calretinin and keratin 5/6. The patient died 14 months after the first operation. This observation confirms the poor prognosis of this entity and the importance of the differential diagnosis of pseudotumoral deciduosis.

Epithelial Mesothelioma With Deciduoid Features
Report of Four Cases Nelson G. Ordóñez, M.D.
From the University of Texas M.D. Anderson Cancer Center, Houston, Texas, U.S.A.

Am J Surg Pathol 2000;24:816-823 Abstract quote Deciduoid mesothelioma is the designation given to an unusual morphologic variant of epithelial mesothelioma that closely simulates exuberant ectopic decidual reaction. Because all four previously reported cases involved the peritoneum and occurred in young women without a history of asbestos exposure, it was suggested that deciduoid mesothelioma was a subtype of epithelial mesothelioma characterized by its unique morphology, that it affects a distinct patient population, and that it is unrelated etiologically to asbestos.
The author reports four cases of mesothelioma with deciduoid features, all of which originated in the pleura. Three of the patients were men and one was a woman. Their ages ranged from 46 to 78 years (mean age, 67 yrs). Two of the patients had a history of asbestos exposure.
These findings indicate that this morphologic variant of mesothelioma is not limited to a specific patient population nor is it restricted to the peritoneum.

Mesotheliomas With Deciduoid Morphology A Morphologic Spectrum and a Variant Not Confined to Young Females
Jonathan H. Shanks, M.D., M.R.C.Path; Martin Harris, M.D., F.R.C.Path; S. Sankar Banerjee, M.D., F.R.C.Path; Brian P. Eyden, Ph.D.; Vijay M. Joglekar, F.R.C.Path; Anne Nicol, F.R.C.Path; Philip S. Hasleton, M.D., F.R.C.Path; Andrew G. Nicholson, M.R.C.Path, D.M.
From the Departments of Histopathology Christie Hospital, Manchester, England (J.H.S, M.H., S.S.B., B.P.E.); Furness General Hospital, Barrow-in-Furness, England (V.M.J.); Mid-Cheshire Hospitals Trust, Crewe, England (A.N.), Wythenshawe Hospital, Manchester, England (P.S.H.); and Royal Brompton and Harefield N.H.S. Trust, London, England (A.G.N.).

Am J Surg Pathol 2000;24:285-294 Abstract quote
Deciduoid mesotheliomas are rare with only four previously reported cases, all affecting the peritoneum of young females.
We describe another six cases (three men and three women; age range 52–65 yrs, median 55 yrs; five peritoneal and one pleural). Three patients had an occupational history of asbestos exposure.
The deciduoid appearance predominated in four cases, whereas in two it represented a minor component within conventional tubulopapillary epithelioid mesothelioma. All tumors were strongly cytokeratin-positive (including CK5/6) and all showed at least focal staining for thrombomodulin, HBME-1, and calretinin. All were negative for epithelial mucin (D/PAS), CEA, BerEP4, LeuM1 (CD15), CD21, CD35, and S100 protein. Five of six cases (83%) were vimentin-positive and two (33%) were focally positive for -smooth muscle actin.
A differential diagnosis of gastrointestinal autonomic nerve tumor (GANT) had been initially considered from the morphology of one case, and we found positivity for some of the ``neuronal'' markers described in GANTs. This prompted us to apply such a panel to the other five tumors, accepting that the cytokeratin positivity encountered in all of our cases would exclude GANT. All cases of deciduoid mesothelioma (100%) were positive for PGP 9.5 and NSE and four of six (66%) were positive for NKI/C3. Weak focal staining (<5% cells) for synaptophysin was seen in two of six tumors. All cases were chromogranin-negative. All cases examined by electron microscopy showed desmosomes and smooth microvilli without rootlets but no neuroendocrine granules.
In conclusion, a deciduoid morphology appears to be part of the histopathologic spectrum encountered in epithelioid mesothelioma. This variant is not confined to female patients and occurs over a wider age range than previously recognized. The overlapping immunophenotype with GANTs illustrates that caution should be exercised when interpreting positivity for ``neuronal'' markers in this context. An immunohistochemical panel that includes cytokeratins should always be used.

Ann Diagn Pathol 2001;5:168-171

EPITHELIOID

Diffuse malignant epithelial mesotheliomas of the peritoneum in women: a clinicopathologic study of 25 patients.
Kerrigan SA, Turnnir RT, Clement PB, Young RH, Churg A.
Department of Pathology, Vancouver Hospital and Health Sciences Center, British Columbia, Canada.

Cancer 2002 Jan 15;94(2):378-85 Abstract quote BACKGROUND: The behavior of diffuse peritoneal mesotheliomas in women and the possible relation between tumor morphology and outcome are uncertain. Reported survival has ranged from < 1 month to > 14 years, and a previous study found that tumor morphology could not be used reliably for predicting outcome. The authors examined the behavior of diffuse epithelial peritoneal mesotheliomas in women and the possible relation between pathologic features and outcome.
METHODS: Twenty-five female patients with diffuse peritoneal epithelial malignant mesotheliomas were divided into two groups: those who survived for < 4 years (60%) and those who survived for > 4 years (40%). Both groups were compared in terms of age, presentation, treatment, survival, tumor architecture, mitotic rate, necrosis, nuclear grade, and immunohistochemical profile.
RESULTS: Patients in the two groups were similar in terms of age at diagnosis (median ages, 50.7 years and 49.9 years), presentation, initial tumor burden, and treatment. In both groups, the most common initial clinical presenting features were ascites and abdominal pain. The tumors typically took the form of multiple nodules measuring < 1.5 cm in greatest dimension. Slightly less than 50% of patients in both groups received some form of chemotherapy or radiation therapy after undergoing tumor-reductive surgery or biopsy. Overall survival ranged from 1 month to 15 years. The median survival was 12 months in the group of women who survived for < 4 years and 7 years in the group of women who survived for > 4 years. Overall, 10 of 25 patients survived for > or = 5 years. One patient was alive with disease 15 years after diagnosis. Although there was a suggestion that the tumors in patients with short survival more often had solid architecture and high-grade nuclei, these findings were not significant statistically. The frequency of necrosis and the mitotic activity were the same in both groups.
CONCLUSIONS: The spectrum of diffuse epithelial peritoneal mesotheliomas in women includes tumors that are highly aggressive and behave much like pleural mesotheliomas, although a sizeable number of tumors, unlike the pleural tumors, are relatively indolent. However, because there do not appear to be morphologic features that reliably identify favorable tumors versus unfavorable tumors, aggressive therapy for all women with diffuse peritoneal mesotheliomas may be warranted.

MYXOID

Extensive myxoid change in well-differentiated papillary mesothelioma of the pelvic peritoneum.
Diaz LK, Okonkwo A, Solans EP, Bedrossian C, Rao MS.
Departments of Pathology, Northwestern Memorial Hospital and Northwestern University Medical School, Chicago, IL; and the Ingalls Memorial Hospital, Harvey, IL.

Ann Diagn Pathol 2002 Jun;6(3):164-7 Abstract quote We present a unique case of papillary mesothelioma of the pelvic peritoneum with extensive myxoid change in a 44-year-old woman.
The patient presented with lower abdominal pain; imaging studies revealed a pelvic mass. Microscopic examination of the surgically resected specimen showed extensive areas of myxoid stroma and only focal areas of classical papillary mesothelioma. A small biopsy of this lesion might have been misinterpreted as a soft tissue neoplasm with myxoid stroma or pseudomyxoma peritonei.
It is suggested that mesothelioma with myxoid change should be included with differential diagnoses of myxoid lesions of the peritoneum.

PAPILLARY

Well-differentiated papillary mesothelioma of the pleura: a series of 24 cases.

Galateau-Salle F, Vignaud JM, Burke L, Gibbs A, Brambilla E, Attanoos R, Goldberg M, Launoy G; Mesopath group.

Department of Pathology CHU Caen, France

Am J Surg Pathol. 2004 Apr;28(4):534-40. Abstract quote Well-differentiated papillary mesothelioma (WDPM) of the pleura represents a distinct mesothelial tumor presenting with unilateral pleural effusion and superficial spreading of stout papillary formations with myxoid cores, lined by bland, flattened, or epithelioid cells, without or with limited invasion of the submesothelial layer. The majority of cases have been reported in the peritoneum in women of reproductive age with no history of asbestos exposure and also in the tunica vaginalis of men. We report 24 cases of pleural WDPM and compared their histologic, epidemiologic, and clinical features with those of classic mesothelioma. Men and women were equally affected, with a mean age of 60 years. Half of the patients had a history of occupational asbestos exposure. In 11 patients with a minimal follow-up period of 24 months, the survival ranged from 36 to 180 months with an average of 74 months as compared with 9.89 months for 1248 paired patients with diffuse malignant mesothelioma. Ten-year survival was 30.8%. We conclude that WDPM is a rare and unusual mesothelial tumor, characterized by a lack of deep invasion and associated with an indolent clinical course and long survival. For these reasons, WDPM is best considered as a specific clinico-pathologic entity distinct from conventional diffuse malignant mesothelioma.

Well-Differentiated Papillary Mesothelioma
Kelly J. Butnor, M.D.; Thomas A. Sporn, M.D.; Samuel P. Hammar, M.D.; Victor L. Roggli, M.D.
From the Department of Pathology (K.J.B., T.A.S., V.L.R.), Duke University Medical Center, Durham, North Carolina; the Department of Pathology and Laboratory Services (V.L.R.), Durham Veterans Administration Medical Center, Durham, North Carolina; and Diagnostic Specialties Laboratory (S.P.H.), Bremerton, Washington, U.S.A.

Am J Surg Pathol 2001;25:1304-1309 Abstract quote
Well-differentiated papillary mesothelioma is an unusual variant of epithelial mesothelioma considered to be of low malignant potential. The majority of previously reported cases developed in the peritoneum of young women without a history of asbestos exposure.
The authors report 14 cases of well-differentiated papillary mesothelioma, seven of which originated in the pleura, six in the peritoneum, and one in the tunica vaginalis. Eleven of the patients were male and three were female, with an average age at presentation of 58 years (range 32–82 years). Six of the patients had a quantifiable history of asbestos exposure. Of the nine cases with complete follow-up, six had clinically indolent disease, one showed resolution after adjuvant chemotherapy, one pursued an aggressive course, and one died of other causes.
These findings indicate that well-differentiated papillary mesothelioma is a rare variant of mesothelioma with a variable clinical prognosis that is etiologically related to asbestos exposure in some cases.

RHABDOID

Mesothelioma with rhabdoid features: an ultrastructural and immunohistochemical study of 10 cases. Ordonez NG. 1Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Mod Pathol. 2006 Mar;19(3):373-83. Abstract quote Mesotheliomas with rhabdoid morphology are rare and only two individual case reports have been documented in the literature. This author reports a series of 10 cases of mesotheliomas with rhabdoid features, nine of which originated in the pleura and one in the peritoneum. Eight of the patients were men and two were women. Six patients had a history of asbestos exposure. Histologically, seven of the mesotheliomas were epithelioid, two sarcomatoid, and one biphasic. The proportion of the rhabdoid cells seen in these cases constituted 15-75% of the individual tumors. Cytoplasmic staining in the rhabdoid cells was seen for pan-keratin and vimentin in all 10 cases, for keratin 7 in eight of eight, for calretinin in nine of 10, and for keratin 5/6 in seven of nine. Nuclear positivity for WT1 was observed in the rhabdoid cells of four of seven cases and membranous reactivity for mesothelin in four of six, and for podoplanin in two of six. Only one case showed desmin positivity in sparse cells in the nonrhabdoid component of the tumor. All of the cases were negative for CEA, MOC-31, TAG-72, CD15, CD34, bcl2, muscle-specific actin, and TTF-1. Ultrastructural studies revealed paranuclear collections of intermediate filaments, but no evidence of rhabdomyoblastic differentiation was seen. The mean survival of five of the six patients for whom this information was available was 3.8 months. The remaining patient had a survival time of 1 year. It is important for pathologists to be aware that mesotheliomas can present rhabdoid features, not only because they can be confused with other malignancies that can exhibit a similar morphology, but also because of their apparently unusually aggressive behavior. The value of immunohistochemistry and electron microscopy in the differential diagnosis of these tumors is discussed.

SPECIAL STAINS/
IMMUNOPEROXIDASE/
OTHER

CHARACTERIZATION

GENERAL

Evaluation of 12 antibodies for distinguishing epithelioid mesothelioma from adenocarcinoma: identification of a three-antibody immunohistochemical panel with maximal sensitivity and specificity. Yaziji H, Battifora H, Barry TS, Hwang HC, Bacchi CE, McIntosh MW, Kussick SJ, Gown AM.

Mod Pathol. 2006 Apr;19(4):514-23. Abstract quote We evaluated the sensitivity and specificity of 10 monoclonal and two polyclonal antibodies for distinguishing epithelioid mesothelioma from adenocarcinoma (AdCA) using immunohistochemistry (IHC). The antibodies were directed against the mesothelial-associated antigens mesothelin, calretinin, cytokeratin 5, thrombomodulin, Wilms' tumor-1 (WT-1) gene product and HBME-1, and the nonmesothelial antigens Lewis-Y blood group (antibody BG8), MOC-31, BerEp4, CD15, and carcinoembryonic antigen (CEA) family. The 133 tumors evaluated included 65 malignant epithelioid mesotheliomas, 22 lung AdCAs, 27 ovarian serous carcinomas, 24 breast carcinomas, and five gastric carcinomas. Diagnoses were based on clinical, histologic, ultrastructural, and/or IHC findings. Calretinin had the best sensitivity for mesothelioma (95%), followed by HBME-1 (84%), WT-1 (78%), cytokeratin 5 (76%), mesothelin (75%), and vimentin and thrombomodulin (68%). Thrombomodulin had the best specificity for mesothelioma (92%), followed by cytokeratin 5 (89%), calretinin (87%) vimentin (84%), and HBME-1 (45%). When ovarian carcinomas were excluded from the analysis, the specificity of mesothelin and WT-1 for the diagnosis of mesothelioma increased to 90 and 81%, respectively. The sensitivity of the nonmesothelial antigens for AdCA was organ dependent, with BG8 performing best in the breast cancer group (96%), and BerEp4, BG8, MOC-31 performing best in the lung cancer group (100%). The specificity of the nonmesothelial antigens for AdCA was 98% for BG8 and CEA, 97% for CD15, 95% for BerEp4, and 87% for MOC-31. A novel statistical analysis technique employing logic regression analysis identified a three-antibody immunohistochemical panel including calretinin, BG8, and MOC-31, which provided over 96% sensitivity and specificity for distinguishing epithelioid mesothelioma from AdCA.

Diffuse malignant mesothelioma of the peritoneum and pleura, analysis of markers. Trupiano JK, Geisinger KR, Willingham MC, Manders P, Zbieranski N, Case D, Levine EA. Department of Pathology, Wake Forest University School of Medicine, Winston-Salem, NC, USA.

Mod Pathol. 2004 Apr;17(4):476-81. Abstract quote Diffuse malignant mesothelioma of the peritoneum is a rare diagnosis. Despite many histopathologic similarities between peritoneal and pleural tumors, clinical and prognostic features may be quite different. There is a paucity of data evaluating molecular features of peritoneal mesotheliomas. Therefore, we compared the results of a battery of immunohistochemical markers, some with therapeutic implications, in patients with primary peritoneal or pleural mesotheliomas. We examined 24 peritoneal and nine pleural malignant mesotheliomas with a battery of immunohistochemical markers (cytokeratin AE1/3, calretinin, c-kit/CD117, desmin, epidermal growth factor receptor (EGFR), estrogen receptors (ER), progesterone receptors (PR), MIB-1, and cleaved caspase-3) in an attempt to distinguish any differences in this tumor arising in these two distinct locations. The results indicate that the only marker to show a significant difference in its staining pattern between these two sites was EGFR (P=0.0004). In all, 92% (22/24) of peritoneal tumors demonstrated 3+ or 4+ immunoreactivity with EGFR, opposed to only 33% (3/9) pleural tumors. There was no significant difference in immunoreactivity between the pleural and peritoneal tumors with c-kit, ER, PR, cleaved caspase 3, calretinin, and desmin. There was a trend toward increased cytokeratin (P=0.07) and MIB-1 (P=0.08) expression in the peritoneal group. There was no significant difference in age, sex, or histologic subtype between the two locations. In conclusion, despite similarities between peritoneal and pleural mesothelioma, there are differences between this neoplasm arising in these two sites. The EGFR expression is more pronounced in peritoneal tumors compared to pleural tumors. The increased expression of EGFR in the peritoneal lesions may be of clinical significance with the recent emergence of epidermal growth factor receptor-targeted therapies.

The immunohistochemical diagnosis of mesothelioma: a comparative study of epithelioid mesothelioma and lung adenocarcinoma.
Ordonez NG.

Am J Surg Pathol. 2003 Aug;27(8):1031-51. Abstract quote A large number of immunohistochemical markers that can facilitate the distinction between epithelioid pleural mesotheliomas and pulmonary peripheral adenocarcinomas have recently become available.

The aim of this study is to compare the value of these new markers with others that are already commonly used for this purpose and to determine which are, at present, the best for discriminating between these malignancies.

Sixty epithelioid mesotheliomas and 50 lung adenocarcinomas were investigated for expression of the following markers: calretinin, cytokeratin 5/6, WT1, thrombomodulin, mesothelin, CD44S, HBME-1, N-cadherin, E-cadherin, MOC-31, thyroid transcription factor-1 (TTF-1), BG-8 (Lewisy), carcinoembryonic antigen (CEA), Ber-EP4, B72.3 (TAG-72), leu-M1 (CD15), CA19-9, epithelial membrane antigen (EMA), and vimentin. All (100%) of the mesotheliomas reacted for calretinin, cytokeratin 5/6, and mesothelin, 93% for WT1, 93% for EMA, 85% for HBME-1, 77% for thrombomodulin; 73% for CD44S, 73% for N-cadherin, 55% for vimentin, 40% for E-cadherin, 18% for Ber-EP4, 8% for MOC-31, 7% for BG-8, and none for CEA, B72.3, leu-M1, TTF-1, or CA19-9. Of the adenocarcinomas, 100% were positive for MOC-31, Ber-EP4, and EMA, 96% for BG-8, 88% for CEA, 88% for E-cadherin, 84% for B72.3, 74% for TTF-1, 72% for leu-M1, 68% for HBME-1, 48% for CD44S, 48% for CA19-9, 38% for mesothelin, 38% for vimentin, 30% for N-cadherin, 14% for thrombomodulin, 8% for calretinin, 2% for cytokeratin 5/6, and none for WT1.

After analyzing the results, it is concluded that calretinin, cytokeratin 5/6, and WT1 are the best positive markers for differentiating epithelioid malignant mesothelioma from pulmonary adenocarcinoma.

The best discriminators among the antibodies considered to be negative markers for mesothelioma are CEA, MOC-31, Ber-EP4, BG-8, and B72.3. A panel of four markers (two positive and two negative) selected based upon availability and which ones yield good staining results in a given laboratory is recommended.

Because of their specificity and sensitivity for mesotheliomas, the best combination appears to be calretinin and cytokeratin 5/6 (or WT1) for the positive markers and CEA and MOC-31 (or B72.3, Ber-EP4, or BG-8) for the negative markers. An extensive and detailed review of the literature is also provided.

Expression of calretinin, thrombomodulin, keratin 5, and mesothelin in lung carcinomas of different types: an immunohistochemical analysis of 596 tumors in comparison with epithelioid mesotheliomas of the pleura.
Miettinen M, Sarlomo-Rikala M.

Am J Surg Pathol 2003 Feb;27(2):150-8 Abstract quote Several immunohistochemical markers, among them calretinin, thrombomodulin (CD141), keratin 5, and mesothelin, have been documented or suggested as useful markers for positive identification of mesothelioma and to differentiate it from pulmonary adenocarcinoma; numerous studies have documented their variable specificity. However, expression of these markers in other types of lung carcinomas has not been systematically explored, although these tumors can enter in the differential diagnosis of mesothelioma.
In this study we immunohistochemically evaluated 596 lung carcinomas of different types for the four above-mentioned mesothelioma markers, all of which reacted with a great majority of epithelioid mesotheliomas studied for comparison. Calretinin expression was common in giant cell carcinomas (67%), small cell carcinomas (49%), and large cell carcinomas (38%), whereas it was rare in usual adenocarcinomas but slightly more common in those with neuroendocrine differentiation (11% and 17%, respectively). Thrombomodulin was present in all keratinizing squamous carcinomas and the great majority (87%) of nonkeratinizing tumors in a membrane-staining pattern. It was moderately common in small cell (27%) and large cell carcinomas (25%) but relatively rare in adenocarcinomas (13%). Keratin 5 was expressed in all keratinizing and the great majority (87%) of nonkeratinizing squamous carcinomas, and a majority of large cell carcinomas (56%) and some small cell carcinomas (27%). It was rare in acinar adenocarcinomas (12%) and absent in those with neuroendocrine differentiation. Mesothelin was present in more than half (53%) of adenocarcinomas and a minority (13%) of large cell carcinomas but was absent in small cell carcinomas. In squamous carcinomas it was more often seen in nonkeratinizing versus keratinizing tumors (31% vs 16%).
These results show that each of these "mesothelioma" markers reacts with different subsets of pulmonary carcinomas with a variable frequency; this should be considered when using these markers in the differential diagnosis of thoracic tumors.

Value of Thyroid Transcription Factor-1, E-Cadherin, BG8, WT1, and CD44S Immunostaining in Distinguishing Epithelial Pleural Mesothelioma From Pulmonary and Nonpulmonary Adenocarcinoma
Nelson G. Ordóñez, M.D.
From the University of Texas M.D. Anderson Cancer Center, Houston, Texas, U.S.A.

