Non-traumatic esophageal perforation: A case report on Boerhaave’s syndrome

Boerhaave’s syndrome is a potentially fatal condition characterized by spontaneous perforation of a previously healthy esophagus, due to severe vomiting or straining. It often presents with non-specific symptoms such as fever, pain, and vomiting and hence may go undiagnosed. The Makler’s triad, consisting of vomiting, chest pain, and subcutaneous emphysema, may be seen in only 50% of cases. Delayed diagnosis may result in complications such as sepsis, mediastinitis, pneumothorax, and multi-organ dysfunction. In general, patients presenting later than 48 h are conservatively managed with esophageal stenting. Surgical repair is usually reserved for those patients who present within 24 h, or are managed conservatively and develop complications. Mortality rises from 0% if treated within 24 h to about 29% if delayed more than 48 h. We present a case of Boerhaave’s syndrome in a 35-year-old male who presented with spontaneous respiratory distress and hemodynamic instability, about 36 h after the onset of vigorous vomiting. The case was managed initially with endoscopic insertion of a self-expanding metallic stent, followed later by surgical closure of the esophageal perforation. The patient, however, developed post-operative septic complications and died after a week

Pleural fluid cytology in prompt diagnosis of pleuro-pulmonary nocardiosis masquerading as COVID-19

Introduction: There are few reports of nocardial infections among the Indian population. We report this case because of its rarity and unique presentation and to highlight the role of cytology in diagnosis. Case Details: A 74-year-old woman presented with fever and chest pain of a duration of 15 days. In view of the coronavirus disease (COVID) pandemic, she was given steroids. She developed breathlessness and was referred to a tertiary care hospital. Her pleural fluid cytology showed filamentous bacteria. A diagnosis of nocardia was confirmed by culture. Discussion: Nocardiosis refers to the localized or disseminated infection caused by filamentous aerobic bacteria of the genus Nocardia. The clinical presentation of nocardiosis is highly variable. In our case, clinical misdiagnosis as COVID-19 and steroid treatment would have caused deterioration of nocardiosis. Conclusion: All patients with pulmonary symptoms should be thoroughly evaluated before considering a diagnosis of COVID-19. Pleural fluid cytology can be of help in the diagnosis of nocardiosis.

Cell HE staining smears and paired cell paraffin sections in detection of epithelial growth factor receptor gene of pleural fluid specimens / 中南大学学报(医学版)

