Peritoneal Fluid Analysis Clinicocytological Study

Introduction: Appropriate peritoneal fluid analysis is themost efficient and effective method of diagnosing the causeof peritoneal effusion. Both nonmalignant and malignantcauses of effusion can be identified by cytology in severalcases in correlation with clinical history and examination.With this basis, the present study on cytology of peritonealeffusion was taken up. Current research aimed to study thecytology of the peritoneal fluid in various diseases to establishclinicocytological correlation, for proper management ofpatient.Material and Methods: 115 samples of peritoneal fluidwere subjected to physical, biochemical and cytologicalexamination.Results: Peritoneal effusion was seen in 62.61% of femalesand 37.39% of males. 66.96% samples were transudative and33.04% were exudative. TLC was less than 500 cells/cu.mm inmost (74.02%) of transudative effusions. 47.36% of exudativeeffusion had TLC greater than 1000 cells/cu.mm and 39.47%of exudative effusion had TLC between 500-1000 cells/cumm. 95 (82.60%) samples had predominantly lymphocytes.18.26% of peritoneal effusions were positive for malignantcells. Most (85.71%) of malignant effusions were exudative.Primary site could be assessed by cytological examination in(57.14%) of malignant effusions.Conclusion: Cytological study of body effusions is neither ascreening test nor a method of early diagnosis of cancer. It isin fact a complete diagnostic modality which aims at pointingout the etiology of effusion as well as in certain cases a meansof prognostication of the disease process. Non malignantcauses are the more common causes of peritoneal effusion.Metastatic carcinomas are the most common tumors found ineffusions.

A clinicopathological study of pleural effusion with special reference to malignant aetiology in a tertiary care hospital in West Bengal

Background: Pleural effusion has varied aetiological factors. It constitutes one of the major causes of morbidity in India as well in other parts of world. Because of the various aetiologies that can cause pleural effusion, itoften present a diagnostic problem, even after extensive investigations. Objective: In this study, authors aimed to identify the common aetiologies causing pleural effusion and their clinical profile in a tertiary care hospital. Materials and Methods: A hospital based cross-sectional study is conducted over a period of one year in tertiary care hospital in West Bengal. 150 patients of pleural effusion above 10 yrs of age were studied. Clinico-pathological, radiological, hematological and biochemical parameters were documented. Results: The most common cause pleural effusion in this study was tuberculosis (64.67%), followed by malignancy (14.67%), parapneumonic effusion (7.33%), cardiac failure (5.33%) and other minor causes. It was commonly seen in male (70%). The occurrence of tubercular pleural effusion was maximum in the age group 31-40 years. Right-sided effusions were more common. Pleural fluid cytology and adenosine deaminase played a pivotal role in the diagnosis of tubercular pleural effusion. Conclusion: The present study highlights tuberculosis as the common causative factor for pleural effusion, labels lung carcinoma as the most common cause of malignant pleural effusion, and defines the clinico-pathological, biochemical and imaging characteristics of different aetiologies of pleural effusion.

Effect of Pleurodesis with 2% Povidone-Iodine in a Tertiary Care Centre, Mahabubnagar, Telangana

Background: Tetracycline, talc, and bleomycin have been proved to be effective in recurrent spontaneous pneumothorax andmalignant pleural effusion. Recent studies have shown the efficacy of 2% betadine in pleurodesis.Objective: The objective of this study was to find out the success rate of 2% betadine in pleurodesis in patients with recurrentspontaneous pneumothorax and malignant pleural effusions.Materials and Methods: The study was conducted in SVS Medical College, Mahabubnagar Dist., Telangana, during the periodof May 2016 - Feb 2019. Patients with malignant pleural effusion and recurrent spontaneous pneumothorax were taken intoconsideration. About 2% betadine with xylocaine was used in this study.Results: A total of 26 patients underwent pleurodesis. Eighteen patients had malignant pleural effusion and eight patients hadrecurrent spontaneous pneumothorax. Of 26 patients, 23 (88.5%) patients had successful pleurodesis. Among 23 patients whohad underwent successful pleurodesis, 16 had malignant pleural effusion and seven had recurrent spontaneous pneumothorax.Conclusion: In our observation, we have seen that pleurodesis with 2% betadine is very effective and inexpensive in pleurodesiswithout many complications

Study on high-fluorescent cell for screening malignant hydrothorax or ascites / 医疗卫生装备

To study the value of high-fluorescent cell for the screening of malignant hydrothorax or ascites. The clinical diagnosis results and hydrothorax or ascites specimens of 400 outpatients registered from January to December in 2014 were collected, and high-fluorescent cells were counted with Sysmex XE-5000 blood cell analyzer, and then stained for microscopy. Receiver operating characteristic (ROC) curve was used to explore the sensitivity, speci-ficity, positive likelihood ratio and negative likelihood ratio of high-fluorescent cell for screening malignant hydrothorax or ascites. The numbers of high-fluorescent cells of the cancer patients were significantly higher than those of the non-cancer patients, with Z equal to -7.372 and P less than 0.05. The values of the area under curve (AUC), sensitivity, specificity, positive likelihood ratio and negative likelihood ratio were 0.801, 70.67%, 84.31%, 4.50 and 0.35 respective-ly. Detection of high-fluorescent may be used to screen malignant hydrothorax or ascites, and further exami-nation and follow-up have to be performed in case the number of high-fluorescent cells in the hydrothorax or ascites is not less than 68.

Etiology and Characteristics of Massive Pleural Effusions Investigated at One University Hospital in Korea / 결핵및호흡기질환

BACKGROUND: Differential diagnosis is very important in patients with pleural effusions. A few studies on the etiologies of massive pleural effusions have been reported, but these were conducted in different decades and locations. In the present study, the etiologic spectrum of massive pleural effusions in Korea, were evaluated through an investigation at one university hospital. METHODS: Retrospective chart reviews were performed in patients having undergone thoracentesis between July 2002 and July 2005. Pleural effusions were deemed to be massive if they occurred in two thirds or more of one hemithorax. The etiologies of massive pleural effusions, pleural fluid findings, serum laboratory findings, and sputum and pleural fluid cytologies were compared. RESULTS: Of 298 pleural effusions cases, 41 (13.8%) had massive pleural effusions. The most frequent causes of massive pleural effusions were malignancy (19; 46.3%) followed by tuberculosis (15; 36.6%), parapneumonic effusion (4; 9.8%) and transudate (3; 7.3%). Compared with massive benign effusions, patients with massive malignant pleural effusions were more likely to have lower adenosine deaminase (ADA) activity, a higher amylase level and higher RBC count in their pleural fluids. Also, compared with non-tuberculosis effusions, patients with massive tuberculous pleural effusions were more likely to have lower RBC and neutrophil counts, but a higher lymphocyte count, adenosine deaminase (ADA) activity and protein level. CONCLUSION: The most common etiologies of massive pleural effusions in Korea are malignancy and tuberculosis. A high ADA content favors a tuberculous condition, while bloody effusions with a relatively lower ADA content. favors malignancy. The proportion of tuberculosis in massive pleural effusions was higher than in previous reports.

Clinical research of vascular endothelial growth factor expression in patients with malignant tumor / 国外医学(肿瘤学分册)

Objective To determine whether vascular endothelial growth factor (VEGF) could be used as a tumor marker by detecting the VEGF levels in serum and effusion from malignant tumor patients. Methods VEGF concentrations were measured using an enzyme-linked immunosorbent assay in the serum from the healthy donors and in the serum and the malignant effusion from the patients. Results The serum VEGF levels from the malignant tumor patients was higher than that from the healthy donors, and there was a significant difference ( P

Detection of Malignant Cells in Pleural Fluid or Ascites by CD44v8-10/CD44v10 competitive RT-PCR