Am J Surg Pathol 2000;24:598-606 Abstract quote
The distinction between malignant pleural mesotheliomas and adenocarcinomas, particularly those originating in the lung, is a difficult diagnostic problem that can be facilitated by the use of immunohistochemical markers.
In this study, the immunoreactivity of thyroid transcription factor-1 (TTF-1), E-cadherin, BG8, WT1, and CD44S was investigated in 50 epithelial mesotheliomas, and 40 pulmonary and 95 nonpulmonary adenocarcinomas. After analyzing the results, it was concluded that E-cadherin and BG8 are useful markers for distinguishing between epithelial mesotheliomas and adenocarcinomas of various origins, including the lung.
Because TTF-1 expression is found almost exclusively in adenocarcinomas of the lung but is absent in mesotheliomas, immunostaining for this marker is particularly useful for distinguishing between these two malignancies. Although WT1 immunostaining may also be useful, its value, as determined in this study, is lower than that reported by other investigators. CD44S immunostaining does not have any practical value in discriminating between epithelial mesothelioma and lung adenocarcinoma.

Immunohistochemical Analysis Still Has a Limited Role in the Diagnosis of Malignant Mesothelioma A Study of Thirteen Antibodies
Fiona Roberts, MRCPath, Christina M. Harper, MBChB, Ian Downie, MSc, and Rodney A. Burnett, FRCPath

Am J Clin Pathol 2001;116:253-262 Abstract quote
To identify the most accurate and useful panel to diagnose mesothelioma, we immunostained sections from 112 mesotheliomas, 18 adenocarcinomas, and 11 reactive pleural specimens with 13 antibodies.
Positive results for mesotheliomas, adenocarcinomas, and reactive pleura, respectively, were CAM5.2, 111, 18, and 11; vimentin, 30, 3, and 3; HBME-1, 75, 10, and 8; thrombomodulin, 31, 2, and 2; calretinin, 43, 6, and 11; and CD44H, 68, 10, and 4. Positive results for adenocarcinoma markers in mesotheliomas and adenocarcinomas, respectively, were carcinoembryonic antigen, 1 and 15; LeuM1, 7 and 9; and Ber-EP4, 5 and 12. All reactive pleura were negative.
Positive results for markers to help distinguish mesothelioma from reactive pleura in mesotheliomas, adenocarcinomas, and reactive pleura, respectively, were epithelial membrane antigen, 76, 17, and 6; p53, 78, 16, and 9; P-170 glycoprotein, 37, 4, and 2; and platelet-derived growth factor receptor beta, 31, 1, and 2.
The differential diagnosis of mesothelioma from adenocarcinoma is based on negative markers. Individual mesothelial markers are of low sensitivity and specificity for mesothelioma. However, diagnostic accuracy is improved by the use of antibody panels. To date there are no antibodies that help distinguish mesothelioma from reactive pleura.

Use of a Panel of Markers in the Differential Diagnosis of Adenocarcinoma and Reactive Mesothelial Cells in Fluid Cytology
Ellen C. Ko, MD, Nirag C. Jhala, MD, Jana J. Shultz, MT(ASCP)SH, QIHC, and David C. Chhieng, MD

Am J Clin Pathol 2001;116:709-715 Abstract quote
To evaluate the use of a panel of markers to differentiate adenocarcinoma and reactive/ inflammatory process in fluid cytology, we stained 29 formalin-fixed, paraffin-embedded cell blocks of effusion fluid from patients with metastatic adenocarcinoma and 24 cell blocks from patients with benign effusion with mucicarmine and antibodies to carcinoembryonic antigen (CEA), B72.3, and calretinin.
Positive staining with CEA, B72.3, and mucicarmine was seen in 22 (76%),20 (69%), and 18 (60%) adenocarcinoma cases, respectively. All except 1 adenocarcinoma was negative for calretinin. No benign cases were positive for B72.3 and mucicarmine. In 1 benign case, scattered epithelial cells demonstrated weak positivity for CEA. The majority of combinations were 100% specific for adenocarcinoma. The highest sensitivity (86%) for adenocarcinomas was achieved with the staining combination of negative for calretinin and positive for any adenocarcinoma marker (CEA, B72.3, or mucicarmine).
The use of a panel of markers that recognize adenocarcinoma and mesothelial cells is useful in the differential diagnosis between metastatic adenocarcinoma and reactive/inflammatory process. The profile of positive staining with at least one of the adenocarcinoma markers and negative calretinin staining is highly specific and sensitive for identifying adenocarcinoma in fluid cytology.

The Role of Desmin and N-Cadherin in Effusion Cytology A Comparative Study Using Established Markers of Mesothelial and Epithelial Cells
Ben Davidson, M.D. , Ph.D. ; Søren Nielsen, C.T. ; Jette Christensen, C.T. ; Pia Asschenfeldt, M.D. ; Aasmund Berner, M.D. , Ph.D. ; Bjørn Risberg, M.D. , Ph.D. ; Preben Johansen, M.D.
From the Department of Pathology (Division of Cytology) (B.D., A.B., B.R.), Norwegian Radium Hospital, Oslo, Norway; and the Department of Pathology (S.N., J.C., P.A., P.J.), Aalborg Hospital, Aalborg, Denmark.

Am J Surg Pathol 2001;25:1405-1412 Abstract quote
The objective of the present study was to analyze the role of the mesothelial markers desmin and N-cadherin in the diagnostic panel of serous effusions.
A total of 181 pleural and peritoneal effusions consisted of 101 cases cytologically diagnosed as malignant (89 carcinomas, 12 mesotheliomas), 78 benign, and 2 inconclusive specimens. All specimens were immunostained using 11 antibodies, against epithelial membrane antigen, Ber-EP4, carcinoembryonic antigen, E-cadherin, CA 125, N-cadherin, desmin, calretinin, p53, vimentin, and CD45. After evaluation of immunocytochemistry results, 110 specimens were diagnosed as malignant (98 carcinomas, 12 mesotheliomas) and 71 as benign (56 cellular, 15 paucicellular). The presence of desmin was detected in benign mesothelial cells in 47 of 56 (84%) reactive cellular specimens compared with 1 of 12 (8%) malignant mesotheliomas and 2 of 98 (2%) carcinomas. N-cadherin was expressed in 48 of 56 (86%) reactive cases, 12 of 12 (100%) mesotheliomas, and 47 of 98 (48%) carcinomas.
In carcinomas, N-cadherin expression was most often seen in ovarian carcinoma but was also found in other carcinomas. Calretinin, an established marker of mesothelial cells, was detected in 52 of 56 (93%) reactive specimens, 11 of 12 (93%) mesotheliomas, and 3 of 98 (3%) carcinomas. Evaluation of staining results led to reclassification of six malignant specimens as benign, whereas 17 cases diagnosed as benign and the two diagnosed as inconclusive were classified as malignant.
In conclusion, desmin appears to be a promising marker for the distinction between reactive mesothelium and malignant epithelial cells in terms of both specificity and sensitivity, and its complementary use with calretinin is recommended. Unlike calretinin, it may also prove valuable for the distinction between benign and malignant mesothelial cells. N-cadherin does not have a role in the distinction between mesothelial and epithelial cells. However, it may prove useful in the characterization of carcinomas of unknown origin. As has previously been shown, a significant number of diagnoses that are based on morphologic examination alone are modified after the use of a broad antibody panel.

Immunohistochemical diagnosis of epithelioid mesotheliomas: A critical review of old markers, new markers.
Ordonez NG.
University of Texas M.D. Anderson Cancer Center, Houston, TX.

Hum Pathol 2002 Oct;33(10):953-67 Abstract quote Numerous new immunohistochemical markers that can be used in the diagnosis of mesothelioma have recently become available. As a result, new panels of antibodies that could be useful for distinguishing between epithelioid mesotheliomas and adenocarcinomas have been proposed. However, great differences of opinion exist regarding the individual value of some of these markers, especially when compared with those whose value has already been established.
This article provides a critical review of the currently available information on those markers that could be useful in the diagnosis of epithelioid mesotheliomas or whose utility remains controversial. A practical approach to the diagnosis of these tumors is also provided.

h-CALDESMON

h-Caldesmon, a Useful Positive Marker in the Diagnosis of Pleural Malignant Mesothelioma, Epithelioid Type. Comin CE, Dini S, Novelli L, Santi R, Asirelli G, Messerini L. Department of Human Pathology and Oncology, University of Florence Medical School, Florence, Italy.

Am J Surg Pathol. 2006 Apr;30(4):463-9. Abstract quote Although a large number of immunohistochemical markers that can facilitate the differential diagnosis between epithelioid pleural mesothelioma and lung adenocarcinoma involving the pleura have proven to be valuable, no single antibody has demonstrated absolute sensitivity and/or specificity in making this distinction. Using immunohistochemical analysis with h-caldesmon, a specific marker for smooth muscle tumors, we examined 70 cases of epithelial mesotheliomas and 70 cases of lung adenocarcinomas. In addition, immunohistochemistry for muscle markers, such as desmin, alpha-smooth-muscle actin, muscle-specific actin, myoglobin, myogenin, myosin, and MyoD-1, was performed on all mesothelioma cases. Reactivity for h-caldesmon was obtained in 68 (97%) of the 70 epithelial mesotheliomas, but in none of the adenocarcinoma cases. All mesothelioma cases were found to be negative for the other muscle markers examined. We conclude that h-caldesmon is a highly sensitive and specific marker and suggest its inclusion in the immunohistochemical panel for the differential diagnosis of epithelioid mesothelioma versus lung adenocarcinoma.

CALRETININ

Calretinin and Other Mesothelioma Markers in Synovial Sarcoma Analysis of Antigenic Similarities and Differences With Malignant Mesothelioma
Markku Miettinen, etal.

Am J Surg Pathol 2001;25:610-617 Abstract quote
Synovial sarcoma (SS) is a mesenchymal neoplasm that typically shows epithelial differentiation. SS commonly metastasizes to lung and pleura, and has also been reported as the primary in these locations. The histologic distinction of SS from mesothelioma may be difficult because of the combination of epithelioid and spindle cells, potentially shared locations, and antigenic expression.
In this study the authors examined 103 well-documented SSs including 41 biphasic, 44 monophasic, and 18 poorly differentiated SSs in comparison with 23 epithelioid and seven sarcomatous mesotheliomas. Most biphasic SSs (29 of 41, 71%) had fields or foci of calretinin-positive tumor cells. The spindle cell components were more often positive (55%), whereas 14% of tumors had positive epithelial cells.
The monophasic and poorly differentiated SSs commonly had foci of calretinin-positive cells (in 52% and 56% of cases respectively). In comparison, all 23 epithelioid mesotheliomas (EM) were extensively calretinin positive and seven sarcomatoid mesotheliomas were variably calretinin positive. HBME-1 positivity was similarly detected in biphasic SS and EM (100% and 87% respectively). Among the other sarcomas, two of 15 malignant peripheral nerve sheath tumors were focally calretinin positive, whereas 16 epithelioid sarcomas, 20 leiomyosarcomas, 20 gastrointestinal stromal tumors, and 20 angiosarcomas were negative. Biphasic SSs differed from mesotheliomas by their more common BerEp4 positivity (90%) whereas EMs showed focal reactivity in 13% cases. Marked CD15 reactivity was rare in both. Wilms tumor protein-1 (WT1) was not detected in SS, but was present in 12 of 17 EMs. CD141 was rare in SS, limited to spindle cell components, whereas EMs typically showed prominent membrane staining in epithelial cells. Simple epithelial keratins were present in all epithelial cells of biphasic SS and mesothelioma (keratin 7[K7], K19), but were only focal in monophasic and poorly differentiated SS. Biphasic SSs were extensively K14 positive (89% of cases), whereas epithelial and sarcomatoid mesotheliomas typically showed only scattered positive cells.
The potentially shared calretinin patterns in SS and mesothelioma require the use of other markers. The discriminating features include extensive BerEp4 positivity, rarity of CD141, and lack of WT1 in SS. Global expression of K7 and K19 in mesotheliomas versus focal expression in monophasic and poorly differentiated SSs, and differential patterns of K14 expression may also be helpful.

CYTOKERATIN

Expression of Cytokeratin 5/6 in Epithelial Neoplasms: An Immunohistochemical Study of 509 Cases
Peiguo G. Chu, M.D., Ph.D. and Lawrence M. Weiss, M.D.
Department of Pathology, City of Hope National Medical Center, Duarte, California Correspondence: Address reprint requests to: Peiguo G. Chu, M.D., Ph.D., Department of Pathology, City of Hope National Medical Center, 1500 East Duarte Road, Duarte, CA 91010.

Mod Pathol 2002;15:6-10 Abstract quote
Cytokeratin 5/6 (CK 5/6) immunoreactivity has been observed in the vast majority of cases of malignant mesothelioma but only rarely in pulmonary adenocarcinomas. Thus, CK 5/6 has been used to distinguish malignant mesothelioma from pulmonary adenocarcinoma. However, the utility of CK 5/6 in distinguishing pleural malignant mesothelioma from pleural metastases from nonpulmonary adenocarcinoma, as well as peritoneal malignant mesothelioma from peritoneal metastatic adenocarcinoma, has not yet been adequately addressed because the tissue expression of CK 5/6 in nonpulmonary neoplasms has not been well defined.
We have studied the CK 5/6 expression in 509 cases of various epithelial tumors by immunohistochemistry. We found that the vast majority of cases of squamous cell carcinoma, basal cell carcinoma, thymoma, salivary gland tumor, and biphasic malignant mesothelioma were positive for CK 5/6. In addition, CK 5/6 immunoreactivity was detected in 15 of 24 cases (62%) of transitional cell carcinoma, in 5 of 10 cases (50%) of endometrial adenocarcinoma, in about one third of cases of pancreatic adenocarcinoma (38%) and breast adenocarcinoma (31%), and in one quarter of cases of ovarian adenocarcinomas (25%).
Our study confirms the diagnostic utility of CK 5/6 immunohistochemistry in distinguishing biphasic mesothelioma from pulmonary adenocarcinoma but raises caution about its use for the differential diagnosis of pleural or peritoneal malignant mesothelioma versus pleural or peritoneal metastatic nonpulmonary adenocarcinoma, because many types of nonpulmonary adenocarcinomas may be positive for CK 5/6.

ESTROGEN AND PROGESTERONE RECEPTORS

Value of estrogen and progesterone receptor immunostaining in distinguishing between peritoneal mesotheliomas and serous carcinomas. Ordonez NG. Department of Pathology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA.

Hum Pathol. 2005 Nov;36(11):1163-7. Epub 2005 Sep 22. Abstract quote The differential diagnosis between peritoneal mesotheliomas and serous carcinomas involving the peritoneum may be difficult, but it can be facilitated by the use of immunohistochemistry. To determine whether estrogen receptors (ER) or progesterone receptors (PR) may have any value as immunohistochemical markers for discriminating between these malignancies, 40 serous carcinomas of the ovary metastatic to the peritoneum, 7 primary peritoneal serous carcinomas, 30 epithelioid peritoneal malignant mesotheliomas, 5 well-differentiated papillary mesotheliomas, and 4 adenomatoid tumors were immunostained for ER and PR. Reactivity for ER was obtained in 35 (88%) of the metastatic serous carcinomas of the ovary and 6 (86%) of the primary peritoneal serous carcinomas, whereas positivity for PR was observed in 24 (60%) of the metastatic serous carcinomas and 4 (56%) of the primary peritoneal serous carcinomas. None of the mesotheliomas or adenomatoid tumors expressed ER or PR. It is concluded that, because of its high sensitivity for serous carcinomas, ER immunostaining could be very useful in distinguishing between serous carcinomas and peritoneal mesotheliomas. Immunostaining for PR, however, has little practical utility.

HER2-NEU (c-ERB-B2)

Malignant mesothelioma does not demonstrate overexpression or gene amplification despite cytoplasmic immunohistochemical staining for c-Erb-B2.
Horvai AE, Li L, Xu Z, Kramer MJ, Jablons DM, Treseler PA.
Department of Pathology, University of California, San Francisco 94143, USA.

Arch Pathol Lab Med 2003 Apr;127(4):465-9 Abstract quote BACKGROUND: Previous studies have shown conflicting results regarding the expression of c-Erb-B2 in malignant mesothelioma. Overexpression of the c-erb-B2 gene product in a subset of mesothelioma may have prognostic or therapeutic implications.
OBJECTIVE: To determine whether malignant mesothelioma demonstrates c-Erb-B2 overexpression and, if so, whether such overexpression correlates with gene amplification.
METHODS: Immunohistochemistry, reverse transcription-polymerase chain reaction, and fluorescent in situ hybridization were used to analyze archived tissue from 37 cases of malignant mesothelioma.
RESULTS: Although immunohistochemical staining for c-Erb-B2 was detected in most mesotheliomas, the staining was cytoplasmic and was not consistent between the 2 different primary antibodies used. Moreover, even cases with strong cytoplasmic staining for c-Erb-B2 did not demonstrate increased messenger RNA levels or gene copy numbers compared to cases that demonstrated no staining.
CONCLUSIONS: Cytoplasmic immunoreactivity for c-Erb-B2 in mesothelioma does not represent gene overexpression or amplification and may be an immunohistochemical artifact.

MESOTHELIN

Value of mesothelin immunostaining in the diagnosis of mesothelioma.
Ordonez NG.
University of Texas M.D. Anderson Cancer Center, Houston, Texas.

Mod Pathol 2003 Mar;16(3):192-7 Abstract quote Mesothelin is a cell surface antigen of unknown function that is strongly expressed in mesothelial cells. Although it was reported in 1992 that immunostaining with the K1 anti-mesothelin antibody could be very useful in distinguishing between epithelioid mesotheliomas and pulmonary adenocarcinomas, no further studies have been published on the value of this marker in the diagnosis of mesotheliomas.
To determine whether mesothelin can assist in discriminating epithelioid mesotheliomas from lung adenocarcinomas or from other carcinomas metastatic to the serosal membranes, 55 mesotheliomas (44 epithelioid, 3 biphasic, and 8 sarcomatoid), 48 carcinomas of the lung (31 adenocarcinomas, 17 squamous carcinomas), and 86 nonpulmonary adenocarcinomas (14 ovary, 5 peritoneum, 9 endometrium, 11 pancreas, 4 stomach, 16 colon, 12 breast, 9 kidney, 4 thyroid, and 2 prostate) were investigated for mesothelin expression using the recently available 5B2 anti-mesothelin monoclonal antibody.
Reactivity was obtained in all 44 (100%) of the epithelioid mesotheliomas, 12 (39%) of the lung adenocarcinomas, and 42 (49%) of the nonpulmonary adenocarcinomas (14 [100%] ovary; 5 [100%] peritoneum; 6 [67%] endometrium; 10 [91%] pancreas; 2 [50%] stomach; 5 [31%] colon; and in none [0] of the breast, kidney, thyroid, or prostate). Three (18%) of the squamous carcinomas of the lung, but none of the sarcomatoid mesotheliomas, exhibited positivity for this marker, nor was any reactivity seen in the spindle cell component of the biphasic mesotheliomas. It is concluded that despite the low specificity of mesothelin for discriminating between epithelioid mesotheliomas and adenocarcinomas, immunostaining for this marker may have some utility in those instances in which the results obtained with the standard panel of immunohistochemical markers used for the diagnosis of mesotheliomas are equivocal.
Because mesothelin is a highly sensitive positive marker for epithelioid mesotheliomas, a negative staining for this marker is an indication against such a diagnosis; however, because of its limited utility, it is not recommended for inclusion in the standard panel of immunohistochemical markers used in the distinction between mesotheliomas and adenocarcinomas.

MUC4

Diagnostic value of MUC4 immunostaining in distinguishing epithelial mesothelioma and lung adenocarcinoma.

Llinares K, Escande F, Aubert S, Buisine MP, de Bolos C, Batra SK, Gosselin B, Aubert JP, Porchet N, Copin MC.

Unite INSERM U560 Laboratoire de Recherche Gerard Biserte, Place de Verdun, Lille, France.

Mod Pathol. 2004 Feb;17(2):150-7. Abstract quote

The distinction between pleural malignant mesothelioma and pleural infiltration by adenocarcinomas has complex therapeutic and medicolegal implications.

Although the panel of adenocarcinoma-associated antibodies and one or two mesothelioma markers is useful in this purpose, most of these antibodies are not totally specific. We determined the diagnostic value of MUC4 immunostaining in this issue. MUC4 gene expression was also studied by in situ hybridization and RT-PCR. MUC4 is a membrane-bound mucin that has been suggested to be implicated in malignant progression in humans and rats. The MUC4 gene is expressed in various normal epithelial tissues of endodermic origin and carcinomas. In the respiratory tract, MUC4 transcripts have been detected in normal respiratory epithelium and lung carcinomas. MUC4 protein was expressed in 32 of 35 (91.4%) lung adenocarcinomas on paraffin-embedded tissue. None of the 41 malignant mesotheliomas nor the 32 cases of benign mesothelial cells expressed MUC4 at the protein and mRNA levels.

We conclude that MUC4 is a very specific (100%) and sensitive (91.4%) marker of lung adenocarcinomas on paraffin-embedded tissue that could be useful in diagnostic practice in the distinction between malignant mesothelioma and adenocarcinoma.