OBJECTIVES@#The advanced non-small cell lung cancer (NSCLC) patients with pleural effusion have no opportunity for surgery treatment. Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) are the first-line drugs for these patients with EGFR-sensitive mutation. However, the disease progression and drug update during or after treatment of EGFR-TKIs bring more challenges and puzzles to clinical diagnosis and treatment, which inevitably requires archived pleural cell samples for EGFR re-examination or comparative study. Understanding the DNA quality of archived pleural fluid samples and effectively using archival data of pleural fluid cells are of great significance for tracing the origin of cases and basic medical research. This study aims to evaluate the consistency of EGFR mutant gene expression between the 2 methods, and to explore a reliable way for preserving cytological data and making full use of cytological archival data via cell HE staining smear and cell paraffin section.@*METHODS@#A total of 57 pleural fluid cytology cases in the Department of Pathology of China Aerospace Center Hospital from October 2014 to April 2021 were selected. Tumor cells were detected by cell HE staining smears and immunohistochemical staining for TTF-1 and Napsin A in the paired cell paraffin sections. There were more than 200 tumor cells in cell HE staining smear and the proportion of tumor cells were ≥70% in matched cell paraffin sections. Patients with 2 cell smears (one for cell data retention and the other for DNA extraction) were selected as the research subjects, and 57 pleural fluid samples were enrolled. EGFR gene mutation was detected by amplification refractory mutation system-polymerase chain reaction in 57 paired cell HE staining smears and cell paraffin sections. DNA concentration was 2 ng/μL. Cell HE smear was amplified side-by-side with DNA samples from paired cell paraffin sections. Result determination was according to the requirements of the reagent instructions. The external control cycle threshold (Ct) value of the No. 8 well of the samples to be tested was between 13 and 21, which was considered as successful and reliable samples. When the Ct value of EGFR gene mutation was <26, it was considered as positive; when the Ct value was between 26 and 29, it was critical positive; when the Ct value was equal or more than 29, it was negative. ΔCt value was the difference between mutant Ct value and externally controlled Ct value. The smaller the ΔCt value was, the better the quality of DNA of the detected sample was.@*RESULTS@#Among the 57 pleural effusion samples, 42 patients were hospitalized with pleural effusion as the first symptom, accounting for 73.7% (42/57). EGFR mutation was detected in 37 samples [64.9% (37/57)]. The mutation rate for 19del was 37.8% (14/37) while for L858R was 48.6% (18/37). Females were 56.7% (21/37) of mutation cases. The mutation consistency rate of cell HE staining smear and matched cell paraffin sections was 100%. The ΔCt values of cell HE staining smears were less than those of matched cell paraffin sections. The mutation Ct values of 37 cytological samples were statistically analyzed according to the preservation periods of the years of 2014-2015, 2016-2017, 2018-2019, and 2020-2021. There were significant differences in cell paraffin section in the years of 2014-2015 and 2016-2017 compared with the years of 2018-2019 and 2020-2021, while no significant differences were found in cell HE staining smear. Statistical analysis of externally controlled Ct values of 57 cytological samples showed that there were significant differences between cell HE staining smears and cell paraffin section in the years of 2014-2015 and 2016-2017, compared with the years of 2018-2019 and 2020-2021. The mutational Ct values of 37 paired cell blocks and smears were all <26, and the externally controlled Ct values of 57 paired cell paraffin sections and HE staining smears were all between 13 and 21.@*CONCLUSIONS@#The DNA quality of cell HE smears and matched cell paraffin section met the qualified requirements. Two methods possess show an excellent consistency in detecting EGFR mutation in NSCLC pleural fluid samples. The DNA quality of cell HE staining smear is better than that of cell paraffin sections, so cell HE staining smear can be used as important supplement of the gene test source. It should be noted that the limitation of cell HE staining smears is non-reproducibility, so multiple smears of pleural fluid are recommended to be prepared for multiple tests.

The yield of malignancy for early fixation versus routine fixation of Pleural fluid samples

Background@#The etiology of pleural effusion remains unclear in nearly 20% of cases. One way to diagnose malignancy is by doing pleural fluid cytology. There are factors that influence the yield of pleural fluid cytology and one of them is appropriate and timely fixation of samples. Currently, there is no local consensus regarding the timing with which the specimen should be fixed.@*Objective@#The study aims to compare the yield of malignancy between early fixation versus usual fixation of pleural fluid samples, meaning there is no set time for fixation to be done.@*Methodology@#The study employed a prospective cross-sectional research design. All patients with pleural effusion who fulfilled the criteria set by the study were included. Two sets of pleural fluid samples were collected amounting to 20cc each. First sample was assigned as Bottle #1 and placed immediately with fixative while the second sample was assigned as Bottle #2. Bottle #2 underwent routine fixation which follows no fixed or standard time of fixation. The time difference between the fixation of two sample groups greatly varied with Bottle #1 fixed immediately right after collection while Bottle#2 depends on the time it will be processed by the laboratory personnel. Both samples were submitted for cell block and cell cytology reading.@*Results@#Characteristics of the 55 patients included in the study showed age group range from 41 to 65 years of age, with 27 male and 28 female patients. Only one third had history of smoking. There were 21.82% who had family history of cancer and with and suspicious mass on chest radiograph. Out of 55 patients, 29 patients had history of previous diagnosis of cancer, 23 had recurrent pleural effusion, and 28 had chest radiograph with suspicious nodules. Based on gross appearance, there were 20 serous and 21 sanguineous pleural fluid noted. Mean cell count was high (1,115.50 ± 741.02) with lymphocytic predominance (82.56 ± 24.46). Elevated protein concentration (5,388.25 ± 8,230.46) and LDH (484.17 ± 248.72) were noted. Glucose (8.78 ± 6.68 mmol/L) was low. There were 21 patients who had high WBC, 24 with high protein and 16 with elevated LDH. There were 3 patients who were positive for AFB and none for KOH. Comparative analysis showed that the pleural fluid samples assigned to the routinely fixed group which were handed to the nurse after thoracentesis, then forwarded to the laboratory through a ward laboratory aide or patient watcherfor fixation with with 95% alcoholby thelaboratory personnel significantly had a longer duration of 406.62 minutes as compared to immediately fixed at 12.27 minutes (P<0.01). For diagnosis of malignancy, significantly more cases were diagnosed in the immediately fixed group with 36.36% cases versus 18.18% (p=0.016).@*Conclusion@#Among patients with suspected malignant pleural effusions, early fixation of pleural fluid samples resulted in higher histopathology yields as compared to those fixed after going through the routine fixation.

