- Email: [email protected]
Pericardial Cytopathology: A Retrospective Analysis of 944 Cases Spanning a 29-year Period
Abstracts
S15
FLUIDS/CSF 17 Squamous Cells in Body Cavity Fluids: A Study of 24 Cases Laura Adhikari, MD, Camille T. Elkins, MD, Paul Wakely, MD Ohio State University, Columbus, Ohio Introduction: Squamous cells in body fluids are a rare event and when seen are often considered contaminants. The last major series examining squamous cells, in particular squamous carcinoma, in major body cavity specimens was a quarter century ago. Materials and Methods: Specimens were retrieved from our database using search codes as “squamous” within the final diagnosis for the past 7 years. Inclusion criteria included patients 18 years or older at time of diagnosis. Results: A total of 29 specimens were recovered. Five specimens were excluded as the diagnosis stated “No squamous cell carcinoma identified” or the specimen represented fine needle aspiration of a cystic lesion. Of the remaining 24 specimens, three were duplicates from three separate patients; therefore, only the first specimen was included for a final tally of 21 specimens. Specimens were from pleural fluid (nZ15, 71%), pericardial fluid (nZ3), pelvic fluid (nZ2), and peritoneal fluid (nZ1). Nineteen were examples of squamous cell carcinoma (primary sites Z 7 lung, 2 cervix, 2 larynx, 2 anus, 2 esophagus, 1 tongue, 1 mandible, 1 skin, 1 vulva) and 2 patients had benign squamous cells only (1 ruptured esophageal adenocarcinoma and 1 non-malignant esophageal rupture). In malignant cases, the “third-type differentiated cell” as described by Graham was cytomorphologically the predominant cell (nZ12) followed by undifferentiated cell (nZ4), polygonal-type cell (nZ2), and fiber-type cell (nZ1). Fourteen specimens showed varying degrees of keratinization. Other cytomorphologic features were refractile rings (76%), keratin pearls (48%), and vacuolated cytoplasm (38%). Herxheimer spirals were absent. The 2 benign cases showed polygonal cell type morphology only. All patients with carcinoma died shortly after fluid collection (range: 6 hours-313 days; mean Z 58.3 days). Conclusion: Malignant squamous cells in body cavity fluids are rare, display the “third-type” cell most often, and represent an extremely poor prognosis. 18 Metastatic Squamous Cell Carcinoma in Effusion Cytology - An Institutional Study Hui Zhu, MD, PhD, Abha Goyal, MD Cleveland Clinic, Cleveland, Ohio Introduction: The cytologic detection of metastatic squamous cell carcinoma is reportedly rare in effusion specimens. There is limited information as to the clinical presentation, the morphologic features and the differential diagnoses of these metastases. Here we present our experience regarding this infrequent finding in fluid cytology. Materials and Methods: A database search was conducted for suspicious and positive cases of “squamous cell carcinoma” in pericardial, pleural and peritoneal fluid cytology specimens from January 1995 to March 2013. Cases with available slides (Thin Prep and/or cell block) were further analyzed. Clinical and follow-up data and cytologic features were recorded. Results: Twenty cases were retrieved e 13 women (35 e 79 years), 7 men (37 e 68 years). Sites of metastases were pleural fluid (n Z14, primaries: 8 lung, 3 cervix, 1 unknown, 1 tongue, 1 tonsil) followed by peritoneal fluid (n Z 4, primaries: 3 cervix, 1 unknown) and pericardial fluid (nZ2, primaries: 1 cervix, 1 tonsil). Cervix and lung were the most common primaries for women and men respectively. Five patients presented with effusion at initial diagnosis. Cytology (Thin Prep and cell block in 16 cases, Thin Prep only in 4 cases) mostly revealed cohesive groups with smooth borders composed of cells with cyanophilic dense to finely vacuolated cytoplasm and coarse chromatin simulating adenocarcinoma/mesothelioma (nZ 7) followed by large cell undifferentiated morphology (nZ 5), single cell pattern with high nuclear/cytoplasmic ratio and dense cytoplasm (n Z3) and atypical keratinized cells with abnormal shapes and nuclei (nZ5).
