DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20201347

Approach for reporting serous effusion fluid in pleural, peritoneal and pericardial cavity and immunohistochemistry

Zahida O. A., Krishnaraj Upadhyaya, Mohammad Niaz, Shreesha Khandige

Abstract


Background: The aim of this study is to make a detailed cytological study of effusion fluids and compare with cell block study of the representative cases and IHC studies were done.

Methods: Prospective study of 216 cases effusion fluids from in and around hospitals, Mangalore. This study conducted over a period of 18 months from October-2014 to April-2016. This study scrutinized and approved by Institutional Ethics Committee. The samples were processed by conventional cytology using Papanicolaou-stain and Cell Block (CB) method using 10% Alcohol-formalin fixative and stained with H and E. The cellularity, architectural patterns, morphological details were studied both smears. Ancillary immunohistochemical staining with calretinin and EMA are done.

Results: A total of 216 cases of effusion fluids with cell block study were included, age range of 13 years to 93 years. Pleural fluid comprised of 55.09%, peritoneal fluid of 43.51% and pericardial fluid of 1.38%. 71% were clinically diagnosed as non-neoplastic and 29% were neoplastic condition. In CS study, 84.5% cases were benign/reactive effusion and 8.5% were positive for malignancy. In CB study, 84.5% were benign/reactive effusion and 10.2% were positive for malignancy. In comparison authors found an increase in diagnostic efficacy by 18%. IHC EMA for adenocarcinoma cells has sensitivity of 100% and calretinin for reactive mesothelial cells has specificity of 100%.

Conclusions: Authors concluded that cell block technique when used as an adjuvant to routine smear examination in effusion fluids has increased the diagnostic yield and better preservation of architectural pattern. IHC is helpful in differentiating between reactive mesothelial and adenocarcinoma cells.


Keywords


Background: The aim of this study is to make a detailed cytological study of effusion fluids and compare with cell block study of the representative cases and IHC studies were done. Methods: Prospective study of 216 cases effusion fluids from in and arou

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References


Spriggs AI. History of cytodiagnosis. J Clin Pathol. 1977 Dec;30(12):1091.

Katti R, Bommanahalli BP, Murthy N. Diagnostic role of cell block method in serous effusions: A comparative study with conventional smear cytology. Ind J Pathol Oncol. 2016 Apr;3(2):281-4.

Scott N, Sutton J, Gray C. Morphometric diagnosis of serous effusions: refinement of differences between benign and malignant cases by use of outlying values and larger sample size. J Clin Pathol. 1989 Jun 1;42(6):607-12.

To A, Coleman DV, Dearnaley DP, Ormerod MG, Steele K, Neville AM. Use of antisera to epithelial membrane antigen for the cytodiagnosis of malignancy in serous effusions. J Clin Pathol. 1981 Dec 1;34(12):1326-32.

Murugan P, Siddaraju N, Habeebullah S, Basu D. Immunohistochemical distinction between mesothelial and adenocarcinoma cells in serous effusions: a combination panel-based approach with a brief review of the literature. Ind J Pthol Microbiol. 2009 Apr 1;52(2):175.

Ensani F, Nematizadeh F, Irvanlou G. Accuracy of immunohistochemistry in evaluation of malignant pleural and peritoneal effusions. Polish J Pathol. 2011 Jun 1;62(2):95-100.

Yahya ZM, Ali HH, Hussein HG. Evaluation of the sensitivity and specificity of immunohistochemical markers in the differential diagnosis of effusion cytology. Oman Med J. 2013 Nov;28(6):410.

Kim JH, Kim GE, Choi YD, Lee JS, Lee JH, Nam JH, et al. Immunocytochemical panel for distinguishing between adenocarcinomas and reactive mesothelial cells in effusion cell blocks. Diag Cytopathol. 2009 Apr;37(4):258-61.

Koss LG. Rare and Unusual Disorders of the Female Genital Tract. In: Melamed MR, Koss LG, eds. Diagnostic cytology and its histopathological basis. 5th ed. Lippincott Williams and Wilkins; 2005:920-948.

Kushwaha R, Shashikala P, Hiremath S, Basavaraj HG. Cells in pleural fluid and their value in differential diagnosis. J Cytol. 2008 Oct 1;25(4):138-43.

Pinelli V, Laroumagne S, Sakr L, Marchetti GP, Tassi GF, Astoul P. Pleural fluid cytological yield and visceral pleural invasion in patients with epithelioid malignant pleural mesothelioma. J Thoracic Oncol. 2012 Mar 1;7(3):595-8.

Simsir A, Fetsch P, Mehta D, Zakowski M, Abati A. E‐cadherin, N‐cadherin, and calretinin in pleural effusions: the good, the bad, the worthless. Diag Cytopathol. 1999 Mar;20(3):125-30.

Dejmek A, Hjerpe A. Reactivity of six antibodies in effusions of mesothelioma, adenocarcinoma and mesotheliosis: stepwise logistic regression analysis. Cytopathology. 2000 Feb;11(1):8-17.

Fetsch PA, Abati A. Immunocytochemistry in effusion cytology: a contemporary review. Cancer Cytopathol: Interd Inter J Am Cancer Soci. 2001 Oct 25;93(5):293-308.

Lee JS, Nam JH, Lee MC, Park CS, Juhng SW. Immunohistochemical panel for distinguishing between carcinoma and reactive mesothelial cells in serious effusions. Acta Cytol. 1996;40(4):631-6.

Gupta RK, Kenwright DN, Fauck R, Lallu S, Naran S. The usefulness of a panel of immunostains in the diagnosis and differentiation of metastatic malignancies in pericardial effusions. Cytopathology. 2000 Oct;11(5):312-21.

Ko EC, Jhala NC, Shultz JJ, Chhieng DC. Use of a panel of markers in the differential diagnosis of adenocarcinoma and reactive mesothelial cells in fluid cytology. Am J Clin Pathol. 2001 Nov 1;116(5):709-15.

Bedrossian CW. Special stains, the old and the new: the impact of immunocytochemistry in effusion cytology. Diag Cytopathol. 1998 Feb;18(2):141-9.