Diagnosis of parapneumonic pleural effusion with serum and pleural fluid Activin A

Abstract Objective The aim is to evaluate the diagnostic value of Activin A levels in serum and pleural fluid on Parapneumonic Pleural Effusion (PPE). Methods The authors collected serum and pleural fluid from 86 PPE and 37 Non-PPE (NPPE) patients. Including Activin A, levels of biomarkers such as Lactate Dehydrogenase (LDH), Procalcitonin (PCT), and C-Reactive Protein (CRP) were measured. All factors were calculated for association with days after admission. The diagnostic potential of biomarkers on PPE was considered by Receiver Operating Characteristic (ROC) curve analysis. Results Levels of Activin A in serum and pleural fluid of PPE patients were significantly higher than those of the NPPE patients. Moreover, concentrations of Activin A in pleural fluid showed a more obvious relevant days after admission. ROC curve analysis found that Activin A in pleural fluid had AUCs of 0.899 with 93% sensitivity and 84% specificity for PPE diagnosis. Conclusion Activin A in pleural fluid correlated with disease severity could act to diagnose PPE.

Hallazgos citoquímicos en líquido pleural de pacientes con COVID-19, atendidos en un servicio de emergencia / Cytochemical findings in pleural fluid from patients with COVID-19, cared for in an emergency department

Objetivo: El presente trabajo tuvo como propósito describir las características físicas, citológicas y bioquímicas, así como clasificar los líquidos pleurales de pacientes con COVID-19 como exudados o trasudados. Material y Métodos: Se realizó un estudio observacional, transversal descriptivo. Se recopiló datos del examen citoquímico de muestras de líquido pleural procesadas entre los meses de abril a setiembre del 2020, en el laboratorio del Centro de Emergencias de Lima Metropolitana (CELIM). Resultados: Durante el periodo de estudio un total de 81 muestras de líquido pleural de pacientes con COVID-19 fueron evaluadas, de estos, 26 cumplieron con nuestros criterios de elegibilidad. Catorce líquidos (54%), tuvieron un color rojo y 18 (69%) tuvieron un aspecto turbio. Los líquidos pleurales exudativos fueron la mayoría (n = 17), las proteínas totales presentaron una media de 3.3 gr/dl (DE: 1.5), LDH una mediana de 544 U/L (RIC: 262-2016), el recuento leucocitario tuvo una mediana de 610 leucocitos/ul (RIC: 180-968) y el recuento diferencial de polimorfonucleares una mediana 29% (RIC: 15-60). En cuanto a las características clínicas, del total de exudados el 41% correspondían a neoplasias y el 23% a neumonías. Mientras que, del total de trasudados (n=9), 45% provenían de pacientes con neoplasias. Conclusiones: En nuestro estudio observamos que la mayoría de las muestras de líquido pleural de pacientes con COVID-19 fueron clasificadas como exudados. Estas presentaron un bajo porcentaje diferencial leucocitario de polimorfonucleares. Los valores de los parámetros bioquímicos tales como proteínas totales y LDH se relacionaron adecuadamente con la clasificación de exudados.