BACKGROUND: CD44 is a cell surface adhesion molecule which has been implicated in various biologic functions as lymphocyte homing and activation, cellular migration and extracellular matrix adhesion. Over-expression of CD44v8- 10 has been found in several cancers and is considered to be associated with tumor progression and metastasis. Recently, a novel molecular method, CD44v8- 10/CD44v10 competitive reverse transcription-polymerase chain reaction(RT-PCR) has been developed for detecting cancer cells over-expressing CD44v8-10. METHODS: We analyzed from benign and malignant pleural effusion and ascites by CD44 competitive RT-PCR and compared to the conventional cytology. RESULTS: The CD44 competitive RT-PCR analysis showed that all the 24 samples associated with benign disease presented a predominant expression of the CD44v10 transcript (v8-10/v10 ratio: 0.126-0.948), whereas 6 of 7 malignant pleural samples associated with cytology positive cancer expressed the CD44v8-10 transcript (v8-10/v10 ratio > 1.00). CONCLUSION: These results indicate that CD44 competitive RT-PCR assay is a useful and adjunct to cytological examination in cancer diagnosis, especially in detecting exfoliated cancer cells in pleural effusion.

The Levels of Interferon-gamma, Interleukin-2 Receptor, Interleukin-6 and Interleukin-10 in the patients with Malignant Pleural Effusion, Tuberculosis Effusion, Parapneumonic Effusion, and Lung Emphysema? / 결핵

BACKGROUND: Cytokines are chemical mediators that control and modulate many infalmmatory processes. They work in different fashions in a variety of diseases. Discriminating between malignant effusion, tuberculous effusion, and parapneumonic effusion are crucial from the clinical view-point in Korea. In the current study, interferon-gamma(INF-γ), soluble interleukin-2 receptor(IL-2R), interleukin-6(IL-6) and interleukin-10(IL-10) were measured for this purpose. METHODS: Pleural fluids from patients with malignant disease, tuberculosis, parapneumonic effusion and lung empysema were collected and gauged using commercial ELISA kits. RESULTS: 34 patients were enrolled in this study. among these 15 cases were malignant effusions, 12 were tuberculosis pleurisy and 7 were paraneumonic effusion and lung empyema. The levels of cytokines measured in this study were as follows, in order of frequency, malignant effusion, tuberculous effusion, parapneumonic effusion and lung empyema. The levels of INF-γ were higher in tuberculous effusion than in malignant or parapneumonic effusion(295.5±585.5 vs. 16.7±50 vs. 10.0±0 pg/ml, p>0.05). The levels of IL-2R were higher in tuberculous effusion than in malignant or parapneumonic effusion(7423.5±3752.8 vs. 3247.4±1713.3 vs. 3790.2±3201.1 pg/ml, p<0.05). No significant differences were found in the levels of IL-6 between the groups(600±12.8 pg/ml in malignant effusion, 556.4±161.7 pg/ml in tuberculous effusion, 514.4±224.8 pg/ml in parapneumonic effusion). IL-10 levels were higher in parapneumonic effusion than in malignant or tuberculous effusions(98.4±141.7 vs. 28.2±55.5 vs. 11.3±11.7 pg/ml, p<0.05). CONCLUSION: These results suggest that the measurement of IL-2R levels in pleural fluids may be a useful means of differentiating between tuberculous effusion and pleural effusions of other origins, and that the measurement of IL-10 levels in pleural fluids may be useful to differentiate between parapneumonic effusion and pleural effusions of other origins.

Usefulness of scoring system distinguishing between benign and malignant effusion based on routine laboratory result / 대한임상병리학회지

BACKGROUND: Detection of malignant effusion is important task in the routine laboratory work. However, in clinical laboratory where only Wright-Giemsa stained slides are examined it is not easy. So the author proposed a scoring system in the differential diagnosis of malignant effusion using the results of routinely tested items. METHODS: 61 samples of exudates (13 ascites, 48 pleural fluids) from 47 patients were included. The scores are summed based on the routine laboratory results. Items were as follows: protein concentration, dominancy of lymphocyte (lymphocyte count over 50%) and morphologic variety of lymphoid cells, mesothelial cell count, eosinophil count, and presence of tumor cells. Total summed full scores would be 8 points. RESULTS: The summed scores of 14 samples of malignant effusion were as follows: 7 points in 2 cases, 6 points in 1 case, 5 points in 8 cases, 4 points in 3 cases, with the mean score of 5.1 points. The 47 benign exudates showed 4 points in 1 case, 3 points in 4 cases, 2 points in 33 cases, 1 point in 9 cases, with the mean score of 1.9 points. If malignancy were postulated as summed score over 4 points, a statistically significant difference was observed between the summed score and effusion type (P<0.0001). CONCLUSIONS: Two groups of effusion can be distinguished: one group that showed more than 4 points, with malignant potential and the other group lower than 3 points with benign effusion. In case with high score, 4 points above, one should pay attention to the presence of malignant cells and even if tumor cells were not found, the possibility of malignant condition should be notified.

Cytologic Features and Distribution of Primary Sites of Malignant Cells in Body Cavity Fluids / 대한세포병리학회지

The authors reviewed 167 malignant effusions from 110 patients, of which the primary site was established on the basis of either biopsy or surgical resection of the primary neoplasm. Main factors analysed were the distribution of primary organs and the cytohistologic correlation of body cavity effusions. The 167 fluid specimens from 110 patients consisted of 90 cases(53.9%) of pleural, 68(40.7%) of peritoneal, and 9(5.4%) of pericardial origins. Histologically they consisted of 82 cases(74.5%) of adenocarcinoma, 8(7.3%) of malignant lymphoma, 6(5.5%) of squamous cell carcinoma, and 3(2.7%) of small cell carcinoma. The most common site among the primary lesions was the stomach in 25 cases(22.7%) followed by the lung in 21 (19.1%), ovary in 17(15.5%), and breast in 7(6.4%). As for the distribution of primary tumors in adenocarcinoma, the most common site was lung in 16 cases (48.5%) in pleural fluid and stomach in 22(48.9%) in peritoneal fluid. In pericardial effusions, all 5 cases were from the lung. As a whole, the cytologic findings of malignant effusion were fairly representative of histologic characteristics of primary lesions. Thus, when the primary lesion is unknown, careful evaluation of effusion cytology is presumed to be a helpful tool for tracing the primary tumor.

Cytologic Analysis of Malignant Effusion / 대한세포병리학회지

Eighty cases of malignant effusion were cytologically studied to elucidate the incidence of primary tumor site and cytologic characteristics of each tumor types. Eighty fluid specimens were composed of 43 ascitic, 35 pleural, and 2 pericardial effusion and primary tumor site had been confirmed by histology. The frequent primary sites were stomach (22 cases, 28%), lung (21 cases, 26%), ovary (11 cases, 14%), liver (7 cases, 9%), and breast (4 cases, 5%). The principal malignant tumors were adenocarcinoma (56 cases, 70%), squamous cell carcinoma (7 cases, 9%), liver cell carcinoma (7 cases, 9%), small cell carcinoma (4 cases, 5%), and non-Hodgkin}s lymphoma (4 cases, 5%). The distinctive cytologic findings according to primary tumor types were as follows ; the gastric adenocarcinomas were mainly characterized by isolated cells and irregular clusters sometimes with signet ring cells. Papillary serous cystadenocarcinoma of ovary showed frequently papillary clusters and occasional psammoma bodies. Breast carcinoma of ductal type showed cell balls with smooth margins. Colonic adenocarcinoma showed rather irregular clusters or palisading pattern of cylindrical cells. Metastatic squamous cell carcinoma, liver cell carcinoma, small cell carcinoma, and non-Hodgkin}s lymphoma showed also characteristic features. These findings indicate that the cytological features observed in the great majority of malignant effusion are similar to those of primary tumor types, which are very helpful to indentify the primary tumor site.