This patient was known to have confirmed pleural malignancy followed up in another service. 

He has previous left VATS: Macroscopy: Labeled "Left pleural rind biopsy".  2 fragments of fatty tissue bearing an incomplete smooth pale grey lining 8 x 5 x 3 mm and 14 x 9 x 5 mm.  Inked, serially sliced.

Microscopy: The biopsy fragments show fibroadipose connective tissue with surface fibrinous exudate. Within the submesothelial stroma, there is a proliferation of atypical epithelioid mesothelial cells forming small nests, trabeculae, and tight acinar arrangements. These cells have moderately pleomorphic nuclei with prominent nucleoli and there are scattered mitotic figures. A sclerotic stromal reaction is present. The surrounding pleural tissue shows features of fibrous pleuritis with mild chronic inflammation. No alveolated lung tissue is included. Atypical cells do not extend into the adipose.
Immunoperoxidase stains have been performed on the mesothelial cells show positive staining for calretinin and CK 5/6, with no staining for EMA.
The findings are suspicious for malignant mesothelioma, however, the presence of adjacent fibrous pleurisy and the absence of invasion into the adipose tissue precludes a definite diagnosis.

Conclusion: Left pleural rind biopsy: Atypical mesothelial proliferation, suspicious for but not diagnostic of mesothelioma.

A second opinion from a different pathologist: features are in keeping with malignant mesothelioma, epithelioid subtype.