Objetive:The purpose of this work was to describe the physical, cytological and biochemical characteristics, as well as to classify the pleural fluids of patients with COVID-19 as exudates or transudates. Materials and Methods: An observational, descriptive cross-sectional study was carried out. Data was collected from the cytochemical examination of pleural fluid samples processed between the months of April to September 2020, in the laboratory of the Emergency Center of Metropolitan Lima (CELIM). Results: During the study period, a total of 81 samples of pleural fluid from patients with COVID-19 were evaluated, of these, 26 met our eligibility criteria. Fourteen liquids (54%) had a red color and 18 (69%) had a cloudy appearance. Exudative pleural fluids were the majority (n = 17), total proteins presented a mean of 3.3 g / dl (SD: 1.5), LDH a median of 544 U / L(IQR: 262-2016), the leukocyte count had a median of 610 leukocytes / ul (IQR: 180-968) and the differential polymorphonuclear count a median 29% (IQR: 15-60). Regarding the clinical characteristics, of the total exudates, 41% corresponded to neoplasms and 23% to pneumonia. While, of the total transudates (n = 9), 45% came from patients with neoplasms. Conclusions: In our study we observed that most of the pleural fluid samples from patients with COVID-19 were classified as exudates. These presented a low differential leukocyte percentage of polymorphonuclear cells. The values of the biochemical parameters such as total proteins and LDH were adequately related to the classification of exudates.

Diagnostic utility of cytospin, cell block and immunocytochemistry in pleural effusion cytology

Background: With the introduction of cytospin, the sensitivity of diagnosing malignancies has increased mainly due to the increase in cellular yield. Cell block also gives the advantage of ancillary testing and allows for retrospective studies. Immunocytochemical markers are used to differentiate and subtype various malignancies in body effusions.Aim of the study was to compare the morphological features of both technique and to assess the diagnostic utility of cell block methods in the cytodiagnosis of pleural effusions.Methods: This was a Prospective observational comparative study of two cytopreparatory techniques. All samples were examined and processed by cytospin and cell block techniques. Continuous data were expressed as Mean±SD (standard deviation) while categorical data were expressed in number, percentage and compared by chi-square (χ2) test.Results: The final diagnosis of both cytospin (147 cases) and cell block (150 cases) techniques was divided into four broad categories: Inadequate, Benign, Suspicious and Malignant. The significant diagnostic cytospin (AUC=0.857, p<0.001) in discriminating positive and negative malignant cases with 75.00% sensitivity (95% CI=53.3-90.2) and 100.00% specificity (95% CI=86.7-100.0) and with 100.0% positive predictive value and 81.2% negative predictive value. In contrast, cell block also showed significant diagnostic but with higher accuracy (AUC=1.000, p<0.001) and sensitivity 100.00% (95% CI=86.7-100.0) and specificity 100.00% (95% CI=86.7-100.0) and 100.0% positive predictive value and 100.0% negative predictive value than cytospin technique.Conclusions: Cell block as a technique should be used in routine practice as it not only increases the diagnostic yield but ancillary test can also be done.

Role of biochemistry, cytology, and biopsy in the etiological diagnosis of pleural effusion- a clinical study

Introduction:Pleural effusion is the most common pleural disorder. It refers to excessive or abnormal accumulation of fluid in the pleural space. It is a commonly occurring medical problem caused by various pathological conditions. To treat patients appropriately, it is important to establish an accurate etiological diagnosis. Material and Method: This is an observational study conducted at a tertiary health care center. The pleural effusion was assessed clinically, biochemically, bacteriologically, cytologically, and histopathologically. Result: Tuberculosis was the most common etiology, followed by malignancy. A pleural biopsy was done in 70 patients. Pleural tissue was obtained in 65 cases. On histopathology,Malignancy was diagnosed in 15, tuberculosis in 35, and non-specific inflammation in 13 cases. Out of 35 histological proven tuberculosis cases, 26 cases had adenosine de-aminase (ADA) more than 70 u/l. Conclusion:Every pleural effusion is not due to tuberculosis but can be due to other causes, malignancy should always be excluded. Pleural fluid cytology and biopsy can give a definite diagnosis in a significant number of cases of pleural effusion. Tuberculosis is still the most common cause of pleural effusion followed by malignancy.

