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Utility of Flow Cytometry Analysis for Pleural Fluids
Abstracts
S15 Success, New York; 3North Shore LIJ - Lenox Hill Hospital, New York, New York
Figure 1
Introduction: Effusions may serve as the initial presentation of malignancy. A majority of malignant effusions are metastatic adenocarcinomas from known or unknown primary tumors. Evaluation of cytomorphologic features is the most important initial step in formulating a diagnosis, followed by utilizing immunohistochemical studies to finalize a proper diagnosis. Materials and Methods: We present seven fluid cases from different sites in which immunohistochemistry was critical to determine the accurate diagnoses and thus the proper course of treatment, despite conflicting cytomorphology (Table 1). Results: Four of the seven cases (two ascites and two pleural effusions) involved distinguishing between adenocarcinoma and mesothelioma; the cytomorphologic impression was contradicted by the immunoprofile. Three cases were determined to be adenocarcinoma after utilization of a full immunopanel, despite the classic mesothelioma intracellular windows, cell microvilli and skirts (Figures 1-3) (although morphologically one case had mixed adenocarcinoma and mesothelioma features). The fourth case appeared to form cell clusters, giving a glandular impression, with classic smooth community borders; a full immunopanel and surgical follow-up confirmed mesothelioma. Three of the seven cases (two pericardial and one Table 1 Effusions cases with contradictory morphological impressions and final diagnoses, and immunoprofiles
15
Age/ SITE Sex
Utility of Flow Cytometry Analysis for Pleural Fluids Maren Fuller, MD, Michael Thrall, MD. Houston Methodist Hospital, Houston, Texas Introduction: Pleural fluid samples with many lymphocytes are commonly received in the cytology laboratory. However, it is difficult to distinguish reactive lymphocytes from Non-Hodgkin’s Lymphoma (NHL) based on morphology alone. Flow cytometry can be a useful test to identify NHL in pleural fluids, however literature on this subject is limited. We aim to address the utility of sending pleural fluid specimens for flow cytometry analysis. Materials and Methods: This study is a 5 year retrospective review of 325 pleural fluid samples from 298 patients with corresponding flow cytometry analysis. The flow cytometry results were correlated with the cytologic findings and clinical data. Results: Of 4,158 pleural fluids received over 5 years, 325 (7.8%) had corresponding flow cytometry analysis. Of these 325 samples, 57 (17.5%) were positive for NHL/leukemia by flