Diagnosis of malignant effusion using cell block and immunohistochemistry

The distinction between reactive mesothelial and adenocarcinoma cells specially signet ring type in serous effusions may be very difficult based only on morphological features particularly in early stage. Reactive mesothelial cells show varying degree of cytological atypia hence posing difficulty in differentiating it from adenocarcinoma cells. We report a case of 45 year old female patient presented with abdominal distension. Patient was an operated case of adenocarcinoma of stomach. Smears prepared from ascitic fluid and cell block shows large number of reactive mesothelial cells and few atypical cells. Atypical cells were immunoreactive for cytokeratin, epithelial membrane antigen and carcinoembryonic antigen. These confirmed the presence of malignant epithelial cells so we reported it as a malignant effusion.

Value of immunocytochemistry in differential diagnosis of gastric adenocarcinoma, reactive mesothelial cells and malignant epithelial mesothelioma in metastatic effusion fluid / 中华病理学杂志

Objective@#To investigate the diagnostic value of some antibodies in peritoneal fluid of patients with gastric cancer and malignant epithelioid mesothelioma in serous effusion.@*Methods@#One hundred and eighty-two cases of serous effusion were collected at Jilin Cancer Hospital, from July 2012 to July 2016. The expression of GLUT1, CDX2, Villin, calretinin and WT1 was evaluated using SP immunocytochemical technique in peritoneal fluid samples collected from 98 patients with gastric cancer and 74 patients with reactive mesothelial cells. The expression of GLUT1, calretinin and WT1 was also evaluated in serous effusion from 10 patients with mesothelioma.@*Results@#The sensitivity of GLUT1, CDX2 and Villin in adenocarcinoma cells was 91.8%(90/98), 68.4% (67/98) and 88.8%(87/98), respectively. The specificity was 95.9% (71/74), 100.0%(74/74) and 100.0% (74/74), respectively. The sensitivity of calretinin and WT1 for reactive mesothelium was 93.2% (69/74) and 79.7% (59/74), respectively. The specificity was 96.9% (95/98) and 100.0% (98/98), respectively. The sensitivity of GLUT1, calretinin and WT1 for mesothelioma was 9/10, 9/10 and 7/10. The reactivity of GLUT1, CDX2, Villin, calretinin and WT1 showed a significant difference (P<0.01) between adenocarcinoma cells and reactive mesothelium. The reactivity of GLUT1 showed a significant difference (P<0.01) between mesothelioma and reactive mesothelium.@*Conclusions@#The optimal combination is a panel of GLUT1, CDX2, Villin, calretinin and WT1 for differential diagnosis between adenocarcinoma cells and reactive mesothelium in peritoneal fluid of patients with gastric cancer. Whereas GLUT1, calretinin and WT1 is the best for differential diagnosis between reactive mesothelium and mesothelioma in serous effusions.

HBME-1 immunostaining in reactive mesothelial versus metastatic adenocarcinoma cells in serous fluid.

Background: The cytological diagnoses of serous effusions are usually made by routine cytomorphology with certainty. However, overlapping cases sometimes exist between reactive mesothelial and adenocarcinoma cells. We tried to evaluate the diagnostic utility of HBME-1 in distinguishing between reactive mesothelial cells and adenocarcinoma in serous effusions. Materials and Methods: Fifty-two cytologic specimens processed by cell-block technique were retrieved from the archive and were assigned to two groups: Group I: 26 effusions containing reactive/benign mesothelial cells; Group II: 26 effusions containing carcinoma cells. Immunostaining with HBME-1 was performed using an Envision technique. The staining intensity of cells, according to proportion of immunoreactive cells, was scored as: 0 (negative), 1+ (<10%), 2+ (10-50%), and 3+ (≥50%); and the predominant staining pattern of positive cells were determined. Statistical analysis and tests of significance were performed using SPSS software. Results: The calculated mean values (in percentile) for stained cells in adenocarcinoma and reactive mesothelial cells were 25.57 and 67.88, respectively ( P = 0.001). Thin membranous, thick membranous, thick and thin membranous, cytoplasmic and combined patterns of staining in adenocarcinoma cells were respectively 4 cases (21.1%), 0 case, 0 case, 8 cases (42.1%), and 7 cases (36.8%), and in reactive mesothelial cells, these were 7 cases (26.9%), 1 case (3.8%), 18 cases (69.2%), 0 case, and 0 case, respectively. The intensity of staining in majority (88.5%) of reactive mesothelial cells was scored 3+, but the distribution varied in the other group. Conclusions: The staining pattern and intensity for HBME-1 is a useful panel for differentiation of adenocarcinoma and mesothelial cells.

Derrame seroso de Morell-Lavalle en un anciano / Morell-Lavalle serous effusion in an elderly

Se describe el caso clínico de un paciente de 60 años de edad, que en 1984 sufrió lesiones traumáticas cerradas y sin fracturas, en la pelvis, caderas y ambos muslos, como consecuencia de un accidente de tránsito, el cual fue operado en el Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba por presentar derrame seroso de Morell-Lavalle, por esta causa. Se realizó exéresis total de una masa quística gigante recurrente en dos tiempos quirúrgicos. El anciano evolucionó satisfactoriamente y todavía en el 2010 se mantiene asintomático.

The case report of a 60 year-old patient who suffered from blunt traumatic injuries and no fractures in the pelvis, hips and both thighs, due to an automobile accident in 1984 is described. He was surgically treated in "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital in Santiago de Cuba as he presented a Morell-Lavalle serous effusion. He had the total exeresis of a giant recurrent cystic mass in two surgical times. The patient had a satisfactory clinical course and in 2010 he is still asymptomatic.

Pathogens and Their Resistance to Antibiotics from 721 Serous Effusion Specimens / 中华医院感染学杂志

OBJECTIVE To analyze the pathogenic results and drug resistance of bacteria isolated from serous effusion specimens from Jan 2006 to Feb 2008 so as to provide evidence for clinical pathogenic analysis and selection of antibiotic. METHODS The bacteria identification and the antimicrobial susceptibility were assayed by routine methods. RESULTS The positive rate of pathogens was 6.80% from 721 serous effusion specimens.There were 49 strains of pathogens which included 15 of Gram-positive bacteria and 28 of Gram-negative bacteria and 6 fungi strains.The most frequently isolated pathogens were Enterobacteriaceae(32.65%) followed by Enterococcus(18.37%),and Pseudomonas aeruginosa(12.25%).The most active compounds against Enterococcus were vanconmycin and linezolid(100.00%),nitrofurantoin and tetracycline(66.67%);the most active compounds against Staphylococcus were vancomycin,linezolid and nitrofurantoin(100.00%),tetracycline and rifampin(75.00%);The most active compounds against Gram-negative bacilli were piperacillin/tazobactam(67.86%),imipenem(64.29%),tobramycin(60.71%),gentamicin(53.57%) and levofloxacin(46.43%). CONCLUSIONS The prevailing pathogens in serous effusion are Gram-negative bacilli,especially Enterobacteriaceae.Data collected in present study provide a valuable information for prophylactic and empirical antibiotic use for serous infection.

Clinical analysis in penicilliosis marneffei complicated with serous effusion / 中国实用内科杂志

Objective To analyze the clinical data of patients with penicilliosis marneffei(PSM),summarize clinical characteristics of serosal involvement and provide experience to diagnose and treat serous effusion.Methods We retrospectively analyzed 61 patients with estabolished PSM infection in our hospital from March,2001 to March,2008.Patients were divided into positive groups while presented one or more abnormal serous effusion such as pleural effusion,ascites,pericardial effusion or cerebrospinal fluid.There were ten patients in positive groups finally,including nine male and one female whose ages ranging from 36yr to 67yr[mean(54.2?8.3)yr].Results(1)There were ten cases with pleural effusion,including two cases with pericardial effusion,five cases with ascites and two cases with abnormal cerebrospinal fluid.Ten cases were misdiagnosed as tuberculous pleurisy and accepted anti-tuberculosis treatment,two cases as tuberculous meningitis,two cases as tuberculous pericarditis,five cases as tuberculous peritonitis and five cases as malignant pleural effusion.(2)All patients manifested with fever,anemia,hypodynamia or emaciation,nine cases with cough,eight cases with chest pain,six cases with dyspnea,two cases with alvi profluvium,three cases with bellyache,five cases with necrotic papula,eight cases with subcutaneous abscess,nine cases with lymphadenectasis,nine cases with splenohepatomegalia and seven cases with moist rales.(3)Total white blood cells count increase in nine cases which mainly presented with significantly increase in neutrophil count[(17.6?5.3)?109/L]and ratio(0.841?0.048).Lymphocyte ratio was relatively low(0.976?0.035),but count was normal[(1.59?0.7)?109/L].(4)Human Immunodeficiency Viruses was negative in all patients and the CD4/CD8 ratio was 1.19?0.38.(5)Ratio of A/G was inversion in ten cases.Bilirubin,erythrocyte sedimentation rate and C-reactive protein increase in six cases,ten cases and ten cases respectively.Abnormal renal function appeared in five cases.(6)All cases were defined according to etiology including hemoculture(5 cases),medulloculture(2 cases),sputum culture(1 case),abscess secretion culture(4 cases) and histopathology(4 cases).(7)Imaging check demonstrated parenchymatous abnormality in lung(10 cases),splenohepatomegalia or abdominal para-aortic lymphadenectasis(9 cases)and osteolytic damage(6 cases).(8)The property of serous effusion which appeared cloudy yellow or uprightness was exudate.The cell count especially neutrophil count and protein content increased in it.(9)Anti-eumycete medicine were administered to four cases and achieved improvement.Three cases died of respiratory failure,cardiac failure,hepatic and renal failure.Two patient's condition aggravated and one patient voluntarily leaved hospital without treatment.Conclusion Penicilliosis marneffei often occurs in serous cavity of normal immune function crowd.Clinical characteristics manifest with chronic pyogenic and infected diseases which appear significant increase in neutrophil count.It invades lung,abdominal organ and might be complicated with pleural effusion,ascites and abnomal cerebrospinal fluid.The property of effusion is consistent with inflammatory efflusion which can be totally absorbed under effective anti-fungal treatment.Clinical prognosis relates with general body state.

Distinction between Reactive Mesothelial and Carcinoma Cells in Serous Effusions by Mucin- and Immuno-cytochemical Panel / 대한세포병리학회지

The cytologic distinction of carcinoma cells from reactive mesothelial cells can be difficult, especially in specimens containing abundant reactive mesothelial cells and inflammatory cells with scant carcinoma cells. This study evaluates the usefulness of mucin and immunocytochemistry for discrimination between reactive mesothelial cells and carcinoma cells, and sensitivity and specificity of these stains for the detection of metastatic carcinoma in serous effusions. Immunocytochemical panel including mucin cytochemistry with the periodic acid-Schiff(PAS) reaction after or without diastase digestion was undertaken on 127 serous effusion specimens with histologically confirmed diagnoses. The specimens including cell smears and cell blocks were stained with PAS and antibodies to carcinoembryonic antigen(CEA), epithelial membrane antigen(EMA), cytokeratin(CK), and vimentin. The sensitivities of these stains for metastatic carcinoma(127 cases) were 49%(46/94) in PAS, 48%(60/124) in CEA, 89%(97/109) in EMA, 88%(93/106) in CK, and 25%(20/81) in vimentin. The sensitivities of stains for reactive mesothelial cells(36 cases) were 19%(7/36) in EMA, 78%(28/36) in CK, and 75%(27/36) in vimentin. The PAS and CEA stains were not reacted with all cases of benign reactive serous effusions containing abundant reactive mesothelial cells. The specificities of stains for metastatic carcinoma(127 cases) were 100% in PAS, 100% in CEA, 81% in EMA, 22% in CK, and 25% in vimentin. The optimal combination of stains for use in a panel was PAS and CEA. Combined results from these two stains yielded an advanced sensitivity of 8% in PAS and 4% in CEA for metastatic carcinoma. EMA wasalso cosiderably useful for identification of carcinoma cells. CK and vimentin were not suitable for distinguishing between reactive mesothelial cells and carcinoma cells.

Expression of human telomerase reverse transcriptase and proliferating cell nuclear antigen in pleural and peritoneal effusion / 第三军医大学学报

Objective To explore the diagnostic value of human telomerase reverse transcriptase (hTERT) and proliferating cell nuclear antigen (PCNA) in pleural and peritoneal effusion. Methods The expressions of hTERT and PCNA were detected by immunocytochemistry in 46 malignant and 21 benign serous specimens. Results hTERT and PCNA were detected respectively in 39 and 29 of 46 malignant specimens, but no expressions in reactive mesothelial cells in all serous specimens. hTERT correlated with PCNA (r=0.30, P