Aetiopathological evaluation of pleural effusions

Background: Pleural Effusion (PE) is a sign of disease and not a diagnosis itself. Hence an attempt was made to find out the etiological diagnosis of pleural effusion in cases.Methods: Single center, observational, cross sectional hospital-based study. Samples were collected by systematic random sampling method; study was conducted in GSL Medical College. Patients admitted with pleural effusion in medical wards and ICU were taken. The patients >14 years age, both genders were included. All patients were interviewed to obtain detailed history and examined thoroughly as per pre-determined protocol. Chest x-ray, chest ultrasonogram, PF analysis, routine general investigations were conducted for all the participants; and pleural cytology in certain cases. PF was aspirated send for various microbiological investigations such as gram stain, culture.Results: Out of 104 study participants, 78 were men and 26 were women and peak incidence of pleural effusion is 41-50 years. In this study, 58% cases were found to be tuberculoid, 25% malignant, 6% pyogenic.Conclusions: Tuberculosis was found to be commonest and more prevalent cause of pleural effusion. Every case of pleural effusion should be meticulously investigated in order to arrive a diagnosis, whether tuberculous or non-tuberculous to proceed for specific therapy.

A study on clinical profile and etiological agents of empyema in hospitalised children in Jaipur, India

Background: Objective is to study the clinical profile and etiological agents of empyema in hospitalised children in Jaipur.Methods: This hospital based prospective study was carried out in the Department of Pediatrics, SMS Medical College, Jaipur between April 2016 to March 2017. Children between 1 month to 18 year of age having empyema thoracis (pleural tap showing pus cells under microscopy or on gross examination purulent exudates) were included in the study. Children with Empyema secondary to post-surgical or post-traumatic cause and with tubercular effusion were excluded from the study. Relevant history, clinical examination and investigation were done. Pleural fluid studies were done for cytology, biochemical analysis , culture and antibiotic sensitivity pattern.Results: Total 100 patients were included in study. Out of total 100 patients 62 (62%) were between 1 month to 5 years. Most common symptoms were fever (94%), breathlessness (87%) and cough (85%). 27% patients were severely malnourished as per IAP classification of PEM. Pleural fluid culture was positive in 29 (29%) patients. Most common organism isolated was Staphylococcus aureus (27%), 87.5% isolates of Staphylococcus aureus had sensitivity to vancomycin and linezolid.Conclusions: Empyema thoracis is frequently encountered complication of bacterial pneumonia. Fever, cough, and respiratory distress were the most common presenting complaints and severe acute malnutrition was an important risk factor. Staphylococcus aureus was found to be the most common organism for childhood empyema.

Cytodiagnosis of Filariasis – A Retrospective Study of 8 Years

Introduction: In India Filariasis is considered to be a majorpublic health problem. India constitutes about 20% of totalglobal burden. Microfilaria are released and circulate inthe peripheral blood with nocturnal periodicity. Due toits extremely rarity it is difficult to detect them in routineperipheral blood smears, Fine Needle Aspiration (FNAC)Smears and body fluids. The objective of our study was toemphasise on having a high index of suspicion of filarialinfection in any swelling especially in patients from endemiczones. This study also aims to highlight the importance ofFNAC as a cheap and effective tool to diagnose microfilaria.Material and Methods: A total of 9590 cases, with lesionsin different sites were encountered in this study.The patientsunderwent thorough clinical examination and routineinvestigations.The cystic lesions that were included in thisstudy were aspirated. The material centrifuged and smearsprepared were stained with Leishman-Giemsa and PAP stain.Results: In this study out of a total of 9590 cases of superficialswellings that were subjected to fine needle aspirationcytology, 11 cases of filariasis were diagnosed on routineFNAC material from various sites. Out of these11 cases,maximum cases of filariasis were reported in lymph nodes (3cases),breast swelling (2 cases), followed by scrotal swellings(2 cases), thyroid swellings (2 cases), parotid (1 case) andPleural (1 case).Conclusions: Filariasis is an uncommon condition and needa high index of suspicion and careful screen of FNA smearsespecially in asymptomatic patients belonging to endemiczones, so as not to miss this incidental finding especially inpatients from endemic areas. This study also highlights theimportance of FNAC as a cheap and effective tool to diagnosemicrofilaria.

