Cytomorphological profile of neoplastic effusions: an audit of 10 years with emphasis on uncommonly encountered malignancies

Our plain-English summary of Cytomorphological profile of neoplastic effusions: an audit of 10 years with emphasis on uncommonly encountered malignancies, by S. Gupta, P. Sodhani, S. Jain (Journal of Cancer Research and Therapeutics, 2012).

The study

• Authors: S. Gupta, P. Sodhani, S. Jain
• Journal: Journal of Cancer Research and Therapeutics
• Published: 2012;8(4):602-9
• Cited by: 24 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Context: The diagnosis of metastatic cancer in fluids is of capital importance as, in most such instances, a rapid fatal outcome of the disease is anticipated.

Aim: To determine the spectrum and cytomorphological features of the common and unusual malignancies presenting with effusions.

Methods And Materials: A total of 11,562 effusion samples received for cytopathological examination over a 10-year period were analyzed retrospectively. Cytomorphological features of neoplastic effusions were studied. Special stains and immunocytochemistry (ICC) were performed to aid the diagnosis in difficult cases.

Observations: The effusion samples comprised of pleural (5018), peritoneal (6340) and pericardial (204) fluids. A definitive diagnosis of classifiable malignancy could be given in 836 (7.3%) of these cases (5.7% adenocarcinomas and 1.6% uncommon malignancies). Adenocarcinoma was the most frequent cause of malignant pleural (70%) and peritoneal effusions (86.9%). The most common primary site for pleural metastasis was lung (35.7%), while for peritoneal metastasis, it was the ovary (54.3%). Among the uncommon neoplastic effusions, hematopoeitic malignancies were the most frequent, followed by squamous cell carcinomas. Primary malignant mesotheliomas were the most challenging to diagnose on effusion cytology. ICC was useful to arrive at a definitive diagnosis in difficult cases.

Conclusions: Cytology is a useful tool to detect malignant effusions. However, in uncommon malignancies presenting as effusions, a detailed clinical history and ancillary investigations are often required to make a correct diagnosis.

In plain English

This was a retrospective review of 11,562 fluid samples sent for cytology (examining cells under a microscope) from a major tertiary care hospital in North Delhi, India, between January 1998 and December 2007. There were 5018 pleural, 6340 peritoneal and 204 pericardial samples. The article does not mention asbestos. Most samples (10,488, or 90.7%) were negative for malignancy. A definite, classifiable cancer was diagnosed in 836 (7.2%): 654 adenocarcinomas and 182 less common cancers. Adenocarcinoma caused 280 of 400 malignant pleural effusions (70%) and 372 of 428 malignant peritoneal effusions (86.9%). Among the less common cancers, hematopoietic (blood-forming tissue) cancers were most frequent, followed by squamous cell carcinomas. There were 14 primary malignant mesotheliomas: 8 in pleural fluid, 4 in abdominal fluid and 2 in pericardial fluid. In only 2 of the 14 (14.3%) did the cells look characteristic enough for a definite diagnosis on cytology. The rest needed special stains and immunocytochemistry to tell them apart from adenocarcinoma. The authors concluded that effusion cytology is useful for detecting malignant effusions, but that unusual cancers are hard to type accurately unless the primary site is known.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review (audit) of effusion cytology samples from one laboratory over 10 years
• Who was studied: 11,562 effusion samples (pleural 5018, peritoneal 6340, pericardial 204) received from a major tertiary care hospital of North Delhi, India, January 1998 to December 2007. Patients were aged 6 to 85 years (mean 51.5).
• Exposure: Not an exposure study. The article examines how cancers appear in body-cavity fluid samples and does not mention asbestos or any other exposure.
• Main results:
  • Of all 11,562 samples, 10,488 (90.7%) were negative for malignancy.
  • A classifiable malignancy was diagnosed in 836 samples (7.2%): 654 (5.7%) adenocarcinomas and 182 (1.6%) uncommon malignancies.
  • Of 400 malignant pleural effusions, 280 (70%) were due to adenocarcinoma.
  • Of 428 malignant peritoneal effusions (ascites), 372 (86.9%) were due to adenocarcinoma.
  • Among the uncommon cancers in effusions, hematopoietic malignancies were most frequent, followed by squamous cell carcinomas.
  • Eight primary malignant mesotheliomas were found in pleural effusions.
  • Four primary mesotheliomas presented with ascites (peritoneal fluid).
  • Two mesotheliomas were found in pericardial effusions.
  • Of the 14 primary mesotheliomas, only 2 (14.3%) could be definitely diagnosed on cytology, even though the diagnosis was already known. In the rest, adenocarcinoma remained a possible diagnosis.
  • Mesothelioma cells had vacuoles that stained for fat but not mucin, and expressed calretinin and CK 5/6. Adenocarcinomas instead expressed CEA, MOC 31 and CK7/20.
  • The authors observed that pleural mesothelioma cells had less cytoplasm with few vacuoles, while peritoneal mesothelioma cells were larger with numerous perinuclear vacuoles.
  • Of 94 hematopoietic malignancies, a correct diagnosis based on cell appearance was made in 73 (77.7%).
  • Of 46 squamous cell carcinomas, 26 (56.5%) were diagnosed on cytology alone.
• The authors' conclusion: The authors concluded that effusion cytology is a useful tool to detect malignant effusions. They added that unusual malignancies are difficult to type accurately unless the primary site is known, and that ancillary tests such as immunocytochemistry may help in difficult cases.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial, Adenocarcinoma, Metastasis, Squamous Cell Carcinoma, Malignant Mesothelioma, Cytology.

Related studies

• Detection of cancer cells in effusions from patients diagnosed with gynaecological malignancies. Evaluation of five epithelial markers — B. Davidson, B. Risberg, et al. (1999)
• Cytological differential diagnosis among adenocarcinoma, epithelial mesothelioma, and reactive mesothelial cells in serous effusions by immunocytochemistry — X.Y. Su, G.D. Li, et al. (2011)
• Utility of cytokeratin 20 in identifying the origin of metastatic carcinomas in effusions — V. Ascoli, S. Taccogna, et al. (1995)
• Ancillary studies in pleural, pericardial, and peritoneal effusion cytology — K.E. Sundling, E.S. Cibas (2018)
• Morphologic and immunocytochemical performances of effusion cell blocks prepared using 3 different methods — X. Jing, Q.K. Li, et al. (2013)
• A diagnosis of malignant pleural mesothelioma can be made by effusion cytology: results of a 20 year audit — A. Segal, G.F. Sterrett, et al. (2013)

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