TELOMERASE REVERSE TRANSCRIPTASE

Expression of Telomerase Reverse Transcriptase (TERT) in Malignant Mesotheliomas Fumiyuki Kumaki, M.D.; Toshiaki Kawai, M.D., Ph.D.; Andrew Churg, M.D.; Françoise B. Galateau-Sallé, M.D.; Philip Hasleton, M.D.; Douglas Henderson, M.D.; Victor Roggli, M.D.; William D. Travis, M.D.; Philip T. Cagle, M.D.; * Victor J. Ferrans, M.D., Ph.D.
From the Pathology Section, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, U.S.A. (F.K., V.J.F.); National Defense Medical College, Tokorozawa, Japan (T.K.); University of British Columbia, Vancouver, Canada (A.C.); Center Hospitalier Regional et Universitaire de Caen, France (F.B.G.S.); University of Manchester, Manchester, U.K. (P.H.); Flinders Medical Center, Bedford Park, Australia (D.H.); Duke University Medical Center, Durham, North Carolina, U.S.A. (V.R.); Armed Forces Institute of Pathology, Washington, DC, U.S.A. (W.D.T.); and Baylor College of Medicine, Houston, Texas, U.S.A. (P.T.C.).

Am J Surg Pathol 2002;26:365-370 Abstract quote To evaluate the usefulness of determinations of telomerase activity for distinguishing malignant from benign mesothelial lesions, immunohistochemical (using a rabbit polyclonal antibody and the peroxidase method; n = 68) and in situ hybridization (using sense and antisense oligonucleotide probes; n = 46) studies were made on malignant mesotheliomas (epithelioid, 39; sarcomatoid, 18, including 2 of the desmoplastic type; and biphasic, 11) and 19 benign mesothelial lesions (benign mesothelial hyperplasia, 3; and reactive pleuritis, 16). In addition, biochemical studies of telomerase activity were made in 9 of the malignant mesotheliomas.
Telomerase activity was detected histochemically in all but one of the malignant mesotheliomas, but only in one (pleuritis) of the benign lesions, in which it was present only in activated lymphocytes. Antisense hybridization signals indicated the presence of telomerase mRNA mainly in the cytoplasm of the malignant cells. Sense probes gave negative results. Biochemical determinations revealed a strong telomerase activity in the 9 malignant mesotheliomas examined.
This study demonstrates the usefulness of immunohistochemical staining for the evaluation of mesotheliomas. The required immunostaining can be performed using paraffin sections of formalin-fixed tissues.

DIFFERENTIAL DIAGNOSIS

KEY DIFFERENTIATING FEATURES

Fibrous Pleurisy

Desmoplastic Mesothelioma

Cellularity greatest immediately under effusion, becomes more fibrotic away from effusion showing sidedness or zonation

No zonation, bulk of lesion is paucicellular, may have abrupt transitions to cellular, frankly sarcomatous foci anywhere in the lesion

Cells immediately under effusion may be very atypical

Cytologic atypia often hard to discern

Capillaries perpendicular to pleural surface

Capillaries inconspicuous

No stromal invasion

Stromal invasion

No necrosis

Bland necrosis

No sarcomatous foci

Sarcomatous foci

No nodular expansion of stroma

Nodular expansions of stroma sometimes present

Malignant epithelioid vascular tumors of the pleura: report of a series and literature review.
Zhang PJ, Livolsi VA, Brooks JJ.
Department of Pathology, Roswell Park Cancer Institute, Buffalo, NY, USA.

Hum Pathol 2000 Jan;31(1):29-34 Abstract quote
Primary malignant vascular tumors of the pleura are rare. The significance and difficulty of distinction between pleural epithelioid hemangioendothelioma (EHE) and angiosarcoma have not yet been addressed.
A new series of pleural angiosarcoma is reported, and the relevant literature is reviewed. Five cases were identified from files of the authors' institutions and personal consultation cases (J.J.B.). Twenty-six cases of primary malignant vascular tumors of the pleura were identified in the literature. In a total of 31 cases, 22 were from the West and 9 from Japan. Patients were 22 to 79 years old (average, 57), and the male/female ratio was 9:1. Prior chronic pyothorax was identified only in cases reported from Japan. History of exposure to radiation or asbestos was noted in a few Western cases. The most common presentation was pleural thickening and effusion. Almost all of the patients died of disease shortly after diagnosis.
A spectrum of histology ranging from characteristic high-grade epithelioid to relatively low-grade EHE-like features was observed in our cases and can be found in previous reports. Most cases showed variable spotty cytokeratin immunoreactivity. Endothelial markers (factor 8, CD34, or CD31) were invariably positive.
Pleural angiosarcomas are often epithelioid and can be easily mistaken for mesothelioma or carcinoma clinically and histologically. Awareness of this rare tumor should prompt the use of endothelial markers when faced with a questionable mesothelioma. When cytokeratin is negative, or focal with strong vimentin reactivity, a vascular tumor should be suspected and confirmed with vascular markers. Because of their invariably aggressive behavior, all epithelioid vascular tumors of the pleura should be considered highly malignant regardless of the presence of EHE-like histological features.

The Separation of Benign and Malignant Mesothelial Proliferations
Churg A, Green FHY, eds.; US–Canadian Mesothelioma Reference Panel:Andrew Churg M.D. Chairman Thomas V. Colby M.D. Secretary Philip Cagle M.D. Joseph Corson M.D. Allen R. Gibbs Blake Gilks M.D. Margaret Grimes M.D. Samuel Hammar M.D. Victor Roggli M.D. William D. Travis M.D. The principal authors of this report are A. Churg V. Roggli T. Colby
From the University of British Columbia, Vancouver, BC, Canada (A.C.); Mayo Clinic, Scottsdale, Arizona, U.S.A. (T.V.C.); Baylor College of Medicine, Houston, Texas, U.S.A. (P.C.); Harvard Medical School, Boston, Massachusetts, U.S.A. (J.C.); Llandough Hospital, Cardiff, Wales, U.K. (A.R.G.); University of British Columbia, Vancouver, BC, Canada (B.G.); Medical College of Virginia, Richmond, Virginia, U.S.A. (M.G.); Diagnostic Specialties Lab, Bremerton, Washington, U.S.A. (S.H.); Duke University School of Medicine, Durham, North Carolina (V.R.); and the Armed Forces Institute of Pathology, Washington, DC, U.S.A. (W.D.T.).

Am J Surg Pathol 2000;24:1183-1200 Abstract quote
The separation of benign from malignant mesothelial proliferations has emerged as a major problem in the pathology of the serosal membranes.
For both epithelial and spindle cell mesothelial processes, true stromal invasion is the most accurate indicator of malignancy, but stromal invasion is often difficult to assess, especially in small biopsies.
In the pleural cavity, deep penetration of a thickened and fibrotic pleura or penetration of mesothelial cells into the fat of the chest wall are good indicators of malignancy; however, superficial entrapment of mesothelial cells and glands by organizing effusions is common in benign reactions and needs to be distinguished from invasion.
In the peritoneal cavity, invasion of fat or of organ walls is again the most reliable indicator of malignancy, but entrapment of benign cells in organizing granulation tissue or between fat lobules is frequent and confusing. Proliferations confined to the pleural or peritoneal space, particularly linear arrays of atypical mesothelial cells on the free surface, should not be called malignant in the absence of unequivocal invasion.
Cytologic atypia is often not helpful in separating benign from malignant reactions, because benign processes are commonly atypical and mesotheliomas are often deceptively monotonous. Densely packed mesothelial cells within the pleural space are frequent in benign reactions, but densely packed mesothelial cells within the stroma favor a diagnosis of malignancy. Organizing effusions (fibrous pleurisy) typically show zonation with high cellularity and cytologic atypia toward the pleural space and increasing fibrosis with decreasing cellularity and lesser atypia toward the chest wall, whereas sarcomatous (including desmoplastic) mesotheliomas do not demonstrate this type of zonation. Elongated capillaries perpendicular to the pleural surface are seen in organizing effusions but are not a feature of sarcomatous mesotheliomas.
The combination of a paucicellular storiform pattern, plus invasion of the stroma (including fat and adjacent tissues), or bland necrosis, overtly sarcomatous foci, or distant metastases, is required for the diagnosis of desmoplastic mesothelioma.
Necrosis is usually a sign of malignancy but is occasionally seen in benign mesothelial reactions. Keratin staining is useful in indicating the distribution of mesothelial cells, and particularly in demonstrating penetration of mesothelial cells into the stroma or adjacent structures, but is of no help in separating benign and malignant proliferations because both are keratin-positive.
Although both p53 and EMA staining have been proposed as markers of mesothelial malignancy, in our experience they are not helpful for the individual case.

Calretinin and Other Mesothelioma Markers in Synovial Sarcoma Analysis of Antigenic Similarities and Differences With Malignant Mesothelioma
Markku Miettinen, etal.

Am J Surg Pathol 2001;25:610-617 Abstract quote
Synovial sarcoma (SS) is a mesenchymal neoplasm that typically shows epithelial differentiation. SS commonly metastasizes to lung and pleura, and has also been reported as the primary in these locations. The histologic distinction of SS from mesothelioma may be difficult because of the combination of epithelioid and spindle cells, potentially shared locations, and antigenic expression.
In this study the authors examined 103 well-documented SSs including 41 biphasic, 44 monophasic, and 18 poorly differentiated SSs in comparison with 23 epithelioid and seven sarcomatous mesotheliomas.
Most biphasic SSs (29 of 41, 71%) had fields or foci of calretinin-positive tumor cells. The spindle cell components were more often positive (55%), whereas 14% of tumors had positive epithelial cells. The monophasic and poorly differentiated SSs commonly had foci of calretinin-positive cells (in 52% and 56% of cases respectively). In comparison, all 23 epithelioid mesotheliomas (EM) were extensively calretinin positive and seven sarcomatoid mesotheliomas were variably calretinin positive. HBME-1 positivity was similarly detected in biphasic SS and EM (100% and 87% respectively). Among the other sarcomas, two of 15 malignant peripheral nerve sheath tumors were focally calretinin positive, whereas 16 epithelioid sarcomas, 20 leiomyosarcomas, 20 gastrointestinal stromal tumors, and 20 angiosarcomas were negative. Biphasic SSs differed from mesotheliomas by their more common BerEp4 positivity (90%) whereas EMs showed focal reactivity in 13% cases. Marked CD15 reactivity was rare in both. Wilms tumor protein-1 (WT1) was not detected in SS, but was present in 12 of 17 EMs. CD141 was rare in SS, limited to spindle cell components, whereas EMs typically showed prominent membrane staining in epithelial cells. Simple epithelial keratins were present in all epithelial cells of biphasic SS and mesothelioma (keratin 7[K7], K19), but were only focal in monophasic and poorly differentiated SS. Biphasic SSs were extensively K14 positive (89% of cases), whereas epithelial and sarcomatoid mesotheliomas typically showed only scattered positive cells.
The potentially shared calretinin patterns in SS and mesothelioma require the use of other markers. The discriminating features include extensive BerEp4 positivity, rarity of CD141, and lack of WT1 in SS. Global expression of K7 and K19 in mesotheliomas versus focal expression in monophasic and poorly differentiated SSs, and differential patterns of K14 expression may also be helpful.

LUNG-SQUAMOUS CELL CARCINOMA

The diagnostic utility of immunohistochemistry in distinguishing between epithelioid mesotheliomas and squamous carcinomas of the lung: a comparative study. Ordonez NG. 1Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Mod Pathol. 2006 Mar;19(3):417-28. Abstract quote As both mesotheliomas and squamous carcinomas can present a wide variety of morphological patterns, they can on occasion be confused. Recently, some groups of investigators have called attention to the difficulties that sometimes exist in distinguishing between these malignancies and the need to define a panel of markers that can assist in reaching the correct diagnosis. The aim of the present study is to compare the value of the various immunohistochemical markers currently available for the diagnosis of mesothelioma and squamous carcinoma of the lung. A total of 30 epithelioid pleural mesotheliomas exhibiting a solid or predominantly solid pattern, and 30 nonkeratinizing squamous carcinomas of the lung were investigated for the expression of the following markers: podoplanin, calretinin, mesothelin, WT1, keratin 5/6, keratin 7, p63, carcinoembryonic antigen (CEA), MOC-31, Ber-EP4, B72.3, BG-8 (Lewis(y)), leu-M1 (CD15), and thyroid transcription factor-1 (TTF-1). All 30 (100%) of the mesotheliomas reacted for calretinin, mesothelin and keratin 7, 93% each for podoplanin, WT1 and keratin 5/6, 13% for Ber-EP4, 7% each for p63, MOC-31 and BG-8, and 0% for B72.3, CEA, leu-M1 and TTF-1. All 30 (100%) of the squamous carcinomas were positive for p63 and keratin 5/6, 97% for MOC-31, 87% for Ber-EP4, 80% for BG-8, 77% for CEA, 57% for keratin 7, 40% for calretinin and B72.3, 30% for leu-M1, 27% for mesothelin, 15% for podoplanin, and 0% for WT 1 and TTF-1. After analyzing the results, it is concluded that from a practical point-of-view, a combination of two positive mesothelioma markers (WT1 and calretinin or mesothelin) with two negative mesothelioma markers (p63 and MOC-31) would allow the differential diagnosis to be established between epithelioid mesotheliomas and squamous carcinomas of the lung in nearly all instances.

PLEURAL AMYLOIDOSIS

Pleural amyloidosis mimicking mesothelioma: A clinicopathologic study of two cases

Amy L. Adams, MD
Claudia Y. Castro, MD
Satinder P. Singh, MD
Cesar A. Moran, MD
From the Departments of Pathology and Radiology, The University of Alabama at Birmingham, AL.

Ann Diagn Pathol 5: 229-232, 2001. Abstract quote
Two cases of pleural amyloidosis are presented. The patients are two men, 70 and 72 years of age respectively. Neither patient had evidence of systemic amyloidosis. Each presented clinically with symptoms of chest pain and dyspnea. Radiologically, both patients showed diffuse pleural thickening similar to that observed in malignant mesothelioma. In both patients, surgical decortication of the pleura was performed.
Histologically, the lesions were characterized by the presence of an amorphous eosinophilic material with focal collections of a lymphoplasmacytic infiltrate. Focal clusters of giant cells were admixed with the lymphoplasmacytic infiltrate. Histochemical stains for Congo red showed strong positive apple-green birefringency. Immunohistochemical studies using kappa and lambda light chains showed polyclonality. The cases discussed herein represent an unusual presentation of amyloid and one that needs to be considered in the differential diagnosis of malignant mesothelioma.

OVARIAN AND PERITONEAL SEROUS TUMORS

The diagnostic utility of immunohistochemistry and electron microscopy in distinguishing between peritoneal mesotheliomas and serous carcinomas: a comparative study. Ordonez NG. 1Department of Pathology, MD Anderson Cancer Center, The University of Texas, TX, USA.

Mod Pathol. 2006 Jan;19(1):34-48. Abstract quote The histologic distinction between peritoneal epithelioid mesotheliomas and serous carcinomas diffusely involving the peritoneum may be difficult, but it can be facilitated by the use of immunohistochemistry and electron microscopy. D2-40 and podoplanin are two recently recognized lymphatic endothelial markers that can be expressed in normal mesothelial cells and mesotheliomas. The purpose of this study is to compare the value of these new mesothelial markers with those that are commonly used for discriminating between mesotheliomas and serous carcinomas, and also to determine the current role of electron microscopy in distinguishing between these malignancies. A total of 40 peritoneal epithelioid mesotheliomas and 45 serous carcinomas of the ovary (15 primary, 30 metastatic to the peritoneum) were investigated for the expression of the following markers: D2-40, podoplanin, calretinin, keratin 5/6, thrombomodulin, MOC-31, Ber-EP4, B72.3 (TAG-72), BG-8 (Lewis(Y)), CA19-9, and leu-M1 (CD15). All 40 (100%) of the mesotheliomas reacted for calretinin, 93% for D2-40, 93% for podoplanin, 93% for keratin 5/6, 73% for thrombomodulin, 13% for Ber-EP4, 5% for MOC-31, 3% for BG-8, and none for B72.3, CA19-9, or leu-M1. All 45 (100%) serous carcinomas were positive for Ber-EP4, 98% for MOC-31, 73% for B72.3, 73% for BG-8, 67% for CA19-9, 58% for leu-M1, 31% for keratin 5/6, 31% for calretinin, 13% for D2-40, 13% for podoplanin, and 4% for thrombomodulin. After analyzing the results, it is concluded that Ber-EP4 and MOC-31 are the best negative mesothelioma markers for differentiating between epithelioid mesotheliomas and serous carcinomas. The best discriminators among the positive markers for mesotheliomas are D2-40, podoplanin, and calretinin. From a practical point of view, Ber-EP4 and MOC-31, in combination with calretinin, and/or D2-40 or podoplanin allow the differential diagnosis to be established between mesothelioma and serous carcinoma in nearly all instances. As a clear distinction could be made between these two malignancies in all of the cases in which electron microscopy was performed, this technique can be very useful in establishing the correct diagnosis when the immunohistochemical results are equivocal or further support of a diagnosis of either mesothelioma or serous carcinoma is needed.

Differential Expression of WT-1 in Serous Carcinomas in the Peritoneum With or Without Associated Serous Carcinoma in Endometrial Polyps. Euscher ED, Malpica A, Deavers MT, Silva EG. From the Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, TX.

Am J Surg Pathol. 2005 Aug;29(8):1074-8. Abstract quote Although differential WT-1 expression between ovarian and uterine serous carcinoma has been discussed in the literature, there have been no studies of WT-1 expression in serous carcinomas in the peritoneum with or without concurrent serous carcinoma in an endometrial polyp. This study addresses this issue and includes a small series of uterine and ovarian serous carcinomas for comparison. Nine peritoneal serous carcinomas with coexistent serous carcinoma in an endometrial polyp, 10 peritoneal serous carcinomas without serous carcinoma in an endometrial polyp, 9 uterine serous carcinomas, and 12 ovarian serous carcinomas were stained with antibody to WT-1. Ninety-two percent of ovarian serous carcinomas and 80% of peritoneal serous carcinomas without serous carcinoma involving an endometrial polyp expressed WT-1. In contrast, 12% of peritoneal serous carcinomas with serous carcinoma in an endometrial polyp expressed WT-1 with the serous carcinoma in the endometrial polyp staining concordantly. For uterine serous carcinoma without an endometrial polyp, only 11% expressed WT-1. Peritoneal serous carcinomas without coexistent serous carcinoma in an endometrial polyp have a WT-1 expression pattern similar to ovarian serous carcinoma while peritoneal serous carcinomas with coexistent serous carcinoma in an endometrial polyp have a staining pattern similar to uterine serous carcinoma. The difference in WT-1 expression among serous carcinomas suggests a difference in biology based on the site of origin. Additionally, the difference in WT-1 expression between peritoneal serous carcinomas with and without coexistent serous carcinoma in endometrial polyps suggests that peritoneal serous carcinoma may have different pathogenetic pathways.

Value of mesothelial and epithelial antibodies in distinguishing diffuse peritoneal mesothelioma in females from serous papillary carcinoma of the ovary and peritoneum.
Attanoos RL, Webb R, Dojcinov SD, Gibbs AR.
Department of Histopathology, Llandough Hospital, Cardiff & Vale NHS Trust, Penarth, UK.

Histopathology 2002 Mar;40(3):237-44 Abstract quote Value of mesothelial and epithelial antibodies in distinguishing diffuse peritoneal mesothelioma in females from serous papillary carcinoma of the ovary and peritoneum
Aims: To evaluate the role of mesothelial markers (calretinin, thrombomodulin, cytokeratin 5/6, and CD44H) and carcinoma markers (polyclonal and monoclonal carcinoembryonic antigen, Leu-M1, CA-125 and Ber-EP4) in distinguishing diffuse peritoneal malignant mesothelioma from primary serous papillary adenocarcinoma of the ovary and peritoneum.
Methods and results: Paraffin-embedded formalin-fixed blocks from 32 diffuse peritoneal mesotheliomas of epithelial subtype (all females), 20 serous papillary ovarian carcinomas and three primary peritoneal serous papillary carcinomas were studied. Calretinin and Ber-EP4 appeared to be the best positive mesothelial and carcinoma marker, respectively. Nuclear calretinin expression was identified in 28 of 32 malignant mesotheliomas with no nuclear immunoreactivity in the cohorts of serous papillary ovarian and peritoneal carcinomas, thus yielding 88% sensitivity and 100% specificity. Ber-EP4 showed 95% sensitivity and 91% specificity for serous papillary ovarian carcin- oma. Thrombomodulin, cytokeratin 5/6 and CD44H immunoreactivities were seen in 18 (56%), 17 (53%) and 15 (47%) of peritoneal mesotheliomas, respectively, and in six (30%), five (25%) and five (25%) of the ovarian tumours, respectively. None of the three primary peritoneal serous papillary carcinomas expressed calretinin, thrombomodulin, cytokeratin 5/6 or CD44H. Polyclonal and monoclonal CEA, and Leu-M1 were expressed by two (10%), one (5%) and seven (35%) serous papillary ovarian carcinomas, respectively. None of the serous papillary peritoneal carcinomas expressed polyclonal CEA, monoclonal CEA or Leu-M1. CA-125 was positive in 19 (95%) and two (67%) ovarian and peritoneal carcinomas, respectively, and in eight (25%) peritoneal mesotheliomas.
Conclusions: Calretinin and Ber-EP4 are useful discriminant markers in distinguishing peritoneal mesothelioma in women from serous papillary ovarian and peritoneal carcinoma. The other mesothelial markers (thrombomodulin, cytokeratin 5/6, and CD44H) and carcinoma markers (polyclonal and monoclonal CEA, and Leu-M1) yielded a too low sensitivity for practical use.

SARCOMATOID RENAL CELL CARCINOMA

Hum Pathol. 2004 Jun;35(6):697-710. Abstract quote Both mesotheliomas and renal cell carcinomas can present a wide variety of morphological patterns. Because of this, renal cell carcinomas that metastasize to the pleura and lung may be confused with mesotheliomas. The aim of the present study was to compare the value of the various immunohistochemical markers currently available for the diagnosis of mesothelioma and renal cell carcinoma. A total of 48 mesotheliomas (40 epithelioid, 8 sarcomatoid), and 48 renal cell carcinomas (24 conventional, 12 chromophobe, 8 papillary, 4 sarcomatoid) were investigated for the expression of the following markers: calretinin, mesothelin, cytokeratin 5/6, WT1, thrombomodulin (TM), N-cadherin, CD15 (leu-M1), MOC-31, Ber-EP4, BG-8 (Lewis(y)), CD10, renal cell carcinoma marker (RCC Ma), carcinoembryonic antigen (CEA), and B72.3. All (100%) of the epithelioid mesotheliomas reacted for calretinin, mesothelin, and cytokeratin 5/6; 93% for WT1; 78% for TM; 75% for N-cadherin, 48% for CD10, 15% for Ber-EP4, 8% for MOC-31, 8% for RCC Ma, 5% for BG-8, and none for CEA, B72.3, or CD15. Of the sarcomatoid mesotheliomas, 88% expressed calretinin, 75% N-cadherin, 38% CD10, and 13% each expressed cytokeratin 5/6, WT1, and TM. All of the remaining markers were negative. Among the RCCs, 81% expressed CD10, 75% N-cadherin, 63% CD15, 50% RCC Ma, 50% MOC-31, 42% Ber-EP4, 8% BG-8, and 2% TM. The remaining markers were negative. The results indicate that calretinin, mesothelin, and cytokeratin 5/6 are the best positive mesothelioma markers for differentiating epithelioid mesotheliomas from renal cell carcinomas. The best discriminators among the antibodies considered negative markers for mesothelioma are CD15, MOC-31, and RCC Ma. An accurate differential diagnosis can be reached with the use of any 2 of the 3 recommended positive markers, which should be selected based on availability and on which ones yield the best staining results in a given laboratory. One of the recommended negative markers may be added to the panel if deemed necessary. If confirmation of renal origin is needed, RCC Ma could be useful. Calretinin is the only marker that appears to have any utility in distinguishing between sarcomatoid mesotheliomas and sarcomatoid renal cell carcinomas.

PROGNOSIS AND TREATMENT	CHARACTERIZATION
PROGNOSIS
GENERAL
Resection margins, extrapleural nodal status, and cell type determine postoperative long-term survival in trimodality therapy of malignant pleural mesothelioma: results in 183 patients. Sugarbaker DJ, Flores RM, Jaklitsch MT, Richards WG, Strauss GM, Corson JM, DeCamp MM Jr, Swanson SJ, Bueno R, Lukanich JM, Baldini EH, Mentzer SJ. Division of Thoracic Surgery and the Department of Pathology, Brigham and Women's Hospital, Boston, Mass 02115, USA.	J Thorac Cardiovasc Surg 1999 Jan;117(1):54-63; discussion 63-5 Abstract quote OBJECTIVES: Our aim was to identify prognostic variables for long-term postoperative survival in trimodality management of malignant pleural mesothelioma. METHODS: From 1980 to 1997, 183 patients underwent extrapleural pneumonectomy followed by adjuvant chemotherapy and radiotherapy. RESULTS: Forty-three women and 140 men (age range 31-76 years) had a median follow-up of 13 months. The perioperative mortality rate was 3.8% (7 deaths) and the morbidity, 50%. Survival in the 176 remaining patients was 38% at 2 years and 15% at 5 years (median 19 months). Univariate analysis identified 3 prognostic variables associated with improved survival: epithelial cell type (52% 2-year survival, 21% 5-year survival, 26-month median survival; P =.0001), negative resection margins (44% at 2 years, 25% at 5 years, median 23 months; P =.02), and extrapleural nodes without metastases (42% at 2 years, 17% at 5 years, median 21 months; P =.004). Using the Cox proportional hazards, the relative risk of death was calculated for nonepithelial cell type (OR 3.0, CI 2.0-4.5; P <.0001), positive resection margins (OR 1.7, CI 1.2-2.6; P =.0082), and metastatic extrapleural nodes (OR 2.0, CI 1.3-3.2; P =.0026). Thirty-one patients with 3 positive variables had the best survival (68% 2-year survival, 46% 5-year survival, median 51 months; P =.013). A previously published staging system using these variables stratified survival (P <.05). CONCLUSIONS: (1) Multimodality therapy including extrapleural pneumonectomy is feasible in selected patients with malignant pleural mesotheliomas, (2) pre-resectional evaluation of extrapleural nodes may select patients for radical therapy, (3) microscopic resection margins affect long-term survival, highlighting the need for further investigation of locoregional control, and (4) patients with epithelial, margin-negative, extrapleural node-negative resection had extended survival.
BASEMENT MEMBRANE
Presence and reduplication of basal lamina	Hum Pathol 2000;31:1341-1345 Transmission electron microscopic analysis found better outcome in patients with tumors that expressed either basal lamina or reduplicated basal lamina in 35 cases
FLOW CYTOMETRY
Prognostic significance of flow cytometric DNA analysis in patients with malignant pleural mesothelioma. Emri S, Akbulut H, Zorlu F, Dincol D, Akay H, Gungen Y, Icli F. Department of Chest Diseases, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey.	Lung Cancer 2001 Aug-Sep;33(2-3):109-14 Abstract quote Malignant pleural mesothelioma (MPM) due to environmental exposure to asbestos and erionite is a relatively common cancer in Turkey. In this study, we investigated the value of flow cytometric (FCM) DNA analysis and other prognostic factors such as age and etiologic factor in the patients with MPM, treated with surgery+/-combination chemotherapy+/-radiotherapy. A total of 40 patients with a median age of 50 (range 30-68) were included in the study. Twenty-nine patients had asbestos exposure in etiology, while 11 had fibrous zeolite (erionite). Paraffin-embedded tumor specimens were studied by FCM for DNA analysis. Twelve patients (30%) had aneuploid tumors and 28 (70%) had diploid ones. Mean S-phase fraction (SPF; %) was 9.1+/-1.1 and proliferation index (PI, SPF+G2/M phase; %) was 11.3+/-0.9. While the median overall survival (OS) was 10+/-2 months (6-14; 95% CI), 1-year survival rate was 45.2%. Only PI was found to be statistically significant for OS in univariate analysis (P=0.013). PI was also found to be an independent prognostic factor for all patients (P=0.035). Aneuploidy was significantly higher in erionite group compared with asbestos group. Male predominance and poor survival were also prominent in erionite group, though not statistically significant. In conclusion, PI is an independent prognostic factor for patients with MPM and the biologic features of the disease may show differences with respect to different etiologies.
HYALURON CONTENT
Hyaluronan content in pleural fluid as a prognostic factor in patients with malignant pleural mesothelioma. Thylen A, Hjerpe A, Martensson G. Division of Pulmonary Medicine, Sahlgrenska University Hospital, Goteborg, Sweden.	Cancer 2001 Sep 1;92(5):1224-30 Abstract quote BACKGROUND: Regardless of the modality of therapy used, malignant pleural mesothelioma is a highly treatment-resistant and invariably fatal disease. Identification of prognostic variables are important for future investigational therapeutic studies. METHODS: The prognostic significance of various clinical variables, including hyaluronan levels in pleural fluid, was evaluated in a retrospective analysis in 100 patients with histologically confirmed malignant pleural mesothelioma. RESULTS: The overall median survival was 11.5 months. Univariate analyses identified histologic subtype, i.e., epithelial or mixed, and elevated content of hyaluronan in the pleural effusion as significant prognostic variables. A multivariate analysis confirmed the independent predictive power of histologic subtype, and an elevated concentration of hyaluronan in the pleural fluid also indicated longer survival in older patients and in patients receiving therapy other than supportive. CONCLUSIONS: The prognostic value of histologic subtype and the concentration of hyaluronan in pleural effusions should be considered when designing and evaluating treatment trials for patients with malignant pleural mesothelioma.
p27
p27(kip1) immunoreactivity correlates with long-term survival in pleural malignant mesothelioma. Bongiovanni M, Cassoni P, De Giuli P, Viberti L, Cappia S, Ivaldi C, Chiusa L, Bussolati G. Department of Oncology, University of Turin, Turin, Italy.	Cancer 2001 Sep 1;92(5):1245-50 Abstract quote BACKGROUND: Pleural malignant mesothelioma (PMM) is a rare and highly aggressive tumor, whose development is strictly related to occupational exposure to asbestos. The prognosis of PMM is generally poor (median survival, 4-12 months), but a few have a relatively long survival. The objective of this study was to evaluate the use of the cell cycle-related proteins p27(kip1) and MIB-1 as prognostic indicators of survival in PMMs. METHODS: Of 621 PMMs, the authors selected 27 cases with a relatively long-term survival (> 24 months) and a control group of 36 PMMs having a shorter (usual) survival (< 24 months). RESULTS: The expression of the p27(kip1) was significantly higher in the long-term survival group compared with the control (short survival) group (81.41% vs. 31.94%; P < 0.0001). The PMMs of epithelioid histotype had a significantly higher p27(kip1) immunoreactivity compared with those of biphasic type (59.24% vs. 38.94%; P = 0.02). In agreement with the data in the literature, the proliferative activity (as detected by MIB-1 immunoreactivity) was significantly higher in short than long survival PMMs (43.53% vs. 14.11%; P < 0.0001) and in the biphasic histotype than in the epithelioid type (43.19% vs. 26.02%; P = 0.006). CONCLUSIONS: The combined expression of high/low p27(kip1) and low/high Ki-67 values identified with 100% specificity and sensitivity long versus short survivors. p27(kip1) represents a reliable additional predictive factor for PMMs and a useful marker to identify patients having a more favorable prognosis.
TREATMENT
CHEMOTHERAPY
Results of a phase II trial of combined chemotherapy for patients with diffuse malignant mesothelioma of the pleura. Kasseyet S, Astoul P, Boutin C. Department of Pulmonology, University Hospital la Conception, Mediterranean University Medical School, Marseille, France.	Cancer 1999 Apr 15;85(8):1740-9 Abstract quote BACKGROUND: Malignant pleural mesothelioma is associated with a poor prognosis because of its resistance to treatment. The authors conducted a Phase II trial in which two drugs (etoposide and 5-fluorouracil) were added to the Cancer and Leukemia Group B cisplatin-mitomycin regimen in an effort to define a more effective chemotherapy. METHODS: Forty-five patients with confirmed Stage II malignant pleural mesothelioma were prospectively enrolled in the study. Thirty-one patients received cisplatin 60 mg/m2 on Day 1, 5-fluorouracil 600 mg on Days 1-4, folinic acid 100 mg/m2 on Days 1-4, mitomycin C 10 mg/m2 on Day 3, and etoposide 100 mg/m2 i.v. on Days 1-3, with prophylactic hematopoietic growth factors. Fourteen patients received cisplatin, 5-fluorouracil, folinic acid, and mitomycin C with the protocol unchanged, and oral etoposide 50 mg on Days 1-21 without growth factors (1 cycle every 28 days). Histology included epithelial (in 33 cases), sarcomatous (in 6), mixed (in 3), and unspecified type (in 3). RESULTS: Two hundred eleven cycles were administered. Treatment was well tolerated and the major toxicity was hematologic: anemia in 30% of cases, neutropenia in 24%, and 2 probable cases of mitomycin-induced pneumonitis. The objective response rate was 38% (17 of 45 were partial responses), and the median response duration was 12 months. The median survival time was 16 months. There were no differences in response or survival between the 31 patients treated with growth factors and the 14 patients treated without them. Survival was slightly better for responders than for nonresponders who had stable disease or progression (20 vs. 10 months, P < 0.05). CONCLUSIONS: This four-drug combination was effective, with a notably high response rate, acceptable toxicity, and good adherence to protocol doses. The impact on survival was limited.
Well-differentiated papillary mesothelioma involving the peritoneal and pleural cavities: successful treatment by local and systemic administration of carboplatin. Shukunami K, Hirabuki S, Kaneshima M, Kamitani N, Kotsuji F. Department of Obstetrics and Gynecology, Fukui Medical University, Yoshida-Gun, Japan.	Tumori 2000 Sep-Oct;86(5):419-21 Abstract quote Well-differentiated papillary mesothelioma (WDPM) of the peritoneum is a rare form of epithelial mesothelioma. It usually shows an indolent course and no standard treatment is available. Only a few cases of WDPM in the pleural cavity have been reported. We report on a 56-year-old post-menopausal woman who presented with ascites and right pleural effusion. Laparotomy followed by biopsy established the presence of WDPM in the peritoneum and pleural cavity. The patient was successfully treated with local and systemic administration of carboplatin.
Prospective trial for the treatment of malignant peritoneal mesothelioma. Loggie BW, Fleming RA, McQuellon RP, Russell GB, Geisinger KR, Levine EA. Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA.	Am Surg 2001 Oct;67(10):999-1003 Abstract quote Malignant peritoneal mesothelioma (MPM) is a rare and often rapidly fatal disease with median survival of 5 to 12 months for untreated cases and 16 months reported after multimodality treatment. We report a prospective clinical treatment study using cytoreductive surgery combined with intraoperative intraperitoneal heated chemotherapy (IPHC) perfusion using mitomycin C for MPM. Twelve patients (11 male with a mean age 51 years) were treated. Seven patients presented with bulky disease and seven with ascites. All underwent exploratory laparotomy with histologically confirmed diagnosis of MPM. Surgical debulking as feasible was performed. Complete gross tumor removal was possible in only one patient. Cytoreduction was followed by a 2-hour closed low-volume IPHC using mitomycin C. One patient died 50 days postoperatively from complications relating to small bowel perforation. Hematologic toxicity of the procedure was minimal. Ascites was controlled in all patients and permanently in 86 per cent of patients presenting with ascites. To date median survival is 34.2 months with median follow-up of 45.2 months. One patient was re-explored for ventral hernia 2 years post-IPHC, had negative peritoneal biopsies, and remains disease-free at 5 years. Given the dismal prognosis associated with MPM the results of treatment with cytoreductive surgery combined with IPHC perfusion are encouraging. The rarity of MPM makes appropriately powered prospective randomized trials unlikely. Therefore, we now offer this approach off protocol; however, further study of this combined modality therapy is warranted.
Combined regimen of cisplatin, doxorubicin, and alpha-2b interferon in the treatment of advanced malignant pleural mesothelioma: a Phase II multicenter trial of the Italian Group on Rare Tumors (GITR) and the Italian Lung Cancer Task Force (FONICAP). Parra HS, Tixi L, Latteri F, Bretti S, Alloisio M, Gravina A, Lionetto R, Bruzzi P, Dani C, Rosso R, Cosso M, Balzarini L, Santoro A, Ardizzoni A. Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Via Manzoni 56, 20089 Rozzano-Milano, Italy.	Cancer 2001 Aug 1;92(3):650-6 Abstract quote BACKGROUND: The cisplatin-doxorubicin combination has shown moderate activity in malignant pleural mesothelioma (MPM; objective response, 25%), and preclinical studies suggest that interferons (IFNs) may have an antiproliferative effect on mesothelioma cell lines with a marked increase in cisplatin cytotoxicity. Therefore, the combined chemoimmunotherapy regimen is an worthwhile approach to evaluate in a Phase II trial. METHODS: From December 1995 to June 1999, 37 previously untreated patients with MPM were treated with cisplatin 60 mg/m(2) intravenously on Day 1 plus doxorubicin 60 mg/m(2), recycled every 3-4 weeks and IFN-alpha-2b, 3 x 10((6)) international units subcutaneously 3 times a week for a total of 6 courses or until progression. Inclusion criteria were histologic diagnosis of MPM and measurable disease defined by computed tomography scan or magnetic resonance imaging. RESULTS: Thirty-four patients were assessable for toxicity and 35 for efficacy according to World Health Organization criteria. One hundred thirty-five courses were administered with a median of 4 cycles per patients. Seventy-six percent of patient presented at least 1 episode of severe myelosuppression (Grade 3 and 4). Severe anemia and thrombocytopenia occurred in 30% and 24% of patients, respectively. Sixty percent of patients presented constitutional symptoms. In the 35 patients assessable for response, the overall response rate was 29% (95% confidence interval, 15-47%). The median duration of response was 8.4 months. With a median follow-up of 19.6 months, the median survival was 9.3 months. One- and 2-year survival was 45% and 34%, respectively. CONCLUSIONS: This combined regimen has definite activity in MPM. However, toxicity, particularly myelosuppression and fatigue, is not negligible and may limit its application.
SURGERY
Pleuropneumonectomy in the treatment of malignant pleural mesothelioma. Grondin SC, Sugarbaker DJ. Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.	Chest 1999 Dec;116(6 Suppl):450S-454S Abstract quote STUDY OBJECTIVES: Malignant pleural mesothelioma (MPM) is predominantly a local/regional disease that results in a survival time that ranges from 4 to 12 months without treatment. Single-modality therapy using surgery, chemotherapy, or radiotherapy alone is largely ineffective. The objective of the study was presentation of the use of pleuropneumonectomy in a multimodality treatment setting and the results. DESIGN: Didactic presentation. SETTING: Academic tertiary-care hospital. PATIENTS: One hundred eighty-three patients who underwent multimodality therapy. INTERVENTIONS: Of all the single-modality treatment approaches, pleuropneumonectomy has been associated most consistently with long-term disease-free survival and has provided the greatest amount of tumor cytoreduction. The technique of pleuropneumonectomy traditionally has been linked with high perioperative mortality and morbidity when compared with that of other cytoreductive techniques such as pleurectomy/decortication. Recently, improvements in operative mortality (< 5%) have been reported, largely due to improvements in patient selection and perioperative management. Multimodality therapy, including chemotherapy, radiotherapy, and extrapleural pneumonectomy, was used to treat patients. RESULTS: Outcomes were presented for 183 patients with MPM who underwent multimodality therapy. CONCLUSIONS: With the development of multimodality therapy, pleuropneumonectomy followed by sequential chemotherapy and radiotherapy has demonstrated a significant survival benefit, especially for patients who have epithelial tumor histology, tumor-free resection margins, and tumor-free extrapleural node status.

Life Insurance Auto Insurance

2010-01-31T06:26:00.001-08:00

I have divided this article into four different sections, each detailing its heading. I hope this makes it easier for you to get the information you require.

Auto Insurance in Alaska
The state of Alaska requires that every single motor vehicle registered there needs to have at least liability auto insurance. Under this State law; all owners of motor vehicles and/or drivers of the same must have the minimum amounts of liability auto insurance, which are:
- $50,000 for death or injury to any one person per accident
- $100,000 for death per accident or total injuries
- $25,000 for property damage per accident
In the event of an auto accident that resulted in property damage, personal injury or death amounting to more than $500; all drivers involved in the accident must show their auto insurance proof. Aside from auto accidents with damage greater than $500, the driver must also present proof of auto insurance any time they are requested to do so by an officer of the law and when comes the time to renew registration. If the driver fails to show proof of auto insurance for accidents with $500 dollars or more worth of damage, the drivers license will automatically be suspended for a period of 90 days to one year. The length of the suspension depends on the drivers driving record. Also, in case of an auto accident here, the guilty drivers auto insurance shall cover the expenses that were caused because of the accident.

Home Insurance in Alaska
You probably would not know this, but compared with to other states, Alaska pays more for home insurance. The reason for this is that they are always at a risk of floods and sub-zero temperatures. Though they have experienced a high increase in home insurance coverage in the past year, there are several ways to save on home insurance. The first is to compare the different insurance companies and see what each of them have to offer. This will enable you to get the right insurance at the price that fits your budget. Second is asking around about the different types discounts. You can ask your insurance company for the discounts you qualify for. And last is that increasing the deductible can save you a decent sum of money. By increasing the deductible, you are basically telling your Alaska Home Owners Insurance Agent that you are going to do everything you can to avoid any claims.
The most common home owners insurance coverages are:
HO-1 - This is for lighting, fire, vandalism, theft and smoke.
HO-2 - This is the same as the HO-1 only with additional perils, such as building collapse, water damage and falling objects.
HO-3 - This is "all perils". Depending on your budget, you can choose between basic and all perils. But what is ultimately important is that you have home insurance which will protect you in case of disaster.

Health Insurance in Alaska
Alaska health insurance enables most residents to be able to afford the increasing cost of health care. Those who have health care are able to escape medical debt, which occurs in two out of five locals. Considering the statistics, it is important, and certainly more cost effective, to have health insurance. Although health insurance varies; most policies pay for hospitalization, surgery, medical tests, pediatric care, doctor visits, and maternity care. Generally the exceptions are cosmetic surgery, hearing aids, dental care, eyeglasses, preventive care and experimental treatments.
Those who are denied by private insurance companies because of medical conditions, the Alaska Comprehensive Health Insurance Association will offer them health insurance. Under the program of the association, those with medical conditions can get insurance on different terms.

Life Insurance in Alaska
When it comes to life insurance, the two most common life insurances in the State of Alaska are term and permanent life insurance.
Term life insurance protects the holder for short periods of time. This is usually over a period of one to several years. This means that the insurance pays only if the person dies during the covered period. Also, since the period covered is only of short duration, the premium is significantly cheaper than permanent life insurance.
Permanent life insurance protects the holder for the rest of their life by a guaranteed death benefit. This means that the coverage is for the entire life of the person. The premium for this type of insurance is of course higher than term life insurance.
In the unstable economy today, it is important to have life insurance for the family. This will enable those who are left behind to get on with their lives without financial difficulties. You might want to consider getting life insurance especially if your family depends on your financial contribution. Compare life insurance now and you might be surprised at how affordable it is and how easily you can squeeze it in to your monthly budget.

