Serous effusions

One hundred and three serous fluid examinations were analysed to try to discover a simple formula whereby a pathological and/or aetiological diagnosis may be made without recourse to multiple, invasive, sophisticated QC expensive procedures. It was hoped also to find features which would identify effusions arising from similar mechanisms. These hopes were not fulfilled. Instead, the study prompts a re-examination of traditional concepts on the question of transudates and exudates, as occurs in our group of patients belonging to the Swazi nation. The literature, with relevant points on the issue in general, is examined.S. Afr. Med. J. 48, 865 (1974)

Pleural, peritoneal and pericardial effusions – a biochemical approach

The pathological accumulation of serous fluids in the pleural, peritoneal and pericardial space occurs in a variety of conditions. Since patient management depends on right and timely diagnosis, biochemical analysis of extravascular body fluids is considered a valuable tool in the patient management process. The biochemical evaluation of serous fluids includes the determination of gross appearance, differentiation of transudative from exudative effusions and additional specific biochemical testing to assess the effusion etiology. This article summarized data from the most relevant literature concerning practice with special emphasis on usefulness of biochemical tests used for the investigation of pleural, peritoneal and pericardial effusions. Additionally, preanalytical issues concerning serous fluid analysis were addressed and recommendations concerning acceptable analytical practice in serous fluid analysis were presented

Struma Ovarii Associated with Pseudo- Meigs’Syndrome

Struma ovarii is a specialized ovarian teratoma composed predominantly of mature thyroid tissue. It is associated with pleural effusion and ascites (Pseudo-Meigs’ syndrome) in 5% of cases. Majorities of the strumas are benign, however occasionally malignant transformation may be seen. We report a case of a 45 years old postmenopausal woman who presented with gradually increasing dyspnoea and distention of abdomen of five months duration. USG abdomen revealed a bulky right ovary with a solid and cystic components and ascites. Her chest X-ray showed bilateral pleural effusion. Hence, clinical diagnosis of malignant ovarian tumor was kept; however, both the ascetic & pleural fluids were cytologically negative for malignant cells. The patient was operated forhysterectomy with bilateral salpingo-ophorectomy. The histopathological examination of the ovarian mass confirmed the diagnosis of struma ovarii. Postsurgical follow up of patient showed spontaneous regression of pleural effusion and ascites. The coexistence of an ovarian tumor, ascites and bilateral pleural effusion that resolves spontaneously on resection of the ovarian mass is known as pseudo-Meigs’ syndrome. Patient with pseudo-Meigs’ syndrome may present a diagnostic problem as they masquerade as carcinoma with malignant effusions. In addition, the coexistence of struma ovarii and pseudo-Meigs’ syndrome is a very rare event

Cytomorphological features of metastatic squamous cell carcinoma in serous effusions

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106699/1/cyt12065.pd

Levels of feline infectious peritonitis virus in blood, effusions, and various tissues and the role of lymphopenia in disease outcome following experimental infection.

Twenty specific pathogen free cats were experimentally infected with a virulent cat-passaged type I field strain of FIPV. Eighteen cats succumbed within 2-4 weeks to effusive abdominal FIP, one survived for 6 weeks, and one seroconverted without outward signs of disease. A profound drop in the absolute count of blood lymphocytes occurred around 2 weeks post-infection (p.i.) in cats with rapid disease, while the decrease was delayed in the one cat that survived for 6 weeks. The absolute lymphocyte count of the surviving cat remained within normal range. Serum antibodies as measured by indirect immunofluorescence appeared after 2 weeks p.i. and correlated with the onset of disease signs. Viral genomic RNA was either not detectable by reverse transcription quantitative real-time PCR (RT-qPCR) or detectable only at very low levels in terminal tissues not involved directly in the infection, including hepatic and renal parenchyma, cardiac muscle, lung or popliteal lymph node. High tissue virus loads were measured in severely affected tissues such as the omentum, mesenteric lymph nodes and spleen. High levels of viral genomic RNA were also detected in whole ascitic fluid, with the cellular fraction containing 10-1000 times more viral RNA than the supernatant. Replicating virus was strongly associated with macrophages by immunohistochemistry. Virus was usually detected at relatively low levels in feces and there was no evidence of enterocyte infection. Viral genomic RNA was not detected at the level of test sensitivity in whole blood, plasma, or the white cell fraction in terminal samples from the 19 cats that succumbed or in the single survivor. These studies reconfirmed the effect of lymphopenia on disease outcome. FIPV genomic RNA was also found to be highly macrophage associated within diseased tissues and effusions as determined by RT-qPCR and immunohistochemistry but was not present in blood

