Cytology of Body Fluid

1. Cytology of Body Fluid Edmund S, Cytology, Chapter 4: Pleural, pericardial, and peritoneal fluid Richard M DeMay, The art & science of cytopathology, Chapter 8: Fluid Leopold G.Koss, Koss’ diagnostic cytology, Chapter 26: Effusion in the presence of cancer Speaker : 黃筱琪 Advisor : 聶鑫 主任 李修南 學姊 Date : 3.15.2006

2. Outline • Representation of the three body cavities • Collection and preparation of specimen • Benign elements • Non-neoplastic conditions • Malignant effusions---primary tumors ---metastatic tumors • Differences Between Adenocarcinoma and Mesothelioma

3. Schematic representation of the three body cavities

4. Transudates Exudate • Increased hydrostatic pressure: Congestive heart failure • Decreased oncotic pressure: cirrhosis, nephrosis, and malnutrition • (decreased albumin) • Inflammation: Infection, infarction, hemorrhage • Tumor Accumulation of fluids in body cavities

5. Cytocentrifuge preparation Cell block Heparinized bottles (3 units heparin/ml) Unfixed Alcohol-fixed Adding plasma and thrombin solution Papanicolaou-stained Wrapped in filter paper Air-dried cytocentrifuge preparation Placed in a cassette Diff-Quik (Hematologic malignancy is suspected) Embedded in paraffin Cut and H&E stain Collection and preparation of specimen

6. Mesothelial cells • Usually dispersed as isolated cells • Binucleation and multinucleation • Occasional small clusters with “windows” • Dense cytoplasm with clear outer rim (lacy skirt) Benign elements Mesothelial cells

7. Reactive mesothelial cell • Pleomorphic and enlarged nuclei • Hyperchromasia • Prominent nucleoli • Mitotic figures

8. Histiocytes Other blood cells • Nuclei often kidney shape • Cytoplasm granular and vacuolated • No window between cells • CD68 positive • Lymphocytes • Eosinophils • Neutrophils • Plasma cells • Red blood cells

9. Acute serositis Eosinophilic effusions • Bacterial infection: pleural empyema, bacterial peritoneal • Color of the fluid: creamy pale yellow (purulent) • Cytology preparation: high cellular and polymorphonuclear leukocytes • Thoracic trauma, pneumothorax, hemothorax, pulmonary infarcts • Cytology preparation: high number of eosinophils • Eosinophilic pleural effusions more common • Charcot-Leyden crystals Non-neoplastic conditions Eosinophilic pleural fluid

10. Tuberculous pleuritis Rheumatoid pleuritis • Color of the fluid: turbid and greenish-yellow • Cytology preparation: high cellular of lymphocytes (T cells) • Differential diagnosis: inflammatory effusion of non-tuberculous origin • Necrotizing granulomatous inflammation (joint disease) • Cytology preparation: clumps of granular debris • multinucleated macrophages Tuberculous pleuritis Multinucleated macrophages

11. Systemic lupus erythematosus • Cytology preparation: Lupus erythematosus cell (LE cell) LE cell

12. Malignant mesothelioma • Clinical history: asbestos exposure, persistent pleural effusions, chest pain • Epithelial (carcinomatous) pattern Malignant effusions---primary tumors

13. Cell-in-cell pattern “More and bigger cells, in more and bigger clusters”

14. Malignant effusions---metastatic tumors

15. Adenocarcinoma • Large nucleoli • Secretory vacuoles • Three dimensional aggregates • Increased N/C ratio • Irregular nuclear membranes

16. Breast cancer Lung cancer • Cannonballs: • Tight packed large balls of cells • Smooth borders • Indian files

17. Ovarian carcinoma • Irregular clusters of cells • Large and clear vacuoles Gastric carcinoma • Signet ring cell pattern

18. Clear cell carcinoma of kidney cancer • Clear or granular and • vacuolated cytoplasm Papillary carcinoma of the thyroid • Psammoma bodies

19. Squamous cell carcinoma Small cell carcinoma • Keratinized or non-keratinized • Tadpoles and bizarre shape • Isolated and molded cells • Scant cytoplasm, inconspicuous nucleoli F4.27 F4.28

20. Non-Hodginkin lymphoma • Large cell lymphoma • Nuclei large than histiocyte • Eccentric nuclei • Abundant blue cytoplasm • Best appreciated in Diff-Quik • Follicular lymphoma • Irregular nuclear contours • Scant cytoplasm

21. Small lymphocytic lymphoma • Differential diagnosis: • chronic inflammation (tuberculosis) • lymphoblastic lymphoma • Small to medium sized lymphocytes • Fine powdery chromatin • Scant cytoplasm

22. Hodgkin lymphoma Multiple myeloma • Reed-Sternbery cells: • Multinucleated cell with • huge inclusion-like nucleoli • Single, lack cohesive aggregate • Numerous malignant plasma cells • Immunocytochemistry stain: • kappa and lambda light chain (+) • CD138 (+)

23. Melanoma Sarcomas • Isolated round cells with prominent nucleoli • Fine brown cytoplasmic pigmentation • Intranuclear pseudoinclusions • Immunocytochemistry stain: S-100(+), HMB-45(+) • Isolated cells Pleomorphic sarcoma Osteosarcoma Liposarcoma Large and bizarre shaped Round cell sarcoma Rhabdomyosarcoma Neuroblastoma Small and uniform shaped Spindle cell sarcoma Fibrosarcoma Leiomyosarcoma Spindle shaped

24. Differences Between Adenocarcinoma and Mesothelioma

25. - + - + + - + - + - - + + - + - + + - + - + - + C: cytoplasm; M: membrane; N: nuclear

26. THE END Thank you for your attention

27. E-cadherin

28. BerEP4

29. B72.3

30. Calretinin