Significance of flower pot cells in effusion cytology

Our plain-English summary of Significance of flower pot cells in effusion cytology, by V. Bharani, P. Singh, N. Gupta, et al (Diagnostic Cytopathology, 2017).

The study

• Authors: V. Bharani, P. Singh, N. Gupta, R. Srinivasan
• Journal: Diagnostic Cytopathology
• Published: 2017;45(10):925-927
• Type of article: Case report
• Read it: PubMed · Publisher

Abstract

Cells with long polar hair-like processes referred to as 'flower pot cells' are a rare but beautiful morphological feature observed in effusions of diverse etiologies. This report describes these cells in effusions seen in ovarian borderline serous tumours, malignant mesothelioma and in reactive mesothelial cells with or without accompanying malignant cells. These processes were better appreciated in air-dried May-Grunwald-Giemsa stained smears.

© 2017 Wiley Periodicals, Inc.

In plain English

This short report from Chandigarh, India, described four fluid samples, three from the abdomen (ascitic fluid) and one from the chest (pleural fluid), in which cells carried long hair-like projections giving a "flower pot" appearance. In a 34-year-old woman, the cells came from a borderline serous tumor of both ovaries. Some of these cells showed a terminal plate, which the authors took to indicate cilia. In a 48-year-old woman, malignant cells confirmed as mesothelial by immunochemistry led to a diagnosis of peritoneal mesothelioma being offered. The patient was lost to follow-up, so tissue confirmation was unavailable. In an 80-year-old woman with metastatic adenocarcinoma linked to a lung mass, an occasional benign reactive mesothelial cell showed the feature. Reactive mesothelial cells in a 47-year-old man with liver disease also showed it, and his fluid had no malignant cells. No ultrastructural studies were done, and the article did not discuss asbestos. The authors concluded that these cells can occur in both neoplastic and benign cells, so cilia should be judged alongside nuclear features rather than taken as a sign of benignity.

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 series (images in cytology report) of four effusion samples
• Who was studied: Four patients at the Postgraduate Institute of Medical Education and Research, Chandigarh, India: a 34-year-old woman, a 48-year-old woman, an 80-year-old woman and a 47-year-old man; dates of the cases not given
• Exposure: Not reported; the article does not mention asbestos or any occupational or environmental exposure. It studied the microscopic appearance of cells in fluid samples.
• Main results:
  • Case 1 (34-year-old woman): ascitic fluid cells with hair-like processes; some showed a terminal plate. Surgery found borderline serous tumor in both ovaries.
  • Case 1: on liquid-based cytology preparation, the projections were hard to see.
  • Case 2 (48-year-old woman): malignant cells in ascitic fluid with hair-like projections, of mesothelial lineage by immunochemistry; a diagnosis of peritoneal mesothelioma was offered.
  • Case 3 (80-year-old woman, pleural fluid with metastatic adenocarcinoma): an occasional reactive mesothelial cell showed the flower pot appearance and was benign.
  • Case 4 (47-year-old man with chronic liver disease): some reactive mesothelial cells in ascitic fluid showed the flower pot appearance; no malignant cells were seen.
• The authors' conclusion: The authors concluded that flower pot cells can be present in neoplastic and benign cells, so the traditional view that cilia suggest benignity must be considered together with nuclear features.
• Limitations the authors state:
  • No ultrastructural studies were done, so the nature of the projections (microvilli or cilia) in the mesothelial cases remains unconfirmed.
  • In the mesothelioma case, follow-up tissue (histologic) confirmation was unavailable because the patient was lost to follow-up.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma, Ovarian cancer.

Medical terms in this study, explained in our Lexicon: Cytology, Mesothelioma, Reactive Mesothelial Hyperplasia.

Related studies

• Immunocytochemical utility of claudin-4 versus those of Ber-EP4 and MOC-31 in effusion cytology — T. Oda, S. Ogata, et al. (2016)
• 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)
• 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)
• IMP3/L523S, a novel immunocytochemical marker that distinguishes benign and malignant cells: the expression profiles of IMP3/L523S in effusion cytology — K. Ikeda, G. Tate, et al. (2010)
• The diagnostic role of BAP1 in serous effusions — B. Davidson, M. Tötsch, et al. (2018)
• Ancillary studies in pleural, pericardial, and peritoneal effusion cytology — K.E. Sundling, E.S. Cibas (2018)

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