Mesothelioma Lawyers

2010-01-31T06:23:00.001-08:00

During the twentieth century one of the most common industrial materials used was also one of the most lethal: Asbestos. Breathing in asbestos fibers can cause many different kinds of ailments including, but not limited to, asbestosis and mesothelioma cancer.
Since mesothelioma cancer is not an everyday ailment, it must be diagnosed by your doctor. The symptoms of mesothelioma cancer include coughing and severe shortness of breath. Since most cases of mesothelioma are not diagnosed for decades after the initial exposure to asbestos, it is usually lethal. The cancer is commonly found attacking the membranes around the lungs, heart and abdominal cavity. If you are diagnosed with mesothelioma cancer then someone is to blame. So if you find yourself sitting at home wondering how you get legal help for such a disease, look no further.
The way to start going about obtaining legal help for mesothelioma cancer is to first get a diagnoses from a well respected doctor, and then begin treatment. You want everything well documented for your upcoming legal battle. And a battle it will be. Most viable mesothelioma cancer cases take months, and in most cases, years to reach a settlement or verdict. After you are sure that mesothelioma cancer is exactly what you're dealing with, and you're taking all the right courses of action medically, then it's time to choose representation.
When choosing a lawyer, you must be critical and patient. This choice could be one of the most important choices you make in your entire life. You want to find an attorney who has a successful background in mesothelioma cases. You are entitled to the best representation available, and the only way to ensure that you're getting that kind of representation is to research and be aware of your options. You can obtain online case studies through a simple search on google.com. There are also several web sites that are dedicated strictly to furnishing names of lawyers who either specialize in or have history with mesothelioma cases.
As a victim of mesothelioma cancer you are entitled to, but not limited to: lost wages, medical bills, travel expenses, medical expenses, pain and suffering, and support for you and your loved ones. When selecting representation, as a client you can research each individual lawyers achievements when it comes to settlements or wins in these areas. Again, this is a delicate and fact based trial. You want the very best representation on your side in the courtroom.

TENS Therapy For Mesothelioma Sufferers

2010-01-31T06:22:00.000-08:00

Any cancer can cause a sufferer a huge amount of pain while the diseases ravages his or her body. While some cancer cures leave a patient cancer- and pain-free, other types of malignant tumor growth is practically incurable. In these cases, one of the best ways to ease a person's suffering is to lessen the pain that he or she is suffering. One way to decrease pain for mesothelioma patients is through TENS therapy.
TENS stands for transcutaneous electrical nerve stimulation. It is an alternative therapy that is often combined with traditional methods of treatment to help stop the pain as well as hopefully the spread of the cancer. Traditional methods of treatment include surgery, as well as chemotherapy and radiation. Patients might undergo several different types of these traditional methods in an effort to combat their cancer.
Mesothelioma is known to be a very painful type of cancer, as well as deadly. It attacks the various linings of the body, such as pleural (lungs), pericardial (heart), peritoneal (abdomen), and even testicular. Since these linings are typically in close contact with the various organs of the body, such as the heart and lungs, it is easy for the cancer to spread to these vital organs. Thus, the survival rate for mesothelioma is not very high, on average.
Because mesothelioma is so painful, TENS therapy is a good way that you can try to combat the suffering. With TENS, electrodes are inserted underneath the skin. They send pulses of electricity to your nerves, which stimulates them and causes them to stop sending pain signals. This works for a shorter period of time and is not used for continuous treatment. Additionally, because you must have the electrodes inserted underneath your skin, this is usually for spot treatment rather than allover pain lessening.
Once the electrodes are placed, the TENS machine is turned on for five to fifteen minutes. During this time, patients describe a warm or tingling sensation which eventually eliminates the pain. Because this is only temporary, you may have to go in to a TENS therapy specialist regularly, or you may even be able to rent the machinery for yourself.
TENS is not meant to be a primary treatment for mesothelioma. It supplements the actual treatment of the tumors. Additionally, as this relies on electrical impulses, it is not good for people who have heart abnormalities or palpitations.
If you have developed the painful cancer of mesothelioma, you may need financial help to get you the treatment you need. One primary cause of mesothelioma is asbestos. If you have been exposed to asbestos and developed mesothelioma, you should talk to an asbestos attorney about your rights. For more information, talk to a Williams Kherkher
mesothelioma lawyer today.

Online Tax Preparation

2010-01-31T06:16:00.001-08:00

Online tax preparation provides you with an easy and safe way to file your taxes. Some accountants have been using this online method to file for their clients for two decades. Between the IRS and some private tax services, online tax return filing has now been updated to accommodate the requirements of individuals as well as businesses.

1. Saves Your Time and Money
Online tax preparation saves your time and money. You will save your time because you can fill in your information using online software without writing all your information manually with your hand. You can save your money by paying less for online services compared to hiring a professional that might be unaffordable to you. You can also think of using free e-file services available.
By filing electronically, you can also receive your refund much faster within a couple of weeks. You can choose direct deposit option in order to get your tax refund deposited directly into your bank account. Filing electronically can save time for the IRS because there is less paperwork or they do not have to re-type your return file.

2. File Your Income Taxes Conveniently
Another advantage of online tax filing is you can file your tax returns conveniently from your home computer if you have access to internet connection. You can fill out your information using online software any time whenever you wish. Whether you use free online software or free/paid e-filing service, you will be able to deal with all your filing needs from your office or home.

3. Make Your Return File Errors-free
Online tax preparation can help you reduce errors because of the error-check feature in the software. Moreover, the software will calculate your mathematical totals accurately for you when you enter the right information. It will prompt you to correct errors before moving forward with the form submission. So, less errors means less chances for an audit and quick processing of your return file.

4. Claim Credits and Deductions that You Qualify for
Now you do not have to worry about which credits to take and which deductions to claim. The easy deduction search tool will help you find out and choose those deductions which will suit you. Claim the deductions suitable to your tax situation so that you may have less chances of being unnecessarily audited by the IRS.

5. Get the Fast IRS Income Tax Refund
When you choose to file your tax return online with direct deposit option, then you will get your refund directly into your bank account within as few as 10 to 14 days. Getting online refund is the fastest and safest way of getting your money back into your pocket.

Steps For Auditing of an Albanian Tax Auditor

2010-01-31T06:13:00.000-08:00

I want to mention that this procedure is the common way, but my wish is to be known the presented material how is conducted a tax audit in Albania. So, let's begin...
Before beginning an audit, the auditors should inform the head of their audit office that neither they nor their relatives will influence on the impartiality and objectivity of the audit, on their judgment regarding the taxpayer to be audited. This means that continuously auditors should inform their superiors if a potential conflict might arise in the future.
The auditor or audit team charged with the duty to conduct an audit in compliance with the deadline specified in the program is introduced to the company to be audited and present the audit notice and respective program to the company manager. Besides the principal manager of the company, it is required that the head of finance and other relevant staff so considered because of their status in the company take part during the presentation of audit program.
The audit team writes down all the problems and concerns raised by the company managers and their employees during the presentation of the audit program and after they are systemized in the verification process.
Conducting the audit
The issues and methods discussed in this part apply to both complete audits and fiscal visits. The auditors should use their judgment to decide on the level and depth of the tests they have made on the company accounts.
Initial stage of audit
Auditor's introduction to taxpayer: The auditors introduction should be accompanied with the presentation of the Audit Notice registered in. The audit should be conducted in the premises of the taxpayer's activity and the auditor should also visit other premises if the activity is not exercised in one single premise. The auditor should always try together more information than the taxpayer has registered and declared. It is important that the audit is conducted when the appointed person is available.
Initial interview
In the first day of audit, the inspector interviews the representative appointed by the company. Obligatory verifications to be included in this interview will be done according to a certain Table of Procedures that exist in the same way as in other countries.
In the case of a partnership all partners should be interviewed. Of special importance is the interview with the company managers, assuming they are the ones who run the business. The following information should be obtained in these meetings:
• General description of the company
• Duties performed by each member of staff in the company
• Detailed information on the company objectives, especially with regard to profit rates and management and organizational forms the company has chosen in order to achieve its objectives
• Checking the accuracy of certain points regarding the information obtained which does not correspond to the information provided
• Identifying additional information required and the deadline for obtaining such information.
The range of problems to be addressed in the course of the interview are described more in details in the points included in the audit program which the inspector has to execute.
The questions and answers should be written in the auditor's notebook, which will provide the basis for the audit report and enrichment of the audit file. These notes are very important because they may be needed in the court to prove that they were written during the audit and the auditor can and must refer to them or ask to do so.
Verification of internal audits
During The interview the auditor should determine the level and effectiveness of internal audits conducted in the company. In order to be able to assess the effectiveness of the internal audit system in the company the auditor identifies the key elements of the audit environment, accounting systems and internal audits for this system.
Creating an opinion on documentation
In spite of the audit office where they are, the auditors should verify the accounts (bookkeeping) for a preliminary analytical review of the positions they want to verify in more details. The auditor should make an analytical analysis of how the bookkeeping is maintained step by step and alongside with the examination of justifying documentation. Such analysis is made in order to compare what is currently reflected with what should be reflected, based on other data. When the results of the analysis differ from expectations, the auditor can investigate these significant differences.
.
Analytical analysis consists of three steps:
Step 1: Determining what is expected to be discovered and to what level will differences be acceptable.
Step 2: Determining the level of registrations/self-declarations
Step 3: Investigating unacceptable differences and potentials for evasion
After determining the differences the auditor call the managers of the audited company to provide the necessary explanations. Failure to provide convincing arguments and justifications for the identified difference constitutes sufficient reason to initiate the definition of the tax assessment.
Evaluation of results
Two possible results can derive from detailed analysis:
1. The test shows that there is a mistake and the auditor should look at the cause, look for another possible mistake and assess the effect of these mistakes on the declared tax obligation. Every invalid payment discovered is on indicator of fraud which requires further actions.
2. The test assesses the full effect of the detected disguise on the declared tax. There are a number of available methods and the most widely used is the method of the norm or the method of average difference. The test conducted and their results should be detailed and stored in the audit file to provide support for every assessment that might follow in a potential appeal in the future.
3. In this respect, the physical inventory is very significant for the test the inspector conducts. It is necessary to attend whenever physical inventories are made in order to make sure that the counting is correct and in compliance with internal audit measures and procedures applied by the company. It is necessary to proceed with tests on the quantities identified by the personnel in charge of counting and storing costs.
Furthermore, it is necessary to:
- compare the observed quantities by tests in inventory files and figures in the bookkeeping;
- make sure of the compatibility of units of measurement and counting that have been used;
With regard to ongoing work it is necessary to:
- compare their composition with the elements resulting from the inventory;
- compare the stages of their progress with the documents which make it possible to follow production.
In order to assess the inventory it is necessary to:
- examine the elements that serve to assess the gross value. In such case it is worth making sure that the assessment adopted to establish the gross value of goods simply implies these elements excluding all other elements like:
- Purchase price without VAT (purchase cost);
- Customs tax;
- Transport cost without VAT, i.e. costs incurred for bringing inventory elements to the existing location and condition;
- Direct costs for the inventory
- if the assessment is based on the real price, it is worth examining invoices from suppliers of the goods in question in order to make sure that the assessment is justified by the price without VAT reflected in such invoices; the same verification should be made for customs rights or transport costs presented to third parties. As regards the transport costs resulting from services supplied by the company and inventory costs, it is necessary to examine documents compiled by analytical bookkeeping, which can help to check whether the costs included in the gross value of these goods are justified;
- If the method of pondered average price has been used for assessment, it is necessary to verify whether the maintained price is not higher than the last purchase price;
- If it is possible to determine the value of every item or category, it is necessary to make sure that they have complied with these values and there has been no global assessment;
- If there have been any modifications in the previously used assessment method, we should make sure that such modifications will not affect the regularity of the balance, and if they do, then we have to specify how it will affect the result;
- Make sure that changes of the condition have been registered as gross value in the account "Changes of raw material condition" or "Changes of condition of goods".
Burden of proof
There are cases when the auditor cannot verify whether the completeness of sums in the accounting registers for the selected accounts. In order to prove that all items have been entered, the auditor should use other sources. It is necessary for the auditor to use his judgment as regards the accounts he wants to analyze until he has reached an acceptable result.
E.g.: (in order to test the comparison between incomes and property of assets from the licensed activity).
a) Does it turn out that according to the data, the economic activity covers the costs to create and increase property of fixed assts or liquidities, both personal or of the economic activity of the family, partners and company manager, or the economic results do not justify the value of this property?
b) Is property of assets in point a) owned by the company or their family members? In such case the investigation should extend further and cooperate with the structures of Investigation and Intelligence Directorate.
When the auditor asks for specific data, it is taxpayer's responsibility to gather the required information and present it to the auditor. The auditor should audit the presented documentation but he should not justify the taxpayer's lack of documentation on incomes and costs. The taxpayer should present the documentation as required by the fiscal and accounting legislation in order to allow the auditor to clearly determine its compatibility with what the taxpayer has filed in his declaration with tax office.
If accounting records and other fiscal documentation are considered legally incompatible by the auditor, it is up to the auditor to decide whether they should be completely or partly used for meeting legislation requirements. In such cases, if the taxpayer does not complete additional documents, the auditor should discuss with the head of office whether to adopt, according to legislation, indirect methods and improvise the real situation of incomes realized by the taxpayer in question.

Tax Investigations

2010-01-31T06:11:00.000-08:00

Income tax returns filed by taxpayers are often incorrect. Sometimes they are incorrect due to simple mistakes, accidents, oversight, confusion, or misunderstanding of the law. Sometimes they incorrect due to gross negligence or reckless disregard of the law. And, sometimes they are incorrect because the taxpayer willfully and knowingly intended them to be incorrect in order to purposely pay less income tax. No matter what the reason, when incorrect returns are identified, they must be corrected, either immediately, or after the conclusion of any criminal proceedings that might be undertaken.

When tax inspectors or investigators confront taxpayers to inquire why the income tax return is incorrect and seek their cooperation to rectify it, the taxpayer will either be cooperative or not. When the taxpayer cooperates, it becomes much easier to determine how much true income the taxpayer earned, or which expenditures are truly allowable under the law, in order to arrive at the correct amount of tax. Cooperative taxpayers may provide their books and records or other documents, and assist the inspector or investigator as he attempts to determine how much additional income tax the taxpayer should pay.

When taxpayers do not cooperate, the inspector, or investigator, can be confronted with a serious dilemma. How can they determine how much additional income tax the taxpayer should pay, if any. They must resort to other methods to obtain the information necessary to calculate the true tax due from the taxpayer.
During a tax criminal investigation, the investigator is required to identify the amount of income that is not reported on the income tax return, and also identify any expenditures that are on the income tax return that are not allowed by law to be included on the return. It is usually not possible to be exact in determining the amount of income, nor is it necessary to identify the exact amount of unreported income. The amount not reported must be substantial, in relation to the amount reported, if any. Small cases, where minor amounts of income are not reported, are not the type of cases the tax investigator should identify and investigate. The tax investigator should always be alert to major cases using the criteria, in order to identify and document the amount of income that is not reported, or to identify expenditures not allowed by law that have been deducted on the tax return, the investigator must identify and gather evidence. This is not an easy task. When taxpayers do not cooperate, it becomes a very difficult task.

In the world of financial investigation, there are methods and techniques available for the investigator to actually re-calculate or reconstruct the taxpayer's true income and expenses, even without his cooperation, or even without his books and records. In fact, as the tax investigator enters the world of criminal justice, where taxpayer engages in fraud, and could therefore could face imprisonment, it is highly likely that taxpayers will cooperate less. Therefore, the tax investigator must become skilled in the use of the techniques available to re-calculate or reconstruct a taxpayer's income and expenses.

However, before these methods are explained, the investigator must fully understand what an income tax return represents, and how it relates to the taxpayer's books of account, commonly called books and records. The section that follows explains how the daily business activities of buying and selling relate to an income tax return. Although this section may appear to be elementary or basic, a review of the nature of an income tax return will clarify the use of the Specific Transaction Method of Reconstructing Income, the most common and effective method available to reconstruct a taxpayer's income, when the taxpayer does not cooperate.
Income tax returns filed by taxpayers are required by the Income Tax Law to contain a summary of all financial transactions the taxpayer engaged in during the tax year. The summary should include all transactions where the taxpayer incurred an expense or other deduction allowed by law through an outlay or expenditure of funds. It should also include all transactions where the taxpayer received or otherwise earned money from selling a product or service.

In general, when the total of all transactions where funds were received exceed the total of all transactions where funds were expended, the taxpayer has a net profit, which is the amount upon which the tax is based. When the total of all transactions where funds were expended exceed the total of all transactions where funds were received, the taxpayer has incurred a net loss, and no tax is required to be paid.

Of course, each specific expenditure must be allowable under the law in order to be included on the income tax return, and each specific receipt of funds must be taxable under the law in order to be required to be reported on the income tax return. Expenditures incurred that are not allowable under the tax laws should still be reported in the taxpayer's books and records, but must not be included on the income tax return. Similarly, the receipt of funds that are not classified as funds subject to tax, should be reported in the books and records of the business, but not included on the income tax return.

In addition, under the accrual method of accounting for expenses and earnings, some expense items may be included on the income tax return even though no actual expenditure was made, and some items may be included as income, even though no funds were actually received.

If the taxpayer engages in specific financial transactions during the year that are required to be included within the summary of expenditures and receipts, but are not, then the income tax return is incorrect.
For example, if the taxpayer engages in a financial transaction where he sells a product or service but does not report the receipt as gross income or gross revenue, then the income tax return is incorrect. Similarly, if a taxpayer includes on his income tax return a financial transaction where funds were expended on a product or service that is not allowed to be deducted under the tax law, the return is also incorrect.

The income tax return is required by law to include all specific financial transactions related to determining a profit of loss. When certain, specific transaction are not included, the tax investigator must be able to identify which specific transactions were not included, and seek to gather evidence of the source and amounts required to be included. Identifying which specific transactions were not properly reported is known as the Specific Transaction Method.
Other methods of re-calculating or reconstructing a taxpayer's true net profit or loss are based on the sum total, or aggregate of all transactions the taxpayer engaged in during the year. These methods do not identify specific transactions of buying and selling. Instead, the net profit is calculated or reconstructed based on the total of all expenditures made, or the total of all funds deposited into bank accounts.

One such method is known as the Net worth Method. This method measures the increases in a taxpayer's net worth between years. Net worth is the amount of assets a taxpayer has accumulated that exceed the amount of liabilities he has accumulated. Increases in net worth are the result of the taxpayer spending money to increase the amount of assets he has, or to reduce the amount of debt he has. In addition, a taxpayer's expenditures that have no lasting value, or do not increase assets, such as expenditures for costly airline tickets for personal vacations, are identified and added to his increase in net worth.

The increase in net worth from one year to another is compared to the amount of income reported on the income tax return. Increases greater than the amount of income reported can be attributable to the taxpayer failing to report all his income, because no one can spend more than he earns. The excess is charged to the taxpayer as unreported income. Of course, adjustments must be made, as described in the text that follows, for loans, gifts, inheritances, and other sources of funds that are not taxable.

Another method is known as the Bank Deposit Method. This method compares the total amount of funds deposited into all bank accounts during the year with the gross receipts reported by the taxpayer on his income tax return. Bank deposits that exceed gross receipts are charged to the taxpayer as unreported income. Again, certain adjustments must be made, and other requirements must be met before the excess can be called unreported income.

The Specific Transaction Method is the most commonly used method and the most easily understood.
All three methods, however, have one common thread. All three require the tax investigator to follow the flow of money, from one person to another. This is accomplished by following the paper trail that financial transactions leave. When products are sold, goods are purchased to be consumed in the course of business, or when services are provided, often based on a contract, records generally exist that reflect the nature of the transaction, particularly if the amounts are large. Such records include purchase orders, sales receipts, inventory lists, invoices, deposit slips, bank statements, etc. By following the money, the tax investigators will encounter individuals who can become witnesses who will ultimately produce the evidence the investigator needs to document his case and establish the taxpayer committed a crime under the Income Tax Law.
Smaller businesses may not maintain books and records, which would increase the difficulty of addressing non-compliance. Other methods are available to address these types of taxpayers. One common method is to impose an annual license fee on small businesses, instead of requiring an income tax return. Such a method greatly reduces the administrative burden necessary to collect a small sum of income tax.

Mesothelioma Lawyers in San Diego

2009-10-21T18:37:00.000-07:00

Mesothelioma Lawyers in San Diego

To understand how to choose a lawyer for this disease, you should first understand the basics of the disease. In the simplest sense, mesothelioma is a cancer of the protective layers of the body cavities, known as the mesothelium.
These tissues have different names depending on the organs they protect. You have probably heard of the peritoneum–this is the covering around the stomach and intestines. Other organs and cavities have their own membranes as well.
Mesothelioma is a cancer of these tissues. They often do not just affect the tissues–they affect the organs they surround and can spread elsewhere. This cancer is most often contracted by exposure to asbestos, a highly dangerous mineral often found in floors, ceilings, and some products.

Employers and landlords are supposed to protect you from asbestos, but often this does not happen. If you have mesothelioma you have probably been exposed to asbestos. If so, you should contact mesotheloma attorneys in your area to see if you have a case against the party responsible for your exposure.
How Do I Choose?
San Diego is a big place. The whole area is so large it is almost connected to Los Angeles now with no real division. Choosing a professional in this area is a daunting task for busy people, so here are some steps to take to make the process easier.
Mesolthelioma lawyers get to know the doctors who treat the disease. Over time they develop relationships and form help networks for patients. Often a doctor will have several contacts in the legal field and a lawyer will have several contacts in the medical field. This helps save you time.
If you have been diagnosed with mesothelioma, your oncologist may be your best source of names for attorney contacts. She will likely have already worked with them on cases and can tell you not only who specializes in your type of cancer but who is best and who is within a short distance from your home or work. If she does not have the right kind of specialist, there are other ways to find the right professional for your case.

You can check with other doctors who deal specifically deal with mesothelioma if your doctor is more of a general oncologist. These doctors may have worked more closely with mesothelioma lawyers in your area of southern California. You can also call local hospitals, various cancer support groups–area law schools are also excellent for references. Also check your union or professional group if you were exposed on the job.
Regardless of where you find your contacts, interview the lawyer, check on his or her background, and get references if you can. If you are ill, the last thing you need is more trouble.

