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Difference between revisions of "Mesothelial cytopathology"
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*[[Sensitivity]] moderate for malignancy (60%).<ref name=pmid>{{Cite journal | last1 = Karoo | first1 = RO. | last2 = Lloyd | first2 = TD. | last3 = Garcea | first3 = G. | last4 = Redway | first4 = HD. | last5 = Robertson | first5 = GS. | title = How valuable is ascitic cytology in the detection and management of malignancy? | journal = Postgrad Med J | volume = 79 | issue = 931 | pages = 292-4 | month = May | year = 2003 | doi = | PMID = 12782778 }}</ref> | *[[Sensitivity]] moderate for malignancy (60%).<ref name=pmid>{{Cite journal | last1 = Karoo | first1 = RO. | last2 = Lloyd | first2 = TD. | last3 = Garcea | first3 = G. | last4 = Redway | first4 = HD. | last5 = Robertson | first5 = GS. | title = How valuable is ascitic cytology in the detection and management of malignancy? | journal = Postgrad Med J | volume = 79 | issue = 931 | pages = 292-4 | month = May | year = 2003 | doi = | PMID = 12782778 }}</ref> | ||
==Specimen types== | ===Specimen types=== | ||
*'''Wash''', e.g. ''peritoneal wash'': expect sheets of (benign squamous) cells. | *'''Wash''', e.g. ''peritoneal wash'': expect sheets of (benign squamous) cells. | ||
*'''Spontaneous''', e.g. ''pleural fluid'': usually no large sheets. | *'''Spontaneous''', e.g. ''pleural fluid'': usually no large sheets. | ||
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This distinction is important as ''wash'' specimens may have pseudopapillae. | This distinction is important as ''wash'' specimens may have pseudopapillae. | ||
=Approach= | ===Approach=== | ||
Look for: | Look for: | ||
#Two cell populations. | #Two cell populations. | ||
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#Small cells with high [[NC ratio]]. | #Small cells with high [[NC ratio]]. | ||
==Features of malignancy== | ===Features of malignancy=== | ||
Strongly suggestive of malignancy: | Strongly suggestive of malignancy: | ||
*3-D clusters. | *3-D clusters. | ||
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*High NC ratio. | *High NC ratio. | ||
=Differential diagnosis= | ===Differential diagnosis=== | ||
*[[Adenocarcinoma]] not otherwise specified (NOS) - most common. | *[[Adenocarcinoma]] not otherwise specified (NOS) - most common. | ||
*Reactive mesothelium. | *Reactive mesothelium. | ||
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*[[Small cell carcinoma]]. | *[[Small cell carcinoma]]. | ||
===Peritoneal cavity specific=== | ====Peritoneal cavity specific==== | ||
*[[Hepatocellular carcinoma]] (HCC) may be associated with ascites... but it is rarely positive for malignant cells.<ref name=Ref_APBR679>{{Ref APBR|679}}</ref> | *[[Hepatocellular carcinoma]] (HCC) may be associated with ascites... but it is rarely positive for malignant cells.<ref name=Ref_APBR679>{{Ref APBR|679}}</ref> | ||
**HCC in ascites fluid is super rare -- ''I haven't seen a case''.<ref>SB. 8 January 2010.</ref> | **HCC in ascites fluid is super rare -- ''I haven't seen a case''.<ref>SB. 8 January 2010.</ref> | ||
=Normal mesothelium= | =Normal mesothelium= | ||
===General=== | |||
Often seen in the context of: | |||
*Gynecologic surgeries - done to exclude malignancy. | |||
*Taps for ascites. | |||
===Cytology=== | |||
Features:<ref name=Ref_APBR674>{{Ref APBR|674}}</ref> | Features:<ref name=Ref_APBR674>{{Ref APBR|674}}</ref> | ||