Chyle test is not a valuable laboratory index in identifying chylothorax after pulmonary resection and lymph node dissection for primary non-small cell lung cancer

Objective: Chyle test is widely used to identify chylothorax after pulmonary resection and lymph node dissection for primary non-small cell lung cancer (NSCLC). Low accuracy of chyle test in identifying chylothorax is rarely reported. This observational study was designed to identify the diagnostic value of chyle test. Patients and Methods: From September 2016 to March 2017, 185 consecutive patients either suspected or histologically documented lung cancer were screened for this observational study. Except exclusion, 108 patients were eligible for further analysis. Daily chest-tube output as well as the postoperative day of chest tube removal was documented. Chyle test was analyzed with 108 cases, and the results were blinded to the thoracic surgeons. Chest tube was timely removed regardless of the results of chyle test. A high-output pleural effusion and an associated change in quality of the pleural fluid, from serous to milky yellowish after normal diet, led to the diagnosis of chylothorax. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of chyle test in identifying chylothorax were calculated. Results: Of 108 patients, 4 (3.7%) were observed with chylothorax after pulmonary resection and lymph node dissection for primary NSCLC. Postoperative chylothorax was conservatively managed in three patients and chest tubes were removed 12 days (from 10 to 16) after surgery. Failed in conservative treatment, one patient underwent thoracic duct ligation performed by video-assisted thoracic surgery. For patients without chylothorax, the median day of chest tube removal was postoperative day 4. Among the 108 patients, 75.9% (82/108) was found with a positive chyle test result, of which 95.1% (78/82) was false positive in identifying chylothorax. The sensitivity and specificity of chyle test in identifying chylothorax were 100% and 25%, respectively. The positive predictive value, negative predictive value, and accuracy of chyle test for chylothorax diagnosis were 4.9%, 100%, and 27.8%, respectively. Conclusions: It was suggested that the specificity and accuracy of chyle test in identifying chylothorax were relatively low. Chyle test is not a good laboratory index in identifying chylothorax. With highly positive result, chyle test should not preclude the removal of chest tube in patients after pulmonary resection and lymph node dissection for primary NSCLC

Role of Adenosine Deaminase in Pleural Effusions and its Cytological Correlation

Diagnosis of pleural diseases creates difficulty due to overlapping features of various benign and malignant conditions. However pleural fluid cytology of closed pleural biopsy specimen is most commonly used procedure to diagnose various pleural diseases in developing country like India. Present study was conducted to establish diagnostic utility of ADA in Pleural Fluids and its correlation with cytological findings. Methods: The present study includes 100 samples of pleural fluid samples taken from patients coming to the Department of Chest and TB, Government Medical College and Hospital, Amritsar with the complaint of pleural effusion. Results: For ADA levels in pleural fluid Sensitivity is 92%, Specificity is 81.33%, Positive predictive value is 62.16% and Negative predictive value is 96.83%. For lymphocyte count in pleural fluid Sensitivity is 100%, Specificity is 16.67%, Positive predictive value is 31.25 % and Negative predictive value is 100%. In Combination of ADA and lymphocyte count to diagnose tubercular pleural effusion Sensitivity is 100%, Specificity is 77.27%, Positive predictive value is 82.14 % and Negative predictive value is 100%. Conclusion: Measurement of ADA level in pleural fluid in combination with the differential count of pleural fluid will give best results to categorize and to rule in the diagnosis of tubercular pleural effusion.