Immunohistochemical stains were employed in 5 cases and HPV (human papillomavirus) in situ hybridization in one case. Conclusion: The cytologic features of metastatic squamous cell carcinoma in effusions are mostly nondescript. Though uncommon, in a patient with a history of squamous cell carcinoma, one should entertain this possibility, and perform the appropriate ancillary studies for its exclusion/confirmation. 19 Pericardial Cytopathology: A Retrospective Analysis of 944 Cases Spanning a 29-year Period Hui Zhu, MD, PhD, Christine N. Booth, MD, Jordan Reynolds, MD Cleveland Clinic Foundation, Cleveland, Ohio Introduction: Pericardial effusion can be a consequence of various diseased states, including infection, autoimmune disease, renal failure, myocardial disease, and neoplasms. Although multiple case reports of malignancyassociated pericardial effusion have been published, few database analysis is available in the literature. In this study, we retrospectively reviewed 944 cytology cases and assessed malignancy-associated pericardial effusion. Materials and Methods: We reviewed our cytology reports for pericardial effusion cases during 1984 to 2012. These cases were classified as benign, atypical, malignant, and non-diagnostic. The malignant cases were further characterized based on either immunohistochemical staining result on cell block preparation or patients’ history. Results: 944 cases were identified and grouped as follows: 768 benign (81.4%); 35 atypical (3.7%); 139 malignant (14.7%); and 2 unsatisfactory (0.2%). Malignant cases included 107 adenocarcinoma (77.0%), 12 lymphoma (8.8%), 9 unclassifiable carcinoma (6.6%), 6 unclassifiable malignant cells (4.3%), 2 mesothelioma (1.4%), 1 squamous cell carcinoma (0.7%), 1 melanoma (0.7%), and 1 small cell carcinoma (0.7%). Of these 107 adenocarcinomas, 68 cases had clinical history and/or immunohistochemical study available for further classification, which included 30 lung primary, 18 breast primary, 3 esophageal primary, 3 ovarian primary, 2 colorectal primary, 1 gastric primary, and 7 unknown primary. The atypical cases (35) are further classified as favor benign (21), favor malignancy (11), and non-diagnostic (5). A significant finding is that patients with metastatic malignancy to pericardial fluid are relatively young, with average age of 54year-old, youngest being 19 and oldest being 81. Male and female are about equally affected. Conclusion: About 15% of pericardial effusion cases are caused by metastatic malignancy, with lung adenocarcinoma being the most common primary site, followed by breast. Relatively young patients are affected, with average age being 54. Clinical history and immunohistochemical study are used to determine the primary site of malignancy. 20 Atypical Pleural Effusions: A Single Institution Experience Over a 7year Period Hui Zhu, MD, PhD, Stephen Gmitro, BS, CT(ASCP), Gail L. Imondi, CT(ASCP), Jordan Reynolds, MD Cleveland Clinic Foundation, Cleveland, Ohio Introduction: Malignant pleural effusion indicates advanced disease. To avoid false positives and false negatives, rare cases are designated as atypical. The goal of our study is to give our institutional experience with our atypical pleural cytology cases with clinical pathologic follow up. Materials and Methods: We reviewed our pleural effusion (PE) cytology reports during 2005 and 2012 for cases that were diagnosed as “atypical cells present.” Slides and clinical information were reviewed to determine if patients were subsequently positive, negative or unclassifiable if pleural biopsy, autopsy, follow-up cytology, or radiographic findings confirmed pleural involvement by malignancy. Quantification of atypical cells present were compared among cases.
S15
FLUIDS/CSF 17 Squamous Cells in Body Cavity Fluids: A Study of 24 Cases Laura Adhikari, MD, Camille T. Elkins, MD, Paul Wakely, MD Ohio State University, Columbus, Ohio Introduction: Squamous cells in body fluids are a rare event and when seen are often considered contaminants. The last major series examining squamous cells, in particular squamous carcinoma, in major body cavity specimens was a quarter century ago. Materials and Methods: Specimens were retrieved from our database using search codes as “squamous” within the final diagnosis for the past 7 years. Inclusion criteria included patients 18 years or older at time of diagnosis. Results: A total of 29 specimens were recovered. Five specimens were excluded as the diagnosis stated “No squamous cell carcinoma identified” or the specimen represented fine needle aspiration of a cystic lesion. Of the remaining 24 specimens, three were duplicates from three separate patients; therefore, only the first specimen was included for a final tally of 21 specimens. Specimens were from pleural fluid (nZ15, 71%), pericardial fluid (nZ3), pelvic fluid (nZ2), and peritoneal fluid (nZ1). Nineteen were examples of squamous cell carcinoma (primary sites Z 7 lung, 2 cervix, 2 larynx, 2 anus, 2 esophagus, 1 tongue, 1 mandible, 1 skin, 1 vulva) and 2 patients had benign squamous cells only (1 ruptured esophageal adenocarcinoma and 1 non-malignant esophageal rupture). In malignant cases, the “third-type differentiated cell” as described by Graham was cytomorphologically the predominant cell (nZ12) followed by undifferentiated cell (nZ4), polygonal-type cell (nZ2), and fiber-type cell (nZ1). Fourteen specimens showed varying degrees of keratinization. Other cytomorphologic features were refractile rings (76%), keratin pearls (48%), and vacuolated cytoplasm (38%). Herxheimer spirals were absent. The 2 benign cases showed polygonal cell type morphology only. All patients with carcinoma died shortly after fluid collection (range: 6 hours-313 days; mean Z 58.3 days). Conclusion: Malignant squamous cells in body cavity fluids are rare, display the “third-type” cell most often, and represent an extremely poor prognosis. 