Cytological Study of Effusions.

Background: Effusion fluid analysis plays an important role in clinical medicine. Clinicians rely on the reports of effusion fluids and use them as complement to their clinical assessment for the diagnosis and management. Aim: To study the incidence of neoplastic and non neoplastic effusions. Objectives: i) To study the gross and microscopic features of effusions; ii) To study the pattern of effusions in various neoplastic and non neoplastic conditions. Material and Method: 550 specimens of pleural, peritoneal and pericardial fluid were studied. Fluid samples were centrifuged for five minutes at 2000 rpm and smears prepared from deposit were stained by Haematoxylin and Eosin (H and E), Giemsa and Papanicolaou stains (Pap). Result: Out of 550, 315 were pleural effusions, 234 peritoneal and one was pericardial. Out of total 315 cases of pleural effusions, 297 were non neoplastic and 18 were neoplastic effusion. Out of total 234 peritoneal effusions 214 were non neoplastic and 20 neoplatic. Commonest malignancy in pleural and peritoneal fluid was adenocarcinoma. Conclusion: Pleural effusion was the commonest fluid in this study. Exudates were predominant in pleural effusion and transudates were predominant in peritoneal effusion. Common causes of exudates in pleural effusion were tuberculosis (TB), pneumonia and malignancy. Common causes of transudates in peritoneal effusion were liver cirrhosis and congestive cardiac failure (CCF). Adenocarcinoma was the commonest malignancy in both pleural and peritoneal effusion (30 cases).

[ diagnostic value of pleural fluid cytology and biopsy compared to surgical procedures in malignant pleural effusion]

As the accumulation of fluid in the pleural cavity is a common finding in patients with cancer, its diagnosis deserves careful consideration. The aim of this study was to compare the diagnostic value of pleural fluid cytology and biopsy to surgical biopsy in patients with suspected malignant pleural effusions. During a cross-sectional study, patients with exudative pleural effusion admitted to the Massih-Daneshvari hospital [Tehran] during an 18-month period were enrolled to determine the diagnostic value of pleural fluid cytology, closed needle biopsy and surgical biopsy in suspicious cases of malignant pleural effusion followed by a six-month final diagnosis. A total of 318 patients [218 men and 100 women, aged 15-85] with a mean age of 59 years were recruited in this study. The sensitivity and negative predictive value of cytology; for diagnosis of malignant pleural effusion were 32.4% and 65.6%; for closed needle biopsy 65.9% and 63.2%, and for surgical biopsy 87.8% and 80%, respectively. A combination of pleural fluid cytology and biopsy has diagnostic value in 80% of cases of malignant pleural effusion and considering its simplicity, availability and low cost, these methods have acceptable diagnostic values compared to surgical biopsy

Endometrioid adenocarcinoma 13 years after total abdominal hysterectomy and bilateral salpingo-oophorectomy

Malignant transformation is an infrequent complication of endometriosis. As endometriosis is an ectopic endometrium, hyperestrogenism may cause hyperplasia or transformation into cancer. We describe a case of a 68-year-old woman who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometriosis. She was subsequently placed on estrogen-only replacement therapy. She presented with left-sided pelvic mass and shortness of breath. Computed tomography of chest, pelvis, and abdomen, demonstrated right-sided pleural effusion and soft tissue mass in the pelvis. Pleural effusion was tapped and biopsy from the peritoneal mass showed metastatic adenocarcinoma; immunohistochemistry findings favored endometrioid adenocarcinoma. She was treated by 6 cycles of Carboplatin/Paclitaxel and responded well. Unopposed estrogen stimulation may lead to premalignant or malignant transformation in the residual foci of endometriosis. Therefore, the addition of progestins to estrogen replacement therapy should be considered in women who have undergone hysterectomy with oophorectomy due to endometriosis

Cytology of body fluids from different sites: an approach for early diagnosis of malignancy.

Malignant effusions are a common presenting sign of malignancy and reflect dissemination. A retrospective study of all fluid samples accessioned at the Department of Pathology, TUTH from April 2000 to October 2002 were done. Over the study period, a total of 584 specimens were examined- 324 peritoneal fluid, 224 pleural fluid, 19 pericardial fluid, 9 knee joint effusion and 8 Cerebro-Spinal Fluid (CSF). One hundred and nine (18.66%) out of 584 cases were found to have malignancy, 57 were male and 52 were female. The age group of the adult male ranged from 42-78 years and female ranged from 43-62 years. Three patients were children with age ranging from 8-11 years. Adenocarcinoma was the commonest that comprised 89%, followed by Non Hodgkin's lymphoma 6.5% squamous cell carcinoma 2.7% and small cell carcinoma comprised 1.8 %. Exfoliative cytology is cheap, rapid and highly effective tool for the evaluation of body fluid and should be advised in all effusion cases.

