Ultrastructural studies of malignant cells in fluids

Our plain-English summary of Ultrastructural studies of malignant cells in fluids, by G.A. Herrera, J.A. Wilkerson (Diagnostic Cytopathology, 1985).

The study

• Authors: G.A. Herrera, J.A. Wilkerson
• Journal: Diagnostic Cytopathology
• Published: 1985;1(4):272-85
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

An ultrastructural study was performed on 104 sequential fluids in which more than eight malignant cells per ten high-power fields were found by routine light microscopy. The study included fluids associated with mesotheliomas, melanomas, lymphomas, squamous-cell carcinomas, small-cell anaplastic (oat-cell) carcinomas, and adenocarcinomas. Electron microscopic examination reliably separated lymphoid from epithelial malignancies and benign from reactive and malignant mesothelial cell proliferations. It also suggested or identified a primary site for the adenocarcinomas. Ultrastructural examination of fluids can be a valuable adjunct to routine light microscopy of cytology specimens. No false-positive diagnoses were encountered. Sampling was the most significant limitation for this technique.

In plain English

This study used electron microscopy to look at cells in 104 sequential body fluid samples in which routine light microscopy had found more than eight malignant cells per ten high-power fields. The cells could be characterized in 69 of the 104 fluids. In the other 35, only a few or no malignant cells were available, and no diagnosis was possible. Of the 69 fluids, 54 were pleural, 11 peritoneal, 3 pericardial and 1 spinal. Most contained adenocarcinoma cells: 52 fluids. The authors reported that, even at low power, malignant mesothelial cells could be told apart from benign and reactive mesothelial cells. Mesothelioma cells had bushy, branching microvilli, and mucus was always absent. Except in seven adenocarcinoma cases, the primary site suggested by electron microscopy was confirmed by biopsy or autopsy. The seven remained unconfirmed. The authors reported no false-positive diagnoses. They named too few malignant cells in some samples as the main problem. The authors concluded that electron microscopy gives a more complete evaluation of malignant fluids. The article does not discuss asbestos or any exposure.

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: Diagnostic case series: electron microscopic (ultrastructural) examination of cells in body fluids
• Who was studied: 104 sequential body fluid specimens in which light microscopy had found more than eight malignant cells per ten high-power fields. 69 could be characterized: 54 pleural, 11 peritoneal, 3 pericardial and 1 spinal. Collection dates and patient details are not given. The authors were at the University of Alabama in Birmingham, the Veterans Administration Medical Center in Birmingham, and a laboratory in Merced, CA.
• Main results:
  • Electron microscopic characterization of the cells was possible in 69 of the 104 fluids.
  • In 35 fluids, only a few or no malignant cells were available, and no diagnosis was possible.
  • Even at low power, benign and reactive mesothelial cells could be distinguished from malignant mesothelial cells.
  • Mesothelioma cells in fluids had well-developed, bushy, branching microvillous borders, and mucus was always absent.
  • Ovarian adenocarcinoma cells had microvilli similar to those of mesothelioma. Unlike mesothelioma cells, they always showed mucus or serous granules and lacked tonofilaments.
  • Among the 52 adenocarcinoma fluids, the primary tumor was not known when the fluid was evaluated in 23. Except in seven cases, the primary site suggested by electron microscopy was confirmed by biopsy or autopsy. Confirmed primary sites were 21 lung, 11 breast, 7 gastrointestinal tract, 4 ovary, 1 pancreas and 1 endometrium.
  • Clara-cell granules were seen in 17 of 21 lung adenocarcinomas examined.
  • In one pleural effusion, light microscopy had confused an oat-cell carcinoma with a signet-ring adenocarcinoma from the stomach. Electron microscopy identified it as neuroendocrine.
  • No false-positive diagnoses were encountered.
• The authors' conclusion: The authors concluded that the study confirms the value of electron microscopy for a more complete evaluation of malignant fluids. They also concluded that it suggests a promising role in identifying the primary sites of adenocarcinomas of unknown origin.
• Limitations the authors state:
  • Some fluids had too few malignant cells, and after processing, not enough malignant cells could be obtained for analysis.
  • In seven adenocarcinoma cases, the primary site suggested by electron microscopy was not confirmed, and these cases were treated as unknown.

Topics

Medical terms in this study, explained in our Lexicon: High-Power Field, Mesothelioma, Carcinoma, Adenocarcinoma, Mesothelial Cells, Cytology.

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