Pleural fluid cholesterol level is an important parameter in differentiating exudative from transudative pleural effusions

Background: The first important step is to decide whether the pleural effusion is transudate or exudates by Light’s criteria. Light’s criteria can misclassify 25% of pleural transudates as exudates. Pleural fluid cholesterol level can differentiate transudates from exudates as a single parameter instead of multiple parameters used in Light’s criteria. Measurement of pleural fluid cholesterol levels to differentiate transudative effusions from exudative effusions.Methods: Consecutive 60 cases of pleural effusion were taken in the study. Pleural fluid analysis was done for parameters of Light’s criteria along with pleural fluid cholesterol levels. First exudative and transudative effusion was classified by Light’s criteria. Other clinical and relevant biochemical tests were done to arrive in the final etiological diagnosis and data were collected and analysed .Pleural fluid cholesterol levels was correlated to Light’s criteria.Results: Total 60 cases of pleural effusion were there in the study. There were 43 exudative and 17 transudative effusions. Mean cholesterol level was 64.2± 7.5mg/dl in exudative effusions and 26.05±8.01 mg/dl in transudates. Pleural fluid cholesterol was ≥55mg /dl in 43 cases of exudates and <55mg/dl in 17 cases of transudates.Conclusions: Pleural fluid cholesterol level of ≥ 55mg/dl had similar sensitivity and specificity to Light’s criteria and as a single important parameter to differentiate exudative from transudative pleural effusion

Cytological And Analytical Study Of Pleural, Ascitic & Pericardial Effusions : One Year Study At Tertiary Care Hospital In Western Maharashtra.

Background :Cytological analyses of body effusions plays an important role in the diagnosis of various lesions. Material & Methods : A retrospective study for one year duration from Jan 2016 to Dec 2016 was undertaken in the Department of Pathology. It includes all samples of pleural, ascitic & pericardial fluid received in cytology section. Results : Cytological analysis was done on all 284 cases of effusion fluids. Pleural fluid was the most common type of fluid received followed by ascitic & pericardial fluids. Maximum number of cases were transudates in nature. 257 cases were non neoplastic & 27 were neoplastic. Adenocarcinoma was the most common morphological pattern. Conclusion : Cytological study of body fluids is an inexpensive & simple procedure, useful in studying the etiology, course of disease and also to monitor the response to the therapy

Merkel Cell Carcinoma Metastatic to Pleural Fluid: A Case Report

Merkel cell carcinoma (MCC) is a rare aggressive neuroendocrine carcinoma of the skin that shows locoregional or distant metastasis. Metastasis of MCC to body cavity effusion is extremely rare; only three cases have been reported so far. Metastatic MCC in effusion cytology shows small blue round cells with fine stippled chromatin like other small blue round cell tumors such as small cell lung carcinoma or lymphoma. The diagnosis of metastatic MCC can grant patients good chances at recently advanced therapeutic options. Here, we present a case of metastatic MCC to pleural effusion with characteristic single file-like pattern.

Preanalytical conditions can interfere with M. tuberculosis detection by PCR in respiratory samples

OBJECTIVES: Tuberculosis is one of the most prevalent infections in humans. Although culture is the reference for diagnosis, its sensitivity is compromised, especially in paucibacillary samples. Because polymerase chain reaction (PCR) amplifies mycobacterial DNA, it is more sensitive than culture for the diagnosis of Mycobacterium tuberculosis (Mtb). However, its performance can be affected by intrinsic sample inhibitors and by the extraction/detection techniques used. METHODS: We evaluated the influence of preanalytical conditions on Mtb detection in samples of sputum (SPU), bronchoalveolar lavage (BAL), and pleural fluid (PF) using combinations of extraction/detection methods. Respiratory samples were prepared to contain different concentrations of red blood cells and nucleated cells to which increasing amounts of Mtb colonies were inoculated and submitted to PCR. RESULTS: Up to 102 CFU/ml of Mtb were detected in the SPU in all methods, except for the Roche extraction/detection method, regardless of the preanalytical sample condition. In BAL samples, medium and high concentrations of cells and high concentrations of red blood cells contributed to a lower Mtb detection, regardless of the extraction method used. In PF, red blood cells were the variable that most interfered with Mtb detection, with better recovery (102 CFU/ml) observed with the Qiagen/Nanogen combination. CONCLUSION: The choice of Mtb extraction and detection method is of fundamental importance for PCR analytical sensitivity, especially when paucibacillary samples and/or samples containing potential PCR inhibitors are analyzed.