Patterns of argyrophilic nucleolar organiser regions in pleural and peritoneal effusions

To evaluate AgNOR size and dispersion as alternate methods to AgNOR counts in order to differentiate malignant from non-malignant effusions. Comparative study. Department of Pathology, Postgraduate Medical Institute, Lahore, from January 2003 to June 2004. A total of 240 samples of pleural and peritoneal effusions were centrifuged, deposits smeared on slides and stained with H and E and AgNOR stain. The diagnosis of malignancy or otherwise was made on H and E staining. AgNOR counts, variation in size and dispersion of AgNOR dots in smears were graded and compared in malignant and non-malignant effusions. Mean AgNOR counts of 11.47 +/- 3.60 and 11.04 +/- 3.89 in malignant pleural and peritoneal effusions, respectively, were significantly [p<0.0001] greater as compared with counts of 3.36 +/- 0.69 and 3.35 +/- 0.66 in non-malignant effusions. AgNOR size and dispersion were of higher grade in significantly greater proportion of malignant as compared with non-malignant effusions [p<0.0001]. Typing of AgNOR size and dispersion was found to be an easy and reproducible alternative to traditional AgNOR counts for differentiating malignant from non-malignant effusions. These parameters should be correlated with already established but expensive techniques of AgNOR area and size imaging by electron microscopy and flow cytometry, as an economical alternative

Derrame Pelural / It spills Pelural

Nota del Editor: la diferenciación entre exudados y transudados constituye el primer paso en el diagnóstico diferencial de los derrames pleurales, desde 1972 el Doctor Richard W. Light propuso unos parámetros como guía para tal diferenciación.Medicina & Laboratorio ha recibido la autorización del propio autor, para la traducción del texto con el fin de que sea una herramienta de consulta en el manejo del ®derrame pleural¼, de vital importancia para la comunidad médica.

Pleural biopsy in the diagnosis of lymphocytic exudative pleural effusion

Pleural effusion is a common clinical problem in developed as well as developing countries. Tuberculosis and malignancy are common causes of exudative pleural effusion with lymphocytic predominance. It is very difficult to diagnose the underlying cause by clinical, radiological or even pleural fluid analysis. These cases usually require pleural biopsy for definitive diagnosis2. Pleural biopsy is a safe ad reliable procedure ad is recomended to perform in all cases of exudative pleural effusion. Objective of this study was to list the frequency of patients with lymphocytic exudative pleural effusion diagnosed on pleural biopsy. This study was conducted at the Institute of Chest Medicine Mayo Hospital Lahore. A total of 50 patients, who fulfilled the criteria, were included in this study and underwent closed pleural biopsy. These were then investigated by histopathology. Histopathological examination of pleural biopsy was performed by department of pathology King Edwerd Medical College Lahore. A total of 5 0 patients underwent; closed pleural biopsy. Adequate pleural tissue was obtained in 30 patients [60% of cases] the most common diagnosis made was granulomatous inflammation most likely tuberculosis. Histopathological evaluation of pleural biopsy specimens can lead to diagnosis in 46% of patients with exudative lymphocytic pleural effusion

Incidencia de malignidad por citopatología en derrames pleurales / Malignancy incidence by cytopathology in pleural effusion

Antecedentes: los descubrimientos de derrames pleurales ofrecen al clínico la oportunidad de muestrear fluidos de cavidades corporales en un ensayo diagnóstico del enfermo. Objetivo: conocer la utilidad del estudio citopatológico para diagnósticar neoplasias en pacientes con derrame pleural. Material y métodos: se realizó un estudio retrospectivo, longitudinal, observacional y desciptivo de 70 pacientes con derrame pleural en un periodo de 19 meses. Resultados: por medio del examen citoquímico de exudado se detectaron 31 pacientes (44.2 por ciento) con derrame pleural, de quienes se envió una segunda muestra para citopatología y se descubrió malignidad en 20 casos (64.5 por ciento), de los cuales seis (30 por ciento) presentaron tabaquismo como antecedente. La mayor incidencia de malignidad en derrames pleurales se presentó en pacientes mayores de 70 años. Conclusiones: es indispensable realizar estudios básicos a todos los pacientes con derrame pleural para poder tomar decisiones acertadas en cuanto al diagnóstico y la terapéutica que contrarreste la enfermedad ya que no es posible determinar un diagnóstico a través del reporte citopatológico puesto que éste describe sólo células compatibles como malignidad

Diagnostic value of determining the pleural and serum lysozyme levels in pleural effusions with special reference to tuberculous type

The present study was undertaken in order to examine the value of the simultaneous pleural fluid and serum lyzozyme determination in the diagnosis of tuberculous pleural effusion. Lysozyme was measured in the pleural fluid and serum of 51 patients with pleural effusions: 15 patients with tuberculous effusion [TB], 15 with malignant effusion [CA], 11 with transudates [TS] and +/- 10 with empyemas [EM]. Serum lysozyme did not show significant differences between different groups. The mean level of pleural fluid lysozymes was statistically significantly increased in tuberculous effusions and empyemas compared to malignant effusions and transudates [P

EMA e CEA em citologia de derrames cavitários / EMA and CEA in cytology of effusions

A técnica de imunoperoxidase foi usada para testar a especificidade do CEA (antígeno carcinoembriônico) e EMA (antígeno de membrana epitelial) em células epiteliais esfoliadas de líquidos cavitários neoplásicos ou reativos. O CEA mostrou-se específico para células tumorais, derivadas de carcinoma. O EMA revelou positividade näo só em células tumorais, mas em 61,5 porcento dos líquidos näo neoplásicos. A coloraçäo para CEA mostrou-se útil näo só no diagnóstico diferencial de células do carcinoma, como também para visualizaçäo de raras células tumorais isoladas em meio a células mesoteliais e inflamatórias.