What is mesothelioma?

Mesothelioma is a cancer of the mesothelium. The mesothelium is a thin membrane that lines the chest and abdomen and surrounds the organs in these areas. The lining around the lungs is called the pleura and in the abdomen it is known as the peritoneum.

About 2000 people in the UK are diagnosed with mesothelioma each year.
Mesothelioma of the lining of the lungs, known as pleural mesothelioma, is much more common than mesothelioma in the peritoneum. For every one person with peritoneal mesothelioma, there will be about 12 people who have pleural mesothelioma.

Pleural mesothelioma

The pleura has two layers: the inner (visceral) layer, which is next to the lung; and the outer (parietal) layer, which lines the chest wall. The two layers of the pleura are usually in contact and slide over each other as we breathe. The membranes produce fluid, which allows them to slide over each other easily.
When mesothelioma develops in the pleura (pleural mesothelioma), the delicate membranes thicken and may press inwards on the lung. Fluid may also collect between the two layers of the pleura: this is known as a pleural effusion.

Structure of the lungs and pleura

Peritoneal mesothelioma

The lining of the abdomen is known as the peritoneum. It also has two layers: the inner (visceral) layer, which is next to the abdominal organs, and the outer (parietal) layer, which lines the abdominal wall.
If the mesothelioma is in the peritoneum it is called peritoneal mesothelioma and causes thickening of the membranes surrounding the abdominal organs and a collection of fluid in the abdomen. The collection of fluid is called ascites and causes swelling of the abdomen.

Side view of the abdomen. The peritoneum is shown as the thick line surrounding the abdominal organs.

How mesothelioma is diagnosed

Most people begin by seeing their GP when they have symptoms. Your GP will examine you and may arrange for you to have some tests or x-rays. You may be referred to hospital for these tests and for specialist advice and treatment. At the hospital, the doctor will take your medical history and occupational history before doing a physical examination.

Chest x-ray

A chest x-ray will be taken to check for any abnormalities in your lungs, such as thickening of the pleura or fluid around the lungs. However, there can be other causes of thickening of the pleura and peritoneum (and fluid around the lungs or in the abdomen) apart from mesothelioma.
The following tests may also be needed to diagnose mesothelioma, and your doctor may arrange for you to have one or more of them at the hospital.

CT scan

A CT scan (computerised tomography scan) takes a series of x-rays, which build up a three-dimensional picture of the inside of the body. The scan is painless but takes from 10 to 30 minutes. CT scans use a small amount of radiation, which will be very unlikely to harm you and will not harm anyone you come into contact with. You will be asked not to eat or drink for at least four hours before the scan.

Having a CT scan

CT scans of the chest and of the abdomen will show the size and position of the mesothelioma and whether it has spread to other parts of the body.
You may be given a drink or injection of a dye that allows particular areas of your body to be seen more clearly. For a few minutes, this may make you feel hot all over. If you are allergic to iodine, or have asthma, you could have a more serious reaction to the injection, so it is important to let your doctor know beforehand.
You will probably be able to go home as soon as the scan is over

Pleural or peritoneal aspiration

If there is fluid in your chest or abdomen, the doctor can take a sample by using a local anaesthetic and passing a needle through the skin into the fluid. Some of the fluid is then drawn off into a syringe and can be analysed in the laboratory to look for mesothelioma cells.
Taking fluid from between the pleura is known as a pleural aspiration and taking fluid from the abdomen is known as drainage of ascites (or peritoneal aspiration).

Biopsy

If you need a biopsy, your doctor will take a sample of tissue from the thickened pleura or peritoneum. A local anaesthetic is used to numb the area and a special type of needle is passed through the skin into the tumour. The needle has a tip that can cut out a sample of the tumour. The doctor may use ultrasound or a CT scanner to position the needle accurately. An ultrasound uses sound waves to build up a picture of the organs in a part of the body. A small device is passed over the skin to show the doctor where the tumour is and guide the needle into the right place.
Sometimes the doctor will want to look at the area of the pleura or the peritoneum directly to get a sample of tissue from the right area. This is done by using a thin flexible tube with a light and camera at the end. The tube (endoscope) can be passed through the skin of the chest, where it is called thoracoscopy, or the abdomen, where it is called laparoscopy. The procedure is done under a general anaesthetic by a surgeon. You will usually be able to go home the same day.
Your doctors may want to check for any signs of spread of the cancer to the nearby lymph glands in the centre of the chest. This central area, around the lower part of the windpipe, is called the mediastinum and the lymph glands which are found there are the mediastinal lymph nodes. This test is called a mediastinoscopy. The test is done under a general anaesthetic and will mean a short stay in hospital. A small cut is made through the skin at the base of the neck. A tube, like a small telescope, is passed into the chest through the hole created by the cut. The doctor can use this tube to examine the area. Samples can be taken for examination under a microscope.
Analysing the biopsy in the laboratory is the only way your doctors can make the diagnosis of mesothelioma. Sometimes, even after taking a biopsy, the doctors may not be sure of the diagnosis, because mesothelioma can be very difficult to distinguish from other illnesses. In this situation, the biopsy samples may be sent to other laboratories to confirm the diagnosis, some of your tests may need to be repeated or you may be referred to another hospital for a second opinion.

Waiting for your test results

It will probably take several days for the results of your tests to be ready and a follow-up appointment will be arranged for you before you go home. This waiting period is likely to be an anxious time for you and it may help to talk things over with a close friend or relative. | cancerbackup

Symptoms of mesothelioma

Mesothelioma often starts as a lot of tiny lumps (nodules) in the pleura, which may not show up on scans or x-rays until they are quite large. The main symptoms of pleural mesothelioma are breathlessness and chest pain. Some people find that their voice becomes hoarse and they have a cough that does not go away.

Peritoneal mesothelioma often causes swelling and pain in the abdomen.

General symptoms

Both types of mesothelioma can cause other general symptoms, such as loss of appetite, sweating (especially at night), weight loss and tiredness. As many of these symptoms can also be caused by other illnesses, your doctor will need to do a series of tests before a diagnosis can be made.

Secured Loan Calculator

2009-07-21T18:36:00.000-07:00

Feel free to use our interactive secured loan calculator. Before deciding to apply for a loan some homeowners find it useful to understand the approximate cost of borrowing in terms of the monthly cost and the interest which is being charged. This is especially useful for homeowners who work to a monthly budget by knowing what their outgoings are such as household bills and mortgage payments versus income received.

To use the loan calculator simply enter the amount you wish to borrow and select a repayment period using the drop down menu. Then enter the interest rate and press the calculate button. The results are calculated using the generic compound interest formulae and show the monthly repayment and the monthly interest charged by the lender. For comparison purposes, which some find useful, an alternative monthly repayment figure is displayed below assuming an interest rate of 5.5% is charged.

Remember, this online calculator tool should be used as a guide only and some lenders will often build in Payment Protection Insurance or (PPI) in addition to possible secured loan application fees. Therefore, the actual monthly repayment amount in reality could be higher.

How to Consolidate Student Loans

2009-04-21T16:43:00.000-07:00

What is Student Loan Consolidation?

Consolidating your student loans generally means one lender will group together multiple loans which you have taken out. Instead of managing numerous simultaneous payments and interest rates, the consolidated loan will compile them into a single loan at a new, fixed rate. The main benefits of consolidation are that:

You will only be responsible for a single account with a single financial institution.
The interest rate for your consolidated loan will not change over time.
Consolidation potentially lower your monthly payment by extending the term of your loan.
- - This may also mean paying more interest in total over the lifetime of your loan.

Despite the possible benefits of consolidating your student loans, there are many reasons why consolidating your student loans may not be your best possible option. Continue reading to determine if consolidation is beneficial to you and how to embark on the process.

Step 1: Decide Whether to Consolidate

There are pros and cons to consolidating depending on your particular situation. Before you rush to consolidate, consider the factors below.

Consolidating your loans at a fixed rate means that if rates go up, yours will stay put. Alternatively, if there is a sharp dip in interest rates, you will still be paying the same fixed rate. So if you think rates will plummet, it might be best to wait things out.
Make sure your loans can be consolidated: consolidation loans are available for most federal loans, including FFELP loans (which include Stafford, PLUS, and SLS loans), FISL, Perkins, Health Professional Student Loans, NSL, HEAL, Guaranteed Student Loans and Direct loans.
There are also private consolidation options available for private student loans. See Step 3: Consolidate Private Loans.
To better understand the ins and outs of consolidation, see Simple Tuition's Guide to Student Loan Consolidation. (Note: The link will open as a PDF file.)
Note that you might pay more overall when you consolidate because you are extending the life of the loan (even if monthly payments are lower).
Do note, however, that the interest you pay on your student loans is tax deductible.
Evaluate the pros and cons of consolidation with your particular loans in mind.
Calculate what your consolidated rate would be to determine if it's worth consolidating.
You'll also need to decide if consolidating all your loans is a good idea, or if you should just consolidate some of them. Because your rate is determined as an average of your current rates, you may want to keep a higher rate loan out of the equation. Calculate your rate without including some high interest loans to decide if you should consolidate all or some of them.

NOTE: Check FinAid before proceeding, to see what advice it offers to current borrowers.

Step 2: Consolidate Your Federal Loans

Consolidating your federal loans means you will pay one monthly bill and will determine a fixed rate for the life of your loan. This rate is generally lower than that of a private consolidation offer.

To determine your consolidation rate for your federal loans, a lender will calculate a weighted average of your current loan rates and then round up to the nearest 1/8, but not to exceed 8.25%.
Calculate your potential consolidation rates using FinAid's consolidation calculator.
Your interest rate also depends on the type of federal loans you have and when you took them out.
You can lock in a lower consolidation rate by consolidating during your grace period (the several months immediately after graduation, during which most lenders will not force you into repayment). Consolidating during your grace period, while ultimately helpful because your interest rate is lower, does force you into immediate repayment, even if you still had a few months left before scheduled payments were to begin.
Because Stafford loan holders who graduated in 2007 or after will pay fixed rate interest, it's not as clear that they should consolidate as it has been in the past.
Note you cannot consolidate loans if you are currently in school.
It is not recommended that borrowers consolidate federal loans into a private loan because you will lose important privileges to defer, apply for a forbearance, or qualify for loan forgiveness under government programs.
And under no circumstances should you pay a fee to consolidate your federal loans.

Step 4: Keep Up with Student Loan News

Keeping up with student loan news if you haven't yet consolidated all your loans will help you determine if it is a good idea going forward.

It could be worth checking in with your school's financial aid department to see if they have an opinion on your consolidation plans or recommend a particular lender.
Use non-profit Student Loan Borrowers Assistance's list of resources to find information about different lenders or to contact legal or financial advisers who can help you.
The New York Times also has a "Times Topic" about student loans that functions like a database of all the current student loan news. Check it regularly to keep up to date on student loan information.
FinAid, a site recommended for its financial aid advice, made a recent statement regarding changes in student loans and consolidation in the wake of the 2008 Financial Crisis:
- - "Borrowers may be concerned by the possible impact of the subprime credit crisis on the cost and availability of federal and private student loans. Federal loans will remain available, although loan discounts will likely be reduced significantly. A higher minimum balance may be required to consolidate. Private student loans will likely have stricter eligibility restrictions, requiring a higher credit score or a cosigner. There may be increases in the interest rates and fees on private student loans. Lenders will encourage borrowers to make payments of interest while they are in school."

Structured Settlement Investments

2009-01-21T18:35:00.000-08:00

Choosing a structured settlement investment as an option for for financial gain can be a viable method of acquiring profit. These settlements are usually paid out to individuals over a period of time and may be the result of an insurance pay out, lottery winnings, annuities or a court judgment. Recipients of these funds are often willing to sell the payments in exchange for a lump sum of cash. There are a variety of reasons why an individual might choose to do this. Receiving money that is owed over time in small increments may not have the same kind of life changing possibilities that a one time payment of a large amount of money can have. This is the main attraction that draws individuals to investors who are willing to pay money for structured settlement payments. Why wait for the money when it can be obtained in one large payment? Of course, sellers will find that they are not going to receive as much money as originally would have been the case. For a structured settlement investment to work, there must be the potential of real profit down the road for the investor. These settlements may have been originally designed to create a steady source of income that will aide the beneficiary for a long time to come. This time frame will usually extend over a period of years. In the minds of some recipients, having access to a larger sum of money in the present is more valuable than having more money in the long run, but having to wait for it.

The decision to participate in a structured settlement investment can depend upon a variety of factors. Individuals who are weighing an offer to sell off any payments that will come in the future are generally more concerned about the present. Pressing financial needs can be very persuasive for the owners of these settlements. Mounting debts, needed home repairs, medical bills, or a child's education can be just some of the reasons that someone might decide to sell off future payments. But the wise seller will take a number of things into consideration. It is generally a good idea to seek counseling from an objective financial professional before making a final decision or signing any contracts. This professional should be functioning independently of any investors and have only the best interests of the seller at heart. Such counselors will usually help a client to understand just how much money will be lost should the client decide to move forward with a structured settlement investment. Advisers will also suggest certain pertinent questions to the client. How much money does the client currently need? Is this need so pressing that it is worth sacrificing future income? Is there any other way that the needed money can be obtained? Since the client will end us loosing a percentage of the settlement's worth, the seller should take the time to weigh all options and to decide if the future cost of the arrangement is worth the present day benefits.

A a structured settlement investment requires a little more than a willing buyer paired with a willing seller. While such arrangements can be a financial opportunity for both parties, the law does not allow individuals to sell off such assets without court approval. Involving a judge is designed to make sure that the seller fully understands what is being sacrificed and that the deal as it is presented is fair and equitable to all concerned. When the request is brought before the court, the seller's current situation and financial need will be presented as well. In addition to the input of a judge, separate legal representation may be called for. Many clients do not realize that they may be able to sell off only a portion of these settlements and are not obligated to sell the entire asset. This approach may offer a client the best alternative since they will be able to obtain cash for current needs while maintaining a portion of the payments that will be paid out over time. This choice can help to provide a sense of security for the future. It is also very important to make sure that the buyer or group of investors who are offering to complete the structured settlement investment are reputable and that there are no hidden fees buried in the agreement.

Selecting a reputable broker who can lead a client through the process of working with a structured settlement investment groups is a very crucial choice. A broker will need to be knowledgeable of the law as it pertains to these contracts. In addition, a broker must also hold the best interests of their clients as a top priority. The strength and comfort that God offers to believers is detailed in the Bible. "Fear thou not; for I am with thee: be not dismayed; for I am thy God: I will strengthen thee; yea, I will help thee; yea, I will uphold thee with the right hand of my righteousness." (Isaiah 41:10)

A structured settlement investment should benefit the purchasing company as well as the seller. These companies do not make such investments as a good will gesture to the seller. Like all investors, they are interested profit. For this reason, the amount of money that is paid to the seller will be less, sometimes substantially less, than the final settlement pay out. There may be fees and other costs associated with these contracts as well. What ever choice a seller might make, a fair contract will honor all concerned parties and provide needed financial relief.

Mesothelioma Patients

2008-10-21T18:34:00.000-07:00

The Symptoms and Diagnosis

In July of 1998, I had a heavy, bronchial-type cough. My doctor said if the cough did not go away completely to come back and see him. At that time, he gave me a chest x-ray, which showed a pleural thickening on my right lung. I was sent to a respirologist who in turn sent me to a thoracic surgeon for an open chest biopsy. It was three months from when I first went to my G.P. with the cough to when I was diagnosed on Oct. 23^rd with metastatic mesothelioma.
I was told many times how I don’t fit the profile –generally men in there 60s and 70s who’ve worked in asbestos-related industries. But I had it and I was told there was nothing that could be done as mesothelioma is always incurable and fatal.

Belle’s Reaction

Many of us wonder what we’d do if told we had a terminal disease. It had crossed my mind in the past especially when I’d heard of people I know who had been given such devastating news. Of course, I couldn’t imagine what they’d be going through – but now I can.
My first reaction was disbelief. I told the surgeon, "How can you tell me I’m going to die? I don’t feel sick." To which he responded, "You soon will." And there were tears. I think it was harder on my family than it was on me. I guess they felt helpless and full of despair.
The first three days after diagnosis were the worst. I cried constantly. I didn’t eat. Then on the third day I received my first ray of hope.

Finding Hope and Help

My sister and two friends had started cruising the Internet looking for information on mesothelioma. One of the women found the Mesothelioma Web. After a 20 minute conversation the clouds started to clear away.
I became encouraged to pursue a cure or treatment. I was told that there are survivors of this disease and people who were living with it. I was advised to look into the various research that is going on.
This conversation gave me what nobody else had – HOPE –and I was buoyed. I was also hungry, all of a sudden, and I tucked into a big meal of steak and onions, potatoes, peas and carrots.
From then on, I wanted as much information as I could get – the latest up-to-date information. Not having a computer, I relied totally on my sister, Malveen, and the two friends, Judith and Rosemary. They found all sorts of information and I spent a part of each day sifting through papers, contacting doctors, researchers, and others diagnosed with the disease.
The more knowledgeable I became, the more empowered I felt. Of course, there were still plenty of tears and days when I felt that I was never going to find an answer.

Choosing a Physician

Finally, after researching, I decided the doctor I wanted to try and cure me was Dr. David Sugarbaker, chief of Thoracic Surgery at Brigham and Women’s Hospital in Boston. I spoke to him on the phone at the end of November. He told me of a new protocol he had recently started and invited me to come to Boston for an assessment , and to see if I fit the criteria for this trial. My appointment was for Jan. 5, 1999 – approximately 2 ½ months from diagnosis.
I was very nervous while sitting in the waiting room that Tuesday. I knew I fit most of the criteria. My heart was strong; my blood was good; all my other organs were normal; I had no chronic diseases or ailments – but I didn’t know if I was in Stage I or if I was beyond, which would make me ineligible for that particular trial.

Miracles Happen

Then a miracle happened. One of Dr. Sugarbaker’s staff came to tell me that a man that was to be operated on Thursday couldn’t because his disease had progressed too far. Others on the waiting list couldn’t get to Boston on time for this operating room opening. So they were offering the spot to me! Dr. Sugarbaker had looked over my reports, MRI, etc. and I fit! I felt like I’d won the lottery. I met with the doctor and spent the rest of the day doing all the hospital pre-op necessities.
The operation is called an extra-pleural pneumonectomy followed by an intraoperative heated wash. My pleura, lung, diaphragm, and pericardium were removed. Then I was washed out for an hour with a drug call Cisplatin that was heated up to 4 degrees above body temperature. A new pericardium and diaphragm were reconstructed with gortex before I was sewn up 5 ½ hours later.

Recovering

This was a very heavy operation and there is a long recovery period. I know I’m not out of the woods yet – that there may be microscopic mesothelioma cells that weren’t eliminated and have started to divide and reproduce.
But can anyone be sure that something similar is not happening in their body or that when they leave the house this morning that they will come back tonight?
What I do know is that my prognosis is infinitely better than it was at the beginning, which was 0%. Every week I notice myself becoming stronger. My stamina is increasing. To look at me you’d never know I had major surgery. The 14 ½" incision is fading. A doctor told me I’d be able to wear a bikini. That’s great news because I’ve never worn one before! Dr. Sugarbaker told me that I’ll be able to continue scuba diving but, "wait six months."

Perspective

I feel a very lucky and truly blessed woman. The road was made much easier with the strength of my family. My friends, community, total strangers and new friends helped or encouraged me.
I found knowledge was a big factor in dealing with my disease. But HOPE was the biggest inspiration!
--Belle

BOB HARTHCOCK OF HOUSTON, TEXAS, 1999

A Hard Worker and Responsible Manager

From 1952 to 1982, Bob worked at the ARMCO Steel Plant in Houston, the largest steel plant west of the Mississippi. During those 30 years, Bob and his wife Jean raised three children, who are now married with children of their own. Bob worked hard during those years. He started out as a helper and worked his way up including duty on the night shift for nine years and as step-up foreman on weekends. Yet he still made the time to coach little league for both his boys every year. He got merit increases every year and eventually became maintenance foreman in charge of several hundred men.

Bob Harthcock believed that responsible management meant hands-on management. Hands-on management meant arriving at work at 5:30 a.m. to meet with the night shift before they went home. It meant walking 9 miles a day to make sure that each and every worker was doing his job and lending a helping hand if necessary. Ironically, it was Bob Harthcock’s strong work ethic and hands-on management that exposed him to deadly asbestos fibers that led to this disease.

The Exposure and the Disease

Bob Harthcock had no earthly idea that the asbestos fibers he breathed in daily as part of his job, were in fact a ticking time bomb, that would one day cause the deadly cancer mesothelioma. He had no earthly idea that the white powdery substance that he brought home on his work clothes would endanger his family. He had no clue that when Jean shook out his clothes before doing laundry, this would one day cause her to suffer from asbestosis and lose 40% of her lung’s diffusing capacity.

Coping and Surviving

Bob and Jean are people that anyone would be proud to have as neighbors. They are totally devoted to each other, to their fellow man and to their faith. They have made the best of their situation.

For the last 10 years they have been full time volunteers, not earning a penny and even paying their own expenses. They have traveled all over Texas and Mexico helping build homes for the homeless and churches for the poor. They have volunteered in hospitals and in ambulances as paramedics. They have taught English and Bible classes, and helped prepare food for the poor in Mexico and Central America, and for the Apache Indians in New Mexico.

Like Bob, many people with this disease are told they will survive 6 to 8 months after diagnosis. Bob has been breaking records with a seven year survival as of 1999. His doctors at M.D. Anderson Cancer Center in Houston are perplexed. Bob, who is a religious man has told them "try prescribing prayer".
NOTE: Bob Harthcock lost his valiant battle with mesothelioma on May 28, 2000, after helping many others deal with this disease. Bob's great-grandson was born on the day of his death.