18 Metastatic Squamous Cell Carcinoma in Effusion Cytology - An Institutional Study Hui Zhu, MD, PhD, Abha Goyal, MD Cleveland Clinic, Cleveland, Ohio Introduction: The cytologic detection of metastatic squamous cell carcinoma is reportedly rare in effusion specimens. There is limited information as to the clinical presentation, the morphologic features and the differential diagnoses of these metastases. Here we present our experience regarding this infrequent finding in fluid cytology. Materials and Methods: A database search was conducted for suspicious and positive cases of “squamous cell carcinoma” in pericardial, pleural and peritoneal fluid cytology specimens from January 1995 to March 2013. Cases with available slides (Thin Prep and/or cell block) were further analyzed. Clinical and follow-up data and cytologic features were recorded. Results: Twenty cases were retrieved e 13 women (35 e 79 years), 7 men (37 e 68 years). Sites of metastases were pleural fluid (n Z14, primaries: 8 lung, 3 cervix, 1 unknown, 1 tongue, 1 tonsil) followed by peritoneal fluid (n Z 4, primaries: 3 cervix, 1 unknown) and pericardial fluid (nZ2, primaries: 1 cervix, 1 tonsil). Cervix and lung were the most common primaries for women and men respectively. Five patients presented with effusion at initial diagnosis. Cytology (Thin Prep and cell block in 16 cases, Thin Prep only in 4 cases) mostly revealed cohesive groups with smooth borders composed of cells with cyanophilic dense to finely vacuolated cytoplasm and coarse chromatin simulating adenocarcinoma/mesothelioma (nZ 7) followed by large cell undifferentiated morphology (nZ 5), single cell pattern with high nuclear/cytoplasmic ratio and dense cytoplasm (n Z3) and atypical keratinized cells with abnormal shapes and nuclei (nZ5).
Immunohistochemical stains were employed in 5 cases and HPV (human papillomavirus) in situ hybridization in one case. Conclusion: The cytologic features of metastatic squamous cell carcinoma in effusions are mostly nondescript. Though uncommon, in a patient with a history of squamous cell carcinoma, one should entertain this possibility, and perform the appropriate ancillary studies for its exclusion/confirmation. 19 Pericardial Cytopathology: A Retrospective Analysis of 944 Cases Spanning a 29-year Period Hui Zhu, MD, PhD, Christine N. Booth, MD, Jordan Reynolds, MD Cleveland Clinic Foundation, Cleveland, Ohio Introduction: Pericardial effusion can be a consequence of various diseased states, including infection, autoimmune disease, renal failure, myocardial disease, and neoplasms. Although multiple case reports of malignancyassociated pericardial effusion have been published, few database analysis is available in the literature. In this study, we retrospectively reviewed 944 cytology cases and assessed malignancy-associated pericardial effusion. Materials and Methods: We reviewed our cytology reports for pericardial effusion cases during 1984 to 2012. These cases were classified as benign, atypical, malignant, and non-diagnostic. The malignant cases were further characterized based on either immunohistochemical staining result on cell block preparation or patients’ history. Results: 944 cases were identified and grouped as follows: 768 benign (81.4%); 35 atypical (3.7%); 139 malignant (14.7%); and 2 unsatisfactory (0.2%). Malignant cases included 107 adenocarcinoma (77.0%), 12 lymphoma (8.8%), 9 unclassifiable carcinoma (6.6%), 6 unclassifiable malignant cells (4.3%), 2 mesothelioma (1.4%), 1 squamous cell carcinoma (0.7%), 1 melanoma (0.7%), and 1 small cell carcinoma (0.7%). Of these 107 adenocarcinomas, 68 cases had clinical history and/or immunohistochemical study available for further classification, which included 30 lung primary, 18 breast primary, 3 esophageal primary, 3 ovarian primary, 2 colorectal primary, 1 gastric primary, and 7 unknown primary. The atypical cases (35) are further classified as favor benign (21), favor malignancy (11), and non-diagnostic (5). A significant finding is that patients with metastatic malignancy to pericardial fluid are relatively young, with average age of 54year-old, youngest being 19 and oldest being 81. Male and female are about equally affected. Conclusion: About 15% of pericardial effusion cases are caused by metastatic malignancy, with lung adenocarcinoma being the most common primary site, followed by breast. Relatively young patients are affected, with average age being 54. Clinical history and immunohistochemical study are used to determine the primary site of malignancy. 20 Atypical Pleural Effusions: A Single Institution Experience Over a 7year Period Hui Zhu, MD, PhD, Stephen Gmitro, BS, CT(ASCP), Gail L. Imondi, CT(ASCP), Jordan Reynolds, MD Cleveland Clinic Foundation, Cleveland, Ohio Introduction: Malignant pleural effusion indicates advanced disease. To avoid false positives and false negatives, rare cases are designated as atypical. The goal of our study is to give our institutional experience with our atypical pleural cytology cases with clinical pathologic follow up. Materials and Methods: We reviewed our pleural effusion (PE) cytology reports during 2005 and 2012 for cases that were diagnosed as “atypical cells present.” Slides and clinical information were reviewed to determine if patients were subsequently positive, negative or unclassifiable if pleural biopsy, autopsy, follow-up cytology, or radiographic findings confirmed pleural involvement by malignancy. Quantification of atypical cells present were compared among cases.