Diagnostic utility of PAX8 and PAX2 immunohistochemistry in the identification of metastatic Müllerian carcinoma in effusions

Morphologic distinction of Müllerian carcinomas from non‐Müllerian carcinomas in effusion specimens by cytomorphology alone can be diagnostically challenging. Therefore, immunohistochemical adjuncts can be useful in differentiating Müllerian from non‐Müllerian metastases. In this study, we evaluated the expression of PAX8 and PAX2 in malignant effusions collected from patients with known Müllerian and non‐Müllerian carcinomas. Sections from cell blocks prepared from 152 effusion specimens (54 and 98 cases representing metastases from Müllerian and non‐Müllerian primaries, respectively) were immunostained with rabbit polyclonal antibodies against PAX8 and PAX2. Immunopositivity was defined as the presence of strong nuclear staining in at least 25% of the tumor cells. Fifty‐two (96%) and 13 (24%) of the 54 Müllerian carcinomas were positive for PAX8 and PAX2, respectively. PAX8 positivity was seen in only four (4%) of 98 non‐Müllerian carcinomas; these represented metastasis from a large cell neuroendocrine lung carcinoma, papillary thyroid carcinoma, renal cell carcinoma, and acinic cell carcinoma of the parotid gland. PAX2 positivity was not seen in any of the non‐Müllerian carcinomas. The results demonstrate that both PAX8 and PAX2 are highly specific markers for metastatic Müllerian carcinomas in cell block preparations from effusion specimens (96% and 100%, respectively). PAX8, however, is more sensitive than PAX2 in identifying Müllerian carcinomas in fluids (96% versus 24%). Overall, immunohistochemistry for PAX8 and PAX2 represent diagnostically useful adjuncts in identifying a Müllerian carcinoma as a source of a malignant effusion. Diagn. Cytopathol. 2010. © 2010 Wiley‐Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87028/1/21442_ftp.pd

Serous effusions in Burkitt lymphomas: a report of two paediatric cases with review of literature

The serosal cavity can be involved in many diseases, both benign and malignant. Such involvement is secondary to occurrence of disease at other sites. Lymphoma, although not a very common cause for serous effusion, is one of the most important one. The reason for serosal involvement in lymphomas has not been fully elucidated. These two cases highlight the importance of pleural and peritoneal fluid examination in the diagnosis of lymphoma. There is correlation between fluid examination and subsequent cytological and histopathological studies, with immunohistochemical confirmation. A comprehensive understanding of the mechanism of serosal involvement in lymphomas may lead to early diagnosis, better patient management and also development of newer treatment modalities for the same

The role of liquid-based cytology and ancillary techniques in pleural and pericardic effusions: An institutional experience

"Epub ahead of print 2015 Jan. 14"BACKGROUND: Fine-needle aspiration cytology (FNAC) of serous membrane effusions may fulfil a challenging role in the diagnostic analysis of both primary and metastatic disease. From this perspective, liquid-based cytology (LBC) represents a feasible and reliable method for empowering the performance of ancillary techniques (ie, immunocytochemistry and molecular testing) with high diagnostic accuracy. METHODS: In total, 3171 LBC pleural and pericardic effusions were appraised between January 2000 and December 2013. They were classified as negative for malignancy (NM), suspicious for malignancy (SM), or positive for malignancy (PM). RESULTS: The cytologic diagnoses included 2721 NM effusions (2505 pleural and 216 pericardic), 104 SM effusions (93 pleural and 11 pericardic), and 346 PM effusions (321 pleural and 25 pericardic). The malignant pleural series included 76 unknown malignancies (36 SM and 40 PM effusions), 174 metastatic lesions (85 SM and 89 PM effusions), 14 lymphomas (3 SM and 11 PM effusions), 16 mesotheliomas (5 SM and 11 SM effusions), and 3 myelomas (all SM effusions). The malignant pericardic category included 20 unknown malignancies (5 SM and 15 PM effusions), 15 metastatic lesions (1 SM and 14 PM effusions), and 1 lymphoma (1 PM effusion). There were 411 conclusive immunocytochemical analyses and 47 molecular analyses, and the authors documented 88% sensitivity, 100% specificity, 98% diagnostic accuracy, 98% negative predictive value, and 100% positive predictive value for FNAC. CONCLUSIONS: FNAC represents a primary diagnostic tool for effusions and a reliable approach with which to determine the correct follow-up. Furthermore, LBC is useful for ancillary techniques, such as immunocytochemistry and molecular analysis, with feasible diagnostic and predictive utility