Austin Texas dwi lawyers

2008-07-21T18:29:00.000-07:00

Austin DWI Lawyers

Austin, Texas DWI Attorneys handling DWI and drunk driving defense cases in Travis County, Texas. Call the Dunham Law Firm today to speak with an Austin DWI Lawyer to find out how they can help you.

Dunham Law Firm has been handling Texas DWI cases since 1989 and has over 200 years combined legal experience. Many of the criminal defense lawyers are former Assistant District Attorneys with many years of trial experience. But hurry time is important for keeping your Texas Driver's License. Fill out the form to your left to have Austin DWI Lawyers with the Dunham Law Firm send you your free arrest report regarding your DWI arrest in Travis County, Texas.
The Dunham Law Firm handles Texas DWI (Driving While Intoxicated), DUI (Driving Under the Influence) and BWI (Boating While Intoxicated) cases in and around Travis County, Texas. Having Texas Board Certified Criminal Law Specialists^* and former prosecutors handling your DWI defense case in Austin can make the difference between winning, going to jail or doing DWI probation. You will find our law firm to be very knowledgeable about Texas DWI Laws and drunk driving penalties and information.
Finding an Experienced DWI Lawyer in Austin When selecting legal representation, realize that the experience of your Austin DWI Attorney in Texas is very important. The way your DWI defense case is handled will have an influence on the outcome and thus your future. Having Texas Board Certified Criminal Law Specialists^* on your side can mean the difference between obtaining a good result and a bad result. At the Dunham Law Firm, many of our criminal defense attorneys have previously been Assistant District Attorneys, spending years perfecting their courtroom skills. We know the procedures of the criminal court system and can make that system work for you.
Proven Track Record against DWI's in Travis County, Texas The Dunham Law Firm has accumulated a highly successful record of acquittals, dismissals and reductions in DWI defense. Each TX DWI is different, but note that the criminal defense lawyers at the Dunham Law Firm always start with the goal of getting your charge of driving while intoxicated in Austin dismissed or reduced to a traffic ticket.
Serious Consequences for a Texas DWI in Austin A Texas DWI charge has serious consequences. You may lose your Texas Driver's License, experience a substantial increase in car insurance rates, pay large fines and court costs, suffer a driver's license surcharge ranging from $3,000.00 to $6,000.00, and possibly face jail time.
Don't leave your future to chance. Select an Austin DWI Lawyer who will fight for you. At the Dunham Law Firm we will work for dismissal or reduction of your DWI charge. If we are successful, you may even be able to have your arrest record and fingerprints torn up! Don't let this arrest record affect your job or your future; call us immediately to discuss how we can handle your Texas DWI.
Affordable Legal Fees and Pay Plans Our legal fees are fair and competitive, especially for Texas Board Certified Criminal Law Specialist. In most DWI cases, we charge a low flat rate and often do not require any money down. The initial consultation is free. When you factor in our legal experience and proven case results, the Dunham Law Firm is a good choice for those who want the highest quality of legal representation at a fair and reasonable cost.
A Word of Warning about your Texas Driver's License You have only 15 days from the date of your DWI arrest in Texas to request a hearing on your Texas Driver's License. According to the Texas DWI laws, if you fail to request a hearing, your Texas Driver's License may be suspended and you face the probability of paying huge fines for several years. It is important that you hire quality legal representation for this hearing to challenge the license suspension. Having legal representation for this license hearing provides an opportunity for your criminal defense attorney to question the arresting police officer. Putting the police officer on the stand helps to establish his or her position, which can be very beneficial to your DWI defense case.
Texas Driver's License Surcharge (Fines) Since 2003, the Texas Department of Public Safety has been authorized to levy a surcharge on Texas Driver's Licenses suspended for DWI and alcohol related arrests. This surcharge can range from $1,000.00 to $2,000.00 per year for three years. Depending on your DWI, you could be facing a $6,000.00 fee just to keep your Texas Driver's License. Now you know why it is so important to fight your driver's license suspension.
Read more about Texas DWI Penalties.
Speak to an Austin DWI Lawyer Today Call the Austin DWI Attorneys at the Dunham Law Firm in Texas today to discuss the ways they can help you keep your Texas Driver's License and try to dismiss or reduce your driving while intoxicated charge. The TX DWI attorneys at the Dunham Law Firm will take the necessary time to explain the whole process of your driving while intoxicated charge that you face.

New York Mesothelioma Lawyers

2008-04-21T18:26:00.000-07:00

ABOUT MESOTHELIOMA

Mesothelioma is a rare cancer in the general population. However, in individuals that were exposed to asbestos, it is not as rare. That’s because the only known, established cause of mesothelioma is asbestos. There are experts that have speculated on other causes. There are incidences of mesothelioma with no known asbestos exposure. However, that does not mean that there was no exposure. The right questions have to be asked. The person asking the question has to be familiar with the uses and applications of the asbestos products. There are many examples where inadequate occupational histories were taken and potential exposures were not investigated.
Mesothelioma is not a lung cancer. It is not caused by smoking. It is a cancer of the mesothelial cells. The asbestos fibers are breathed in, travel through the lung and become lodged in the pleura, the thin, Saran Wrap-type membrane that lines and encases the lung. The pleura produces a special lubricating fluid that facilitates the ability of the lungs to move inside the chest during breathing. The process of irritation from the infiltration of the asbestos fibers creates changes in the cells which causes the mesothelioma. This is known as pleural mesothelioma. Less common is peritoneal mesothelioma, which is a cancer of the membrane that encompasses the lining of the abdomen.
In a typical case, an individual with mesothelioma will experience chest pain (usually caused by a build-up of fluid in the pleural space called an effusion) and shortness of breath. Since many doctors, even pulmonologists, may not have expertise in the area of asbestos-related diseases, these symptoms are often considered, at first, to be attributable to other medical problems. A biopsy of the pleural tissue or fluid may reveal the cancer of the mesothelial cells and a proper diagnosis can be established. A history of the individual’s occupational exposure will in most instances be taken. The patient may or may not recall the precise nature of his exposure to asbestos. Since there is no “safe” level of exposure to asbestos. even brief, low level exposures may be enough to cause mesothelioma.
Mesothelioma is an aggressive cancer that strikes over 3000 individuals per year. The incidence of mesothelioma is actually increasing. That is because of the long latency period associated with this asbestos-caused cancer, i.e. the time between the exposure to asbestos and the onset of the disease, is typically at least 10 years and as many as 60 years after exposure. That means that a worker in a factory or shipyard or otherwise exposed in the 1940’s or 1950’s may not experience any symptoms of mesothelioma until this year. Click here for the occupations and activities that placed people at risk for exposure to asbestos.
For the workers who contract mesothelioma and their families, the course of this asbestos-caused cancer is devastating. If you don’t know if you have mesothelioma, and want to identify a doctor specializing in asbestos-related injuries in New York State or in other locations, click here. If you have been diagnosed with mesothelioma, and want to explore mesothelioma treatment options,
There is presently no known cure for mesothelioma. As the disease progresses, the cancerous cells harden the pleura and spread. As time passes, breathing, sleeping and eating become more difficult. It becomes increasingly more challenging for the victim to engage in normal activities and enjoy life.
A number of treatments may be available to help contain the spread of the disease and reduce the pain associated with it. Chemotherapy, radiation and radical surgery to remove the lung and/or pleura are among the options that will be explored by the treating physician.
This disease was preventable. Many of the corporations that manufactured and profited from the sale of asbestos-containing products were aware of the hazards of asbestos. They were aware or could have been aware as early as the 1920’s. Alternative fibers were available in the 1920’s that could have been used instead of asbestos. But asbestos was cheap, and available, and was a good filler and binder. Notwithstanding the deadly hazards of this fiber, corporations chose to rip asbestos out of the earth and recklessly use it in products from the 1920’s through the 1970’s and 1980’s, until most of these products were banned in the United States and abroad. The manufacturers did not warn workers exposed to the asbestos in their products until, at the earliest, the mid-1960’s and the warnings were terribly inadequate. The result is that many Americans have unnecessarily and tragically contracted asbestos-related diseases such as mesothelioma, lung cancer, other cancers and asbestosis, a scarring of the lung or pleural tissue.
The large settlements and verdicts associated with mesothelioma cases are not accidental. Jurors who have the opportunity to review the internal documents of these manufacturers and sellers of these products are outraged by the actual knowledge of these corporations and access to knowledge about the hazards of asbestos.

San diego dui defense

2008-01-01T18:23:00.000-08:00

San Diego DUI Lawyer Darren Kavinoky is an aggressive and experienced Drunk Driving Defense attorney who has achieved more not guilty, hung jury, and case dismissal DUI verdicts than any other lawyer in the region. This San Diego DUI Attorney is frequently retained to lecture and consult across the country on the topic of DUI Defense, and has built a successful law practice from his excellent reputation as a top DUI defender.
California DUI Lawyers are often retained by judges, other attorneys, and members of law enforcement who have been arrested and charged with drunk driving. Many of the police officers who hire him have testified against his previous DUI clients in Jury Trials that resulted in acquittals.

Your best defense is the right dui attorney

Hiring the right DUI attorney to defend your case can be even more important than the strength and amount of evidence against you. Darren Kavinoky has been dedicated primarily to DWI defense for over thirteen years, focussing on criminal cases such as DUI (Driving under the Influence), Vehicular Manslaughter, Vehicular Homicide, Felony DUI charges, Minor (under age 21) Zero Tolerance offenses, DUID (Driving Under the Influence of Drugs), and related cases in San Diego County and surrounding California regions.
Your arrest has actually triggered two cases, one in Superior Court, and an administrative case with the DMV to suspend your driver's license - view our past Jury Trial results and DMV Hearing outcomes to see how we fight both very seriously, handling them independently for one flat fee.
Hiring an attorney who is known as a skilled and tenacious fighter by the local prosecutors can make a strong difference in your case, there are times when charges are never filed or later dropped entirely.

Dui only defense vs. general criminal law

1. If you're speaking to a general criminal attorney who tells you they have handled DUI cases successfully, ask them how many times in the past year they have actually taken a DWI case to Jury Trial and achieved a "not guilty" or "hung jury" verdict? Or even in the past five years? Ask them what the average burn off rate of alcohol per hour should be for a male or female based on weight? Ask them when a person reaches their peak absorption level? Ask them what they know about the partition ratio? How about the Widmark Hypothesis? How about a rising BrAC? If they can't fluently answer these questions, save your money, you won't stand a chance.
2. Is the general criminal lawyer a member of the authoritative National College of DUI Defense. Do they qualify for membership in this elite organization of DUI experts? Membership with this organization indicates that your attorney is committed to drunk driving laws and is active in the specialized DUI defense community. In 2003, the American Bar Association established DUI Defense as a specialty area of law, and the NCDD is the only organization in the nation accredited to certify lawyers in DUI related defense. The members of NCDD represent the most experienced and qualified DUI Lawyers in the nation.
3. Look for an Attorney who is a Certified Operator AND Maintenance Technician of the Intoxilyzer brand of Alcohol Breath testing machines. Darren Kavinoky is certified in the Intoxilyzer 8000, the most current breath testing equipment in use by the California Highway Patrol.
4. Look for an Attorney who is certified as both Administrator and INSTRUCTOR in Standardized Field Sobriety Testing by NHTSA, the National Highway Traffic Safety Administration that sets the guidelines and procedures for San Diego Police Officers. It is likely that the prosecution and arresting officer in your case are trained as administrators in SFST's, you'll need an attorney who is at least as knowledgeable, but preferably qualified to teach these guidelines to the actual officers and prosecutors.
5. Confirm your Lawyer is a member of the California DUI Lawyers Association. Membership with this organization indicates that your attorney is commited to DUI and qualified to defend you if your case proceeds to trial.
6. Look for an Attorney who is a member of the California State Bar, the Trial Practice Inn of Court, and serves on the Resolution Committee of the Conference of Delegates for the California Bar.
7. Ask yourself if you would rather have a lawyer who is more qualified than the arresting officer and prosecutor regarding your BAC tests, related equipment, field sobriety tests, alcohol physiology and pharmacokinetics, or an attorney who is going to immediately try to plea your case down? If he or she suggests they are going to get you probation in lieu of jail, reduce your fines, etc., prior to examining the police report and evidence pertaining to your case, there's a good chance they've already decided to lose, and likely don't understand DUI enough to take a case to trial, nor want to. Find out! It is essential that your attorney have a reputation for going the distance, not planning your punishment by pre-convicting you. You don't need a lawyer to help you plead guilty, it's free.
8. Would you hire a general physician to perform heart or brain surgery? How proficient and specialized can you expect a general criminal attorney will be in DUI? Given its scientific and technical complexities? An attorney who spreads attention across a broad spectrum of crimes and areas of practice cannot possibly stay current and skilled enough to challenge the growing enforcement of DUI laws in today's high-tech courtrooms. A recent publication released by the American Prosecutors Research Institute names impaired driving as among the most challenging and complex cases on the docket, adding "... few other cases present a more complex and wordy statute, a greater likelihood of technical, scientific evidence, or the very real likelihood of expert defense testimony".
9. Darren Kavinoky is not a former prosecutor nor police officer. He has never held the job of throwing people in jail. We are, and always have been, staunch advocates of freedom and civil rights. He works diligently to keep his clients out of jail, and when a sentence is unavoidable, valiantly works for a rehabilitative alternative to spare his defendants from incarceration. We view imprisonment as barbaric and unnecessary punishment for DUI related offenses.
If you think you'll benefit from an attorney who is DUI dedicated and loves to win, please send us an eMail or complete a simple online case evaluation. San Diego DUI Attorney Darren Kavinoky and The Kavinoky Law Firm will give your case the personal attention it requires and be there for you every step of the way. Your problem is our problem and we will handle your case as we would want our own case handled. You may reach us 7 days a week, 24 hours a day at (619) 231-7412. After hours and weekend appointments are available. We offer a free consultation, and there is never a fee to speak with us about any matter.

Free quote for car insurance

2007-10-11T18:17:00.000-07:00

Welcome to Kanetix, your online source for Canadian car insurance quotes. Kanetix’s auto insurance quote comparison service brings consumers, who are searching for reasonable car insurance rates in Canada, together with insurance companies in a one-stop shopping environment. Car insurance quotes are currently available in Alberta, Ontario, Quebec, New Brunswick, Nova Scotia and Prince Edward Island for personal-use vehicles.

Introduction to auto insurance quotes in Canada

Your auto insurance is there to protect you against financial loss if you are in an accident. Your auto insurance is, essentially, a contract between you and your insurance company. You pay a premium, and in return, the insurer agrees to pay for any losses as they are defined in your car insurance policy.

Auto insurance and the law

In Canada, it is the law to have auto insurance. Your car insurance is valid anywhere in Canada and the United States. It’s a good idea to take your proof of car insurance with you whenever you drive because you must produce it if a police officer requests. If you are found driving without valid auto insurance, you can have your driver’s licence suspended and your vehicle impounded.
In Canada, each province and territory establishes their own required minimum insurance coverage. However, you often can get options that go beyond the basics. One of the nice things about insurance is that you can modify your policy to make certain that you’ve got the exact protection you require, without paying for extra insurance you may not need.
The law does not require that you get car insurance to cover physical damages to your automobile. However, if you have a newer automobile you’ll want to protect your investment and consider purchasing Collision and Comprehensive coverage.

What does auto insurance cover?

Your auto insurance generally provides property, liability and medical coverage:

Property coverage pays for damage or theft of your car.
Liability coverage pays for your legal responsibility to others for bodily injury or property damage.
Medical coverage pays for the cost of treating injuries, rehabilitation and sometimes lost wages and funeral expenses.

Dui san diego

2007-07-01T18:09:00.000-07:00

Welcome to San Diego County DUI Law Center's California Drunk Driving Defense Resources

If arrested for a San Diego DUI, you need a Top-Rated San Diego DUI defense lawyer. San Diego California DUI criminal attorney Rick Mueller is a highly specialized San Diego DUI & DMV defense lawyer who personally & aggressively handles your entire San Diego DUI problem.

Browse this Premier San Diego DUI Lawyer Info Source

Complete, worry-free San Diego DUI information shows you California drunk driving laws, California DUI penalties, San Diego DUI police evidence, saving your California or out of state driver's license, DMV suspensions & hearings, what must be done within 10 days of a San Diego DUI arrest, San Diego DUI courts & DMV, San Diego DUI courts, San Diego DUI breath test defenses, San Diego DUI blood test defenses, avoiding a San Diego DUI, military base DUI, San Diego DUI expungement, San Diego DUI attorney & lecturer Rick Mueller's exclusive drunk driving defense biography with extensive experience since 1983, why you need a premier San Diego DUI Specialist attorney, and what is now important to do next.

San Diego DUI Attorney Consultation

Please first take a few minutes to complete a Free San Diego DUI Evaluation to (a) find out your best San Diego DUI strategy, (b) keep you driving and (c) immediately receive helpful emails & a proposal from San Diego DUI lawyer Rick Mueller to handle your case. Or call Rick now on his cell phone at (619) 218-2997.

What you must do within 10 days of being arrested
If you need to save your California or state driver's license or privileges, your San Diego DUI defense lawyer has only ten (10) calendar days to contact San Diego DMV to schedule a hearing! Do not schedule yourself because if you contact San Diego DMV to schedule an administrative per se hearing date conflicting with your San Diego DUI defense attorney's calendar, DMV will not reschedule, meaning you may not get the San Diego DUI lawyer of your choice. There is no rush as long as your chosen San Diego DUI attorney contacts or serves DMV by the tenth day from your San Diego drunk driving arrest or your pink DMV order of suspension served on you after a San Diego DUI detention. San Diego California DMV attorney Rick Mueller has a video showing other San Diego DUI lawyers how to carefully attack & knock out just a single DMV issue (and there are many complicated DMV sub-issues) to save your driving privilege in order for you to avoid the reissue fee and/or the filing of an SR-22 Proof of Insurance Certificate.

Who is San Diego California DUI Lawyer Rick Mueller?

As San Diego's DMV Guru, San Diego DUI attorney Rick Mueller has successfully saved the driving privileges of many happy clients. San Diego Drunk Driving lawyer Rick Mueller dedicates 100% of his law practice to vigorously defending those accused of a DUI in San Diego county.

Rick is the only San Diego DUI lawyer who is the Editorial Consultant for the most comprehensive reference book for California DUI law, California Drunk Driving Law, the book known as California's Bible of DUI Defense. Rick is a Specialist member of the California DUI Lawyers Association, and a member of the National College for DUI Defense & the National Association of Criminal Defense Lawyers.

Rick Mueller is the attorney for the San Diego County DUI Law Center, a Professional Corporation, which focuses on California DUI and DMV law. He has been in practice since 1983 and received his Juris Doctor degree from Chicago Kent College of Law.

On August 1, 2009, Rick taught at the Mexican American Bar Association's annual DUI seminar at Loyola Law School in Los Angeles.
On September 27, 2008, Rick recently lectured on Advanced Strategies and Tactics for Handling California DMV APS Cases at the California Attorneys for Criminal Justice Annual Rules of the Road DUI Seminar, in Rancho Mirage. Rick has been a featured Speaker at numerous DUI / DMV seminars in San Diego County in the last several years and is frequently chosen to deliver lectures on the subject of defending driving under the influence cases and DMV hearings. Rick regularly speaks at Strategies in Handling DUI Cases seminars, and has spoke at the DUI & Drug Defense seminar, the Bar Association's Drunk Driving - DMV seminars, and the California Public Defenders' DUI training seminars.

Well-known and highly respected attorney Rick Mueller specializes exclusively in California DUI and DMV law. With extensive experience and valuable resources, Rick has earned a reputation in California for successfully representing DUI / drunk driving clients and is considered to be among the best DUI defense lawyers in San Diego.

Rick's knowledge is often sought out by other criminal defense attorneys in San Diego who take on DUI cases. Rick stays on the cutting edge of DUI / DMV issues in San Diego California drunk driving defense cases by keeping up with current California DUI laws, the latest California drunk driving case rulings, DUI science literature, national & California state legal treatises, and scholarly articles written in the area of San Diego California DUI / drunk driving defense.

For independent ratings of San Diego DUI attorney Rick Mueller and other lawyers so you can choose the right lawyer

* World's largest legal directory
* Unbiased Avvo Rating
* Disciplinary sanction history (none)
* Ratings and reviews from clients & other DUI lawyers

Your San Diego DUI

San Diego California DUI lawyer Rick Mueller understands how devastating an arrest for a San Diego DUI - driving under the influence of alcohol and / or drugs can be. You may have had your license taken away and / or served a pink DMV order of suspension, had you vehicle impounded, and spent the night in San Diego County jail.

You may face loss of employment, family repercussions, San Diego County Jail custody, loss of your driving privilege, huge fines, California DUI alcohol program, a vehicle ignition interlock device, vehicle impound/forfeiture, community service, trash detail, DMV hassles, high California DUI insurance rates, . You may be worried, suffering from unnecessary anxiety, and seek immediate help. You may not know what to do, how to do it, or what to do first. You really want sincere solutions to your San Diego DUI. Proper San Diego DUI help is here.

A San Diego DUI / Drunk Driving conviction can result in loss of reputation, costly fines, attendance at alcohol or education classes, suspension or revocation of your license, stigma, and increase in and / or cancellation of automobile insurance, installation of an ignition interlock device in your car, and, in perhaps, jail or prison. In San Diego California, where drivers must use freeways, and public transportation is generally lacking, losing the privilege to drive can ruin a person's employ or career, not to mention one's personal life.