*"Window" or "space" between attached cells (due to microvilli). | *"Window" or "space" between attached cells (due to microvilli). | ||
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=Reactive mesothelium= | =Reactive mesothelium= | ||
===General=== | |||
*May be due to any number of causes. | |||
*Can be severe in the context of [[chronic renal failure|(peritoneal) dialysis]].<ref name=pmid2323293>{{Cite journal | last1 = Selvaggi | first1 = SM. | last2 = Migdal | first2 = S. | title = Cytologic features of atypical mesothelial cells in peritoneal dialysis fluid. | journal = Diagn Cytopathol | volume = 6 | issue = 1 | pages = 22-6 | month = | year = 1990 | doi = | PMID = 2323293 }}</ref> | |||
===Cytology=== | |||
:''See [[Mesothelial_cytopathology#Malignant_mesothelioma|mesothelioma]]''. | |||
====Images==== | |||
<gallery> | |||
Image: Peritoneal fluid - post-DC insertion -- high mag.jpg | PF - high mag. (WC) | |||
Image: Peritoneal fluid - post-DC insertion -- very high mag.jpg | PF - very high mag. (WC) | |||
Image: Peritoneal fluid - post-DC insertion - alt -- very high mag.jpg | PF - very high mag. (WC) | |||
</gallery> | |||
===Sign out=== | ===Sign out=== | ||
<pre> | <pre> | ||
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===Cytology=== | ===Cytology=== | ||
Features: | Features: | ||
*Lupus erythematosus cells, usually abbreviated ''LE | *Lupus erythematosus cells, usually abbreviated ''[[LE cell]]s'':<ref>URL:[http://www.tabers.com/tabersonline/ub/view/Tabers/143167/34/L_E__cell http://www.tabers.com/tabersonline/ub/view/Tabers/143167/34/L_E__cell]. Accessed on: 12 April 2012.</ref> | ||
**Pink blobs (representing a denatured nuclei) - phagocytosed by | **Pink blobs (representing a denatured nuclei) - phagocytosed by a [[neutrophil]].<ref>URL: [http://library.med.utah.edu/WebPath/IMMHTML/IMM008.html http://library.med.utah.edu/WebPath/IMMHTML/IMM008.html]. Accessed on: 12 April 2012.</ref> | ||
Image: | Image: | ||
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===IHC=== | ===IHC=== | ||
* | *[[Calretinin]] +ve. | ||
*WT-1 +ve. | *WT-1 +ve. | ||
*[[D2-40]] +ve. | *[[D2-40]] +ve. | ||
*[[TTF-1]] -ve. | *[[TTF-1]] -ve. | ||
*CEA -ve. | *CEA -ve. | ||
*[[p63]] -ve.<ref name=pmid18064689>{{Cite journal | last1 = Pu | first1 = RT. | last2 = Pang | first2 = Y. | last3 = Michael | first3 = CW. | title = Utility of WT-1, p63, MOC31, mesothelin, and cytokeratin (K903 and CK5/6) immunostains in differentiating adenocarcinoma, squamous cell carcinoma, and malignant mesothelioma in effusions. | journal = Diagn Cytopathol | volume = 36 | issue = 1 | pages = 20-5 | month = Jan | year = 2008 | doi = 10.1002/dc.20747 | PMID = 18064689 }}</ref> | |||
==Adenocarcinoma== | ==Adenocarcinoma== | ||
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Image: Adenocarcinoma - pleural fluid 3 - TTF-1 -- very high mag.jpg | Adenocarcinoma - TTF-1 - very high mag. (WC) | Image: Adenocarcinoma - pleural fluid 3 - TTF-1 -- very high mag.jpg | Adenocarcinoma - TTF-1 - very high mag. (WC) | ||
</gallery> | </gallery> | ||
===IHC=== | |||
Breast: | |||
*ER +ve/-ve. | |||
*Calretinin -ve. | |||
Colon: | |||
*CK20 +ve. | |||
*CDX2 +ve. | |||
*Calretinin -ve. | |||
Lung: | |||
*TTF-1 +ve. | |||
*Calretinin -ve. | |||
==Colorectal adenocarcinoma== | ==Colorectal adenocarcinoma== | ||
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===IHC=== | ===IHC=== | ||
*WT-1 +ve. | *WT-1 +ve. | ||
*CA-125 +ve. | *[[CA-125]] +ve. | ||
*D2-40 +ve. | *D2-40 +ve. | ||