Diagnostic problems in serous effusions

Our plain-English summary of Diagnostic problems in serous effusions, by C.W. Bedrossian (Diagnostic Cytopathology, 1998).

The study

• Author: C.W. Bedrossian
• Journal: Diagnostic Cytopathology
• Published: 1998;19(2):131-7
• Type of article: Review
• Cited by: 105 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Summary of the article

This narrative review, presented at an IAP Symposium in Budapest in October 1996, described diagnostic challenges and pitfalls in the cytologic examination of pleural, pericardial and peritoneal fluids. The author outlined how the mesothelium responds to injury and repair, and listed common causes of mesothelial hyperplasia, including infection, infarction, liver disease, radiation, chemotherapy and foreign substances such as talc and asbestos. Reactive mesothelial cells were described as able to mimic malignancy, and the author advised against using the term "atypical" without a clarifying comment. For malignant mesothelioma, the author noted attention arising from the medico-legal implications of asbestos exposure. Suspicion was advised in the setting of a history of asbestos exposure, appropriate X-ray findings and an unexplained bloody effusion. Approximately 90% of mesotheliomas were stated to be pleural in origin. Cytologic features of mesothelioma were described, along with special stains, immunostains (CEA, keratin, EMA, Ber-Ep4, Leu M1, B72.3) and hyaluronic acid testing for separating mesothelioma from adenocarcinoma. In the author's experience, electron microscopy was the most reliable method of diagnosing mesothelioma. The review also covered metastatic malignancies, clues to the primary site, and antibody panels. Proliferative markers (AgNOR, PCNA, Ki-67, MIB-1) were reported to help separate malignant effusions from mesothelial hyperplasia, but PCNA and Ki-67 did not distinguish mesothelioma from carcinoma.

PubMed has no abstract for this study, and the article doesn't print one. We wrote this summary from the full article with the help of AI. It is not the authors' wording.

In plain English

This article was a narrative review of diagnostic challenges and pitfalls in the cytologic examination of pleural, pericardial and peritoneal fluids. It reported no new patient data. The author described how mesothelial cells lining body cavities react to injury. Reactive mesothelial cells may mimic malignancy, and asbestos was listed among foreign substances that cause mesothelial hyperplasia. The author stated that pleural plaque is a form of fibrosis resulting from asbestos exposure. Whether the incidence of mesothelioma was truly increasing, the author wrote, awaited ongoing epidemiologic studies. According to the author, mesothelioma should be suspected in a clinical setting that includes a history involving asbestos exposure, appropriate X-ray findings and an unexplained bloody effusion. Approximately 90% of mesotheliomas were described as pleural in origin. The review compared stains, immunostains and electron microscopy for telling mesothelioma from adenocarcinoma. In the author's experience, electron microscopy was the most reliable method for diagnosing mesothelioma. The author emphasized that cytologic clues are not absolute and need to be correlated with clinical data.

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: Narrative review (diagnostic pitfalls article), presented at a symposium; no original study data
• Who was studied: No patients were studied. The subject was the cytology of pleural, pericardial and peritoneal fluids (serous effusions). The article was presented at the IAP Symposium, Budapest, Hungary, October 1996.
• Exposure: Asbestos was discussed only in general terms; no fiber types were named. It was listed, with talc, as a foreign substance causing mesothelial hyperplasia, and was described as the cause of pleural plaque.
• Main results:
  • The author stated that pleural plaque is a special form of fibrosis (the 'basket weave' pattern) resulting from asbestos exposure.
  • The author wrote that whether there is a true increase in the incidence of mesothelioma awaited ongoing epidemiologic studies.
  • According to the author, mesothelioma should be suspected in a clinical setting that includes a history involving asbestos exposure, appropriate X-ray findings, and an unexplained bloody effusion.
  • The author stated that a bloody effusion is an almost universal mode of presentation of mesothelioma.
  • The author stated that approximately 90% of mesotheliomas are pleural in origin, with the remainder in the peritoneum, alone or together with pleural tumors.
  • The author warned that individual reactive mesothelial cells, taken out of context, may mimic malignancy.
  • The author stated that CEA positivity with keratin negativity is strong evidence for carcinoma, and the reverse is strong evidence for mesothelioma.
  • In the author's experience, electron microscopy was the most reliable method of diagnosing mesothelioma.
  • The author stated that the proliferative markers PCNA and Ki-67 separate malignant effusions from mesothelial hyperplasia, but do not distinguish mesothelioma from carcinoma.
• The authors' conclusion: The author emphasized that cytologic clues are not absolute and need to be correlated with clinical data. The author relied on panels of antibodies and electron microscopy to identify the site of origin of metastatic carcinomas.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Pleural plaques and thickening.

Medical terms in this study, explained in our Lexicon: Pericardial, Mesothelium, Reactive Mesothelial Hyperplasia, Chemotherapy, Talc, Reactive Mesothelial Cells, Malignant Mesothelioma, Asbestos Exposure.

Related studies

• Utility of HBME-1 immunostaining in serous effusions — V. Ascoli, C. Carnovale-Scalzo, et al. (1997)
• Usefulness of Claudin 4 in the cytological diagnosis of serosal effusions — S. Lonardi, C. Manera, et al. (2011)
• 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)
• Value of immunocytochemistry in the study of malignant effusions — M.R. Mason, C.W. Bedrossian, et al. (1987)
• Calretinin. A selective marker of normal and neoplastic mesothelial cells in serous effusions — M.C. Barberis, M. Faleri, et al. (1997)
• MMP-7 is a highly specific negative marker for benign and malignant mesothelial cells in serous effusions — B. Davidson, H.T. Stavnes, et al. (2016)

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