Pleural effusion cytology of embryonal rhabdomyosarcoma

Our plain-English summary of Pleural effusion cytology of embryonal rhabdomyosarcoma, by K.S. Thompson, J.D. Jensen, N. Bhoopalam, et al (Diagnostic Cytopathology, 1997).

The study

• Authors: K.S. Thompson, J.D. Jensen, N. Bhoopalam, C.V. Reyes
• Journal: Diagnostic Cytopathology
• Published: 1997;16(3):270-3
• Type of article: Case report
• Cited by: 11 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

This case report concerns an embryonal rhabdomyosarcoma of the testis in a 31-yr-old white male patient who underwent radical left orchiectomy, followed by combined irradiation and chemotherapy, and who 2 yr later presented with dyspnea at rest, nonproductive cough, and lower back pain for 1 wk. Chest radiographs demonstrated a bilateral pleural effusion and diffuse infiltrating lesion of the pleurae, mimicking a mesothelioma. The pleural fluid displayed noncohesive, malignant, small, round cells about 2-5 times larger than mature lymphocytes. They had large, darkly stained, pleomorphic nuclei and bubbly cytoplasm with poorly defined borders. The diagnosis of embryonal rhabdomyosarcoma was supported by a positive myosin immunostaining and ultrastructural findings of intracytoplasmic actin and myosin-type microfilaments. Our case is also notable in that the tumor was a pure rhabdomyosarcoma involving a testicular origin, and the patient is the oldest reported in the literature.

In plain English

This was a case report about one patient, a 31-year-old white man at Hines VA Hospital. A cancer that started in his testicle later spread to the lining of the chest (the pleura), where on imaging it looked like mesothelioma. The tumor, removed with the left testicle, was a pure embryonal rhabdomyosarcoma, a cancer of cells that normally develop into muscle. It spread to the lungs, to a mass near the left kidney and to pelvic lymph nodes. After chemotherapy and surgery, the patient stayed free of recurrence for one year. The cancer then returned with fluid in the chest and pleural thickening that a CT scan showed as a mesothelioma-like lesion. Cells in the fluid were small, round and 2 to 5 times the size of mature lymphocytes. They stained positive for myosin, and electron microscopy found actin and myosin-type filaments in rare cells. The patient declined further treatment and died 6 months later, and no autopsy was done. The article does not discuss asbestos. The authors concluded that, to their knowledge, this was the oldest reported patient with pure testicular embryonal rhabdomyosarcoma.

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: case report (one patient)
• Who was studied: One 31-year-old white male patient at Hines VA Hospital (Illinois) with embryonal rhabdomyosarcoma of the testis
• Exposure: No asbestos or occupational exposure is reported. The article is about diagnosing a tumor that mimicked mesothelioma. The only exposures mentioned are smoking half a pack of tobacco for 4 years and two beers a week.
• Main results:
  • In this patient, the tumor removed with the left testicle was a completely resected, pure, testicular embryonal rhabdomyosarcoma.
  • After chemotherapy and surgery for spread of the tumor, the patient was free of recurrence for 1 year.
  • At recurrence, a CT scan showed pleural effusion and a lesion of the pleura that resembled mesothelioma.
  • Tumor cells in the pleural fluid were small and round, about 2 to 5 times the size of mature lymphocytes.
  • The tumor cells stained positive for myosin.
  • Immunostains for actin, cytokeratin, leukocyte common antigen, vimentin and carcinoembryonic antigen were negative.
  • Under electron microscopy, better-differentiated tumor cells showed actin and myosin-type microfilaments.
  • The patient declined further treatment and died 6 months later; no postmortem examination was performed.
• The authors' conclusion: The authors concluded that the pleural fluid studies confirmed metastatic, recurrent embryonal rhabdomyosarcoma from the testis. To their knowledge, this was the oldest patient reported with pure testicular embryonal rhabdomyosarcoma.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Cytology, Orchiectomy, Chemotherapy, Dyspnea, Chest X-Ray, Bilateral, Mesothelioma.

Related studies

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• Utility of BAP1 Immunohistochemistry and p16 (CDKN2A) FISH in the Diagnosis of Malignant Mesothelioma in Effusion Cytology Specimens — H.C. Hwang, B.S. Sheffield, et al. (2016)
• 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)
• Loss of expression of BAP1 is a useful adjunct, which strongly supports the diagnosis of mesothelioma in effusion cytology — J. Andrici, A. Sheen, et al. (2015)
• Fluorescence in situ hybridization in the definitive diagnosis of malignant mesothelioma in effusion cytology — S. Savic, N. Franco, et al. (2010)
• Diagnostic usefulness of EMA, IMP3, and GLUT-1 for the immunocytochemical distinction of malignant cells from reactive mesothelial cells in effusion cytology using cytospin preparations — K. Ikeda, G. Tate, et al. (2011)

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