Study of pleural fluid cholesterol and lactate dehydrogenase to differentiate exudate from transudate and compared with Lights criteria

Background: Patients with diabetes mellitus (DM) are at an increased risk of dying from cardiovascular diseases, the reason for which is not completely understood. Aim: To study the clinico-demographic profile of type 2 diabetes patients with cardiac autonomic neuropathy (CAN). Materials and methods: This was a cross sectional study involving 100 patients attending the diabetic clinic of a tertiary care hospital. Demographic data was collected and autonomic function testing was done with Ewing and Clark’s tests. Results: The prevalence of CAN was 58 %. CAN had statistically significant association with increasing duration of diabetes (p < 0.00001), increasing values of HbA1c (p < 0.00001), and with combined use of insulin and oral medications (p < 0.05). Conclusion: There is a high prevalence of CAN in the diabetic population providing a large pool of patients awaiting effective interventions.

Diagnostic Value of Pleural Fluid Bilirubin/Serum Bilirubin Ratio versus Pleural Fluid Protein/Serum Protein Ratio to differentiate Exudative from Transudative Pleural Effusion.

Background: Pleural effusion is the abnormal and excess accumulation of serous fluid in the pleural space. A number of biochemical tests are required to differentiate transudative from exudative pleural effusion. Pleural fluid to serum protein ratio, pleural fluid to serum lactate dehydrogenase ratio and pleural fluid to serum bilirubin ratio and serum cholesterol are commonly done to differentiate transudative from exudative pleural effusion. Methods: In this study on 25 patients with pleural effusion, by predefined criteria, these patients were divided into three groups as transudative, tubercular and non tubercular exudative group. All patients were investigated to differentiate transudative from exudative pleural effusion. Apart from routine investigations, biochemical tests of pleural fluid as well as blood were performed. Pleural fluid to serum protein ratio and pleural fluid to serum bilirubin were done in all patients. Results: Pleural fluid to serum protein ratio to differentiate exudative pleural effusion showed sensitivity, specificity, positive predictive value and negative predictive value of 86.66%, 100%,100% and 83.33% respectively. Pleural fluid to serum protein ratio to differentiate transudative pleural effusion showed sensitivity, specificity, positive predictive value and negative predictive value of 100%, 86.66%, 83.33% and 100%. Pleural fluid to serum bilirubin ratio to differentiate exudative pleural effusion showed sensitivity, specificity, positive predictive value and negative predictive value of 100%,85.71%,84.62% and 100% respectively. Pleural fluid to serum bilirubin ratio to differentiate transudative pleural effusion showed sensitivity, specificity, positive predictive value and negative predictive value of 85.71%,100%,84.62% and 84.62% respectively. Conclusion: It is concluded that pleural fluid bilirubin to serum bilirubin is a simple, easy, cost effective and highly useful parameter to distinguish transudative from exudative pleural effusion but it does not tell the etiology of pleural effusion.

Analysis of pleural fluid – A one year study

Background: Cytological study of pleural fluid is a simple, cost effective non invasive technique to detect specific pathologies in the pleural cavity. Though it has relatively low specificity and sensitivity owing to its very nature, it can be of immense help in detecting malignancies and nonneoplastic aetiologies such as infection. Aim: To evaluate pleural fluids with clinical correlation. Materials and methods: The present work was a descriptive cross sectional analytical retrospective type of study undertaken at the department of Pathology of a tertiary care rural hospital over a period of one year from January 2015 to December 2015. Pleural fluids were processed according to standard protocol and studied. They were analysed for cell count, cell features and presence of organisms (if any). Malignancies were also noted. Results: Out of a total of 338 fluid samples received in the one year, a total of 130 cases (38.46%) of pleural fluids were received. Majority of cases were females 72 (55.38%). Mean age of presentation was 51.60 years. A total of 13 cases (10.0%) were malignancies. 89 cases (68.46%) were pleural exudates and 41 (31.53%) were transudates. Conclusion: Pleural fluid comprised of one of the major specimen to be received for evaluation. Owing to its dynamic nature, the pleural cavity has a potential to be a haven to various pathologies. In our study, exudative effusions were commonly encountered, in which, tuberculosis was the prime cause. Malignancies also played an important role giving rise to effusions.