Rheumatoid pleuritis
Less than 5% of patients with rheumatoid arthritis develop pleural involvement. The effusion can be unilateral or bilateral and a pericardial effusion may also occur in some cases. The cytologic picture is very characteristic. Abundant clumps of granular debris Macrophages The abundant granular material can stain green, pink, red or orange with the Papanicolaou stain, […]
Systemic lupus erythematosus (SLE)
Systemic lupus erithematosus (SLE) About one-third of patients with SLE develop a pleural or pericardial effusion, or less commonly a peritoneal effusion. The characteristic cell is the lupus erythematosus (LE) cell, a neutrophil or macrophage containing an ingested cytoplasmic particle called hematoxylin body. The hematoxylin body can be green, blue or purple with the Papanicolaou […]
Eosinophilic effusions
Eosinophilic effusions Eosinophilic pleural effusion is an uncommon disorder characterized by a very high number of eosinophils, usually more than 10% of the cells. Some cases occur in the setting of a predisposing cause, but in about one-third of cases the origin remains obscure. Most cases resolve spontaneously. Eosinophilic pericardial and peritoneal effusions are even […]
Physiopathology of the effusions
Physiopathology of the effusions The pleural, pericardial and peritoneal cavities are lined by a single layer of flat or cuboidal mesothelial cells called the serosa. In normal conditions these cavities contain only a small amount of fluid, enough to lubrificate the adjacent visceral and parietal surfaces as they move over each other. In disease states, […]
Malignant effusions
Malignant effusions Some tumours have a greater tendency than others to spread to the serosal cavities. The most common causes of malignant pleural effusion are lung cancer in men and breast cancer in women. In some cases, a malignant pleural effusion can be the first manifestation of lung cancer, whereas it is very uncommon for […]
Specimen collection
Specimen are obtained by inserting a needle into the pleural space (thoracentesis), pericardial space (pericardiocentesis) or peritoneal cavity (paracentesis). Less commonly, fluid is obtained by suction during thoracic or abdominal surgery. Fluid is collected in clean containers and sent unfixed to the laboratory. To prevent clotting, which widely disperses cells, thus hindering their evaluation, fluid […]
Malignant mesothelioma
Malignant mesothelioma Malignant mesothelioma arises most commonly in the pleura and rarely in the peritoneum. The occurrence of this tumour is related to asbestos exposure. The tumour grows as multiple plaques and large nodules on the serosal surface. Most patients have an effusion at the time of presentation. The effusion is often bloody; if not, […]
Accuracy
Cytology is more sensitive than blind biopsy in patients suspected of serosal metastases, presumably because fluid provides a more representative sample. Cytologic examination supplemented by culture of the fluid is more reliable than a biopsy to detect tuberculosis. Cytologic examination of the effusions has a substantial false-negative rate. Some studies estimated the sensitivity of cytology […]
Primary effusion lymphoma
Primary effusion lymphoma It is a large B-cell lymphoma which presents as a pleural, pericardial or peritoneal effusion. There is no associated mass lesion or lymphadenopaty. Most cases arise in the setting of HIV infection. The prognosis is poor. Cytologic diagnostic features Dispersed large cells Round or irregular nuclei, prominent nucleoli Abundant basophilic cytoplasm (Romanowsky […]
Reporting terminology
Diagnoses are reported as negative for malignant cells, positive for malignant cells or suspicious for malignancy, followed by a description. A case is called suspicious when the abnormal cells are too poorly preserved or too few to support a definite diagnosis of malignancy. Criteria for the adequacy of effusion specimens have not been established.