San Diego DUI lawyer Rick Mueller personally handles every San Diego drunk driving case with the needed care and attention you deserve. Initially, Rick can immediately show you how to get your hard copy California driver's license back today and successfully help you get your driver's license suspension stayed (stopped) pending resolution of the DMVstop 'n snatch / administrative per se hearing. You will be free to drive anywhere in San Diego & elsewhere: to work, school, and other personal places you like to go to.

Rick will personally do a thorough San Diego DUI defense investigation & DUI discovery process, including Rick's personal review of each and every document, police report, DMV DS 367 sworn Officer's Statement, San Diego DUI test record, San Diego DUI witness statements, and your version of events by you completing the critical free San Diego DUI attorney Evaluation. San Diego DUI / Drunk Driving lawyer Rick Mueller will undoubtedly strive to successfully achieve the best possible outcome for you!

How can you know if you found a qualified San Diego California DUI Lawyer for yourself?

Various types of lawyers handle San Diego drunk driving cases, including public defenders, general practitioners, criminal defense lawyers, and DUI Specialist attorneys.
Some excellent questions to begin asking when searching for a San Diego California DUI lawyer are:
" What are his/her California DUI attorney's qualifications?
" Is he/she a Specialist member of the California DUI Lawyers Association?
" How long has he/she been a member of the National College for DUI Defense?

" Does he/she teach other attorneys in San Diego how to handle DUI cases?

" Is he/she a Contributing Editor to the Bible for California DUI Defense - California Drunk Driving Law?

" Was he/she recently asked to be a Contributing Editor/Author to the hottest/best-selling DUI book: Attacking and Defending Drunk Driving Tests?

" Does he/she maintain a library of DUI materials, books, manuals, studies, memos, points & authorities and documents solely designed to help a person accused of a San Diego County DUI?

" How much of his/her practice is DUI Defense?

" Is he/she quick and thorough when responding to emailed questions or concerns?
Whether or not you ultimately end up hiring a San Diego California DUI & DMV Defense Lawyer Specialist with this much experience, it is a smart idea to look closely at the credentials of a California DUI Lawyer Specialist in this highly complex field.

San Diego County Public Defender?

If you think you can get a Public Defender, think again. If you have a job or assets, you simply do not qualify. If you apply for a Public Defender, you will have to swear under oath. If you do meet the financial eligibility criteria for a public defender for the Criminal Court side of your DUI case: (a) public defenders do not handle DMV matters; and (b) your court appointed attorney will not be available to discuss your DUI case with you until they have been officially appointed by the Judge no sooner than the date of your first court appearance, or arraignment. Being that the 10 day grace period for requesting a DMV Licensing Hearing would have already lapsed, it is strongly recommended that you retain a qualified and proven a San Diego DUI Attorney Specialist to represent your quasi-civil matter with the Department of Motor Vehicles.

US Mail Privacy Warning: San Diego Attorneys Mail You "DUI" Mail After Your Arrest!

You may be feeling a little down. It gets more depressing when you see your mail.

Don't want persons living at your home to know you were arrested? Hurry home.
Why? San Diego attorneys send "Jail Mail."

Some San Diego lawyers pay $ for your name and address. They solicit you with outdated, invasive, and unreliable "DUI" letters.

Your mail box gets filled with embarrassing words printed on the envelopes:

"DUI"
"Drunk Driving"
"Arrested"
"Former Prosecutor"
"Court-related "
"DMV"
"Legal Advertisement"
"Urgent"
"Law Offices"
"Attorney"

If you are looking for a cheap lawyer, you may want to read some Junk Mail. (Coupons & rebates are enclosed in some letters.)
On the other hand, for obvious reasons, you probably want to retain the best San Diego DUI & DMV Defense Lawyer you can afford.

Remember: Good San Diego lawyers are not cheap. Cheap San Diego lawyers are usually not any good.

And whether or not the lawyer or attorney sending mail in San Diego are really DUI lawyers or DUI attorneys is an important Question.

Consolidate Private Student Loans

2007-04-14T18:03:00.000-07:00

Consolidate Private Student Loans

The pursuit for higher education can be an expensive endeavor both financially and emotionally. For such a noble quest, it is a shame that it must be pursued under the looming shadow of overwhelming loan payments. It is well worth your time to look into the options available for consolidating your student loans. Read on to learn how to consolidate your private student loans. It may keep you from what can amount to a life sentence enforced by your creditors.

Instructions

Step 1

List all the outstanding private student loans that you owe, listing them in order from the highest balance to the lowest. For each one, list the interest rate, pay off amounts, loan period and payment address.
Step 2

Review the terms on each of your current loans. Terms such as pre-payment penalties may make it prohibitively expensive to refinance a particular loan by consolidating it with another.
Step 3

Clean up your credit report. When you apply for to consolidate your student loans, the interest rate will be based on your credit score. It is essential that your review your credit report and make sure there are no errors, which are common on most credit reports. If you have paid off a loan or closed a credit card and it is still listed on your credit report, it can significantly affect your credit score. Make sure that any errors are corrected.
Step 4

Determine your objectives for consolidating your student loans. The different student loans typically do not compete on interest rates, so they are pretty similar from one education lender to the other. However, here are some objectives that you can accomplish by consolidating your student loans:*You will have a single payment rather than two or more, making it easier to manage the loan.*If one or more of your private student loans has a variable interest rate, consolidating into a home equity loan will lock in your interest rate.*You can benefit from lower monthly payments because, by consolidating the loans, the terms are re-set, extending the amount of time you have to pay-off the loan. This does come at a price, though, because you will end up paying more in interest.*If your credit score has improved by 50 to 100 points since you applied for the loans, you can save significantly by consolidating because your interest rate will be much lower.
Step 5

Research the different terms that are offered by different education lenders. Pay particular attention to any pre-payment penalties. Verify whether the interest rates are fixed or variable. If you apply with a co-signer, find out when you can remove the co-signer from the loan. Find out the associated costs such as loan origination fees, and whether or not you can roll them into the loan if you choose to. Find out additional incentives offered by each lender such as interest rate reduction for setting up automatic payments from your bank account.
Step 6

Consider the pros and cons of consolidating with non-education lenders. Consider applying for a personal loan from your bank. Consider a home equity loan.
Step 7

Contact one of your current loan company. They may agree to consolidate all loans at a lower rather than lose you as a customer.
Step 8

Short-list the education lenders (and/or non-education lenders). Compare and make your selection. Apply to consolidate your loan.

Lemon Law California

2007-01-14T17:51:00.000-08:00

All the California state lemon law information you need is right here…

California’s Song-Beverly Consumer Warranty Act, more commonly referred to as the California Lemon Law was passed into state law over 20 years ago in order to provide relief to buyers of problematic vehicles in the State of California. The California Lemon Law applies to vehicles that were purchased or leased in the state of California wherein the auto dealerships have been unable to repair the vehicle within the warranty period after being given a reasonable number of opportunities (statutory specifics apply). For qualifying vehicles, the automobile manufacturer must give the buyer his or her money back and pay off the outstanding loan balance, or replace the vehicle with a comparable model. A replacement vehicle under the California Lemon Law only occurs if both consumer and manufacturer agree to a replacement.

The California Lemon Law also requires that the automobile manufacturer pay for the consumer's hourly attorney's fees and costs on a lemon law case. This makes the lemon law economically feasible for those who would otherwise not be in a position to hire an attorney.

The California Lemon Law can cover any new or used vehicle that still has a manufacturer’s limited warranty still in effect. Many consumers who have purchased “manufacturers certified pre-owned” used cars do not know that they have the same rights under the California lemon law as do buyers of new vehicles. Some buyers purchase used vehicles without even knowing that the vehicle may even have been a “manufacturers certified pre-owned” to the previous owner, which is applicable to the present owner! Many vehicles have “hidden” or “secret” power-train warranties that a used car buyer does not readily know about. Your lemon law attorney can get this information as part of your lemon law case.

Many consumers purchase from the dealer what they believe to be an “extended warranty”. This is a misnomer in the state of California. With the exception of one German high-end manufacturer, every other “warranty” that is administered by the dealer (whether factory or secondary market) is a “Service Contract”, and NOT applicable to California Lemon Law. Dealers *call* these “extended warranties”, as do consumers, but they are NOT.

What about problems with dealer-installed, non-factory parts/accessories like alarms, wheel/tire packages, glass etch, paint protection, fabric protection, custom grilles, spray-in bed liners (for trucks), DVD/entertainment systems, custom paintwork, truck lift kits, and the like in regards to California Lemon Law?

Non-factory items installed by the dealer are a matter between the DEALER and the CONSUMER, and not a responsibility of the automobile manufacturer. If a manufacturer agrees to repurchase or replace the vehicle under the California Lemon Law statute, the consumer does NOT receive any monetary reimbursement/ compensation for these items, as they are outside of how the vehicle was “as built” from the factory. Consumers are allowed (if no cosmetic damage/holes/etc. are left behind) to remove and keep these items, but if factory items were originally involved, then when the aftermarket (non-factory) item is/are removed by the consumer, the OEM (original part) must be purchased by the consumer and installed in place of the aftermarket item so that the vehicle is returned (surrendered) in “as built” condition. Also, vehicles must be returned with no cosmetic damage, worn-out tires, compromised windshield, scraped alloy wheels, etc. “Normal wear and tear” is acceptable, but varies in degree of interpretation by each automobile manufacturer. A good “rule of thumb” is the vehicle is inspected much like when a leased vehicle is checked-out at the end of the lease. The consumer, at the consumers sole expense, must correct the deficiencies/damage prior to returning (surrendering) the vehicle.

A California Lemon Law claim/case is best left to the lemon law attorney, who is best equipped to deal with the automobile manufacturer by using and enforcing the word “law” behind the phrase “California Lemon Law”. Utilizing a lemon law attorney “levels the playing field” between consumer and manufacturer, and distances the consumer from the frustration of having to deal with automobile manufacturers, who would otherwise be happier if there were no California Lemon Law at all.

Arizona Dui Attorney

2006-10-04T17:35:00.000-07:00

Arizona Dui Attorney

Practice areas include representing clients charged with drunk driving, aggravated DUI, extreme DUI, and implied consent violations.. Arizona DUI attorneys Weintraub and Weintraub offer legal representation to those arrested for drunk driving in Phoenix, East Valley and West Valley.. At the Maasen Law Firm, you will find the highest quality of Phoenix Arizona DUI Defense Lawyer, DUI Attorney In AZ, Attorney DUI Tucson, legal advice and expertise . Arizona; Arkansas; California; Colorado; Connecticut; Delaware; District Of Columbia In addition to giving you immediate access to local DUI attorneys, we also give you useful . DUI Forensic Case Dismissed: November 5, 2009 Phoenix DUI Blood Case Not Guilty on All Counts Read More / Contact Our Firm DUI Forensic Case Dismissed: November 5, 2009 Phoenix . Arizona DUI attorneys Weintraub and Weintraub offer legal representation to those arrested for drunk driving in Phoenix, East Valley and West Valley.

Los Angeles Criminal Attorney

2006-07-03T17:45:00.000-07:00

Los Angeles, San Fernando Valley, and Santa Clarita
Valley Criminal Defense Attorney

You’ve just been arrested for a criminal charge in the Los Angeles area. Or maybe it’s a loved one, a son or daughter, or spouse who has been arrested. As would be expected, there are many unanswered questions and concerns. The most important question is: Who can help us resolve the challenges we are facing? The answer: Los Angeles Criminal Defense Lawyer Gregory Caplan, a local defense attorney who focuses his attention on helping clients and their families with cases in Los Angeles area courts.

News of an arrest can be an unsettling event, but it is reassuring to know that there is help available. You need the criminal defense lawyer who understands the challenges you face, and takes the time to evaluate your individual situation to determine the most effective strategies for you. Los Angeles Criminal Defense Lawyer Gregory Caplan understands the impact that criminal charges can have on a person and his family. He has helped hundreds of clients effectively resolve their criminal cases in local Los Angeles County Courts.
As a Los Angeles Criminal Defense Lawyer, Gregory Caplan provides answers to his clients’ questions, and works towards resolving their criminal charges by utilizing comprehensive approaches in the local courts. His unique strategies are the product of his extensive background in criminal law, which included a period of nine years as a California prosecutor. Mr. Caplan emphasizes his practice on helping clients in Los Angeles, the San Fernando Valley (including Burbank Court), as well as in the Santa Clarita Valley. Gregory Caplan was the Prosecutor in the Burbank Courthouse for the Burbank City Prosecutor from 2000-2006. During that time, and thereafter, he successfully handled 1000s of cases in the various courtrooms of the Burbank Superior Court, as a Burbank Criminal Lawyer.
What is it that differentiates Criminal Defense Lawyer Gregory Caplan from other attorneys? Mr. Caplan evaluates each case, as well as his client’s needs, to effectively and efficiently guide them through the challenges of the local courts, and provides to them a clear understanding of the courtroom process. Unlike many criminal defense lawyers, Mr. Caplan understands the local procedures and practices of the courthouses in which his clients’ cases are heard, and can provide the benefit of the “local advantage.”

One important example of the “Local Advantage” would be Mr. Caplan’s significant familiarity with “City Attorney Diversion” programs, which quietly exist in the local City Attorneys’ Offices, as well as some area courtrooms, giving persons charged with crimes, an opportunity to earn dismissals of their charges upon successful completion of program requirements. Criminal defense lawyers in Los Angeles who are unfamiliar with these possibilities simply cannot advise you of the alternatives which exist for your case.
You can reach Criminal Defense Lawyer Gregory Caplan directly at (213) 400-5355 or 818-536-3630 to discuss your immediate concerns, and find out what he can do now to help.

Background of Gregory Caplan-
Los Angeles Criminal Defense Attorney

Mr. Caplan has a substantial background in criminal law, beginning with 12+ years working for law enforcement and prosecution agencies in California. Mr. Caplan’s legal career started in the Los Angeles District Attorney’s Office in 1995. He learned the prosecution systems, as well as courtroom protocol of the district attorney, and worked directly with numerous deputy district attorneys who are still employed in the local courtrooms. Mr. Caplan understands as a Los Angeles Criminal Lawyer, time is a critical factor in effectively resolving his clients charges. Mr. Caplan makes productive efforts to provide important information to the prosecutor before charges are initiated. (See the Case Results Page for Details.) When Mr. Caplan works on a client’s matter, he uses his extensive background to help clients resolve their situation. His comprehensive system provides his clients a huge benefit in their cases. (For examples, go to the Los Angeles webpage).

Mr. Caplan was the Courtroom Prosecutor for the city of Burbank for a period of six years. In addition to his extensive courtroom responsibility, he also implemented many practices and procedures which are used today in the Burbank Court. His understanding of this court, the bench officers, deputy city attorneys and deputy district attorneys, as well as court personnel, provides his clients with an opportunity to receive effective representation from a Burbank Criminal Defense Attorney. Mr. Caplan has developed an effective criminal defense practice in the Santa Clarita Courthouse, as well. The Santa Clarita Courthouse, also known as the Newhall Courthouse or Valencia Courthouse, is well-known its hard-line treatment of criminal charges, such as DUIs/Drunk Driving, Hit and Run, Drug or Alcohol-Related Charges, Petty Theft/Shoplifting, as well as traffic violations. Gregory Caplan understands effective Santa Clarita Criminal Defense Attorney strategies for each of the three criminal courtrooms, the bench officers, and court personnel, at the Santa Clarita Courthouse, and efficiently handles criminal cases there for his clients. (See our Santa Clarita webpage for details.)

Mr. Caplan is a successful San Fernando Valley criminal defense attorney in Van Nuys, San Fernando, Burbank, and Glendale. He is available to help you with your charges in any of these courts. (See the San Fernando Valley webpage for information.)

Los Angeles Criminal Defense in the Local Communities

It is well known in the local communities in and around Los Angeles, that extraordinary resources are focused on proactive law enforcement, as well as strict prosecution for offenses committed within each of the city limits. The Burbank Leader, Glendale News-Press, Crescenta Valley Sun, La Canada Valley Sun, Antelope Valley Press, Daily Pilot, Coastline Pilot, and Huntington Beach Independent, which are the area newspapers and sources of online news in Los Angeles and neighboring cities, present wide-ranging columns regularly updating detailed examples of local cities’ strict enforcement practices. The CSUN Daily Sundial, the local college news source, regularly reports on related enforcement practices, which can have severe consequences on area college students. Seemingly insignificant violations, which have been reported in the above news resources, such as open-container offenses, are regularly prosecuted as misdemeanor charges. It is important, as you can see from the law and order focus of the Los Angeles community, that it is crucial to hire a Los Angeles Criminal Defense Lawyer to help you with your case, who knows the court system and effective strategies for your case. (See the Burbank webpage for details.)

Los Angeles Criminal Defense Lawyer Services

Gregory Caplan understands that efficient and effective criminal defense is important when it comes to his clients’ criminal cases. He devotes significant effort and energy into protecting each of his clients’ rights and serves as their advocate in court. If you are charged with a violation in any one of the Los Angeles Superior Courts, including courts in Los Angeles, the San Fernando Valley (as well as Burbank Court), and the Santa Clarita Valley, it is in your best interest to speak with criminal defense attorney, Gregory Caplan. The legal penalties for a criminal conviction are far too severe to forgo the representation of a knowledgeable lawyer. Criminal Defense Attorney Gregory Caplan will defend you in court, challenge evidence presented against you, and safeguard your individual rights. At the Law Offices of Gregory Caplan, Mr. Caplan provides clients the resources, guidance, and direction they need to be prepared for their court proceedings.

Los Angeles, San Fernando Valley, and Santa Clarita Valley Practice Areas
Gregory Caplan has helped many clients facing drug charges, weapons charges, and drug crime charges. He has also assisted clients who have been charged with theft crimes. Mr. Caplan is has defended clients charged with driving under the influence, hit and run, and serious traffic infractions. As an extremely effective negotiator, Mr. Caplan can assist clients with their local code violations, as well. The Law Offices of Gregory Caplan can inform you about your rights in regard to bench warrants, arrest warrants, and failure to appear.

Contact Our Criminal Defense Law Offices
The Law Offices of Gregory Caplan are proud to provide dependable legal counsel for clients throughout Los Angeles, the San Fernando Valley, and Santa Clarita Valley. As an attorney with years of practice experience, Gregory Caplan has helped many clients contest their serious criminal charges. Mr. Caplan understands the life altering effects a criminal conviction can have on his clients, which is why he strives to provide them with the guidance and resources they need to be successful in court. With convenient office locations to serve you, Gregory Caplan is prepared to effectively handle your criminal case.

College loan consolidation

2006-04-23T17:31:00.000-07:00

What is college loan consolidation? Going to college is one of the most important steps in one’s life, but it is also one of the most expensive ones. Nowadays, nearly everybody who goes to college has to borrow money from some lender – parents, the federal government, or private institutions.
When one has multiple lenders and is heavily in loan over college loans, there is not much to be done but start repaying them one by one, or to consolidate them.
There are many programs aimed at helping present or former students to consolidate their loans. College loan consolidation has the indisputable advantage that it is easier to manage one loan than multiple ones. Also, since interest rates have fallen, consolidating many loans into a single, low-interest one is a way to decrease the gross payment for college.
When you start college loan consolidation, first examine their sources. A rule of thumb is that federal loans, which generally have lower interest rates, are never consolidated with loans from private sources.
Also, the amount of money that you owe is another issue to consider. Many loan consolidation companies do not deal with amounts less than USD 10,000, while others do not have a minimal requirement. Other companies have eligibility requirements so that only graduates can use their services.
By consolidating your college loans now, you can achieve one more thing – extend the term for payment to 15 or even 30 years. This can be a partial solution for you, if you now don’t have the money to pay it, but bear in mind that by extending the term you will pay much more interest.
With all that said, the decision whether to consolidate or not is solely up to you. Sometimes it proves that the charges for the consolidation exceed the drop in interest, so think twice before you consolidate!

Remortgage

2006-01-14T17:10:00.000-08:00

When you remortgage, you are switching your mortgage to another deal, and frequently another lender.
Remortgages can be used for various reasons, most people simply switch mortgage because it will work out cheaper for them.
For example, the introductory discounted interest rate may have finished with your current lender; therefore you could get a discount, or a lower APR, with another lender.
Other individuals may use a re-mortgage to consolidate their debts, if they take out their remortgage for a larger amount than owed on the existing mortgage.
If you are looking to replace your existing mortgage for one with lower repayments please fill out our quick enquiry form.
It is possible to remortgage up to 95% of your property. If you have already paid off a large proportion of your mortgage, it may be better for you to consider an Equity Release Plan rather than a re-mortgage.

Getting a remortgage is something that almost all mortgage borrowers have to do, apart from those that make enough money to pay off all of their loan at once, or those rare borrowers who choose long-term fixed-rate mortgages. The remortgage process is relatively simple, and many borrowers remortgage once every couple of years to get the best rates. Studies have indicated that those who remortgage regularly are likely to spend less on interest over the life of their loans compared to those who allow their mortgage to revert to standard variable rates.

Why remortgage?

Whether you have a fixed-rate mortgage, a tracker mortgage or another type of discount rate, your mortgage will likely be set at a special rate for a limited period of time. Typical examples include a two-year fixed-rate mortgage or a three-year tracker mortgage. When this special period comes to an end, mortgage holders have to choose a new deal or their mortgage will revert to the lender’s standard variable rate, usually considerably higher than special deals.

How does a remortgage work?

Mortgage holders search for the most competitive loan possible to choose where to remortgage to. Depending on the near future, different mortgage products will represent better or worse value, and it is up to the consumer to predict this or rely on an independent financial adviser.
For instance, if interest rates are to climb during the special deal period, a fixed-rate mortgage will protect the borrower from rate rises and ensure a guaranteed level of repayments. However, if interest rates are going to fall, a tracker mortgage will follow Bank of England base rate down, potentially providing cheaper mortgage repayments. Other special deals such as variable rates and discounted rates may represent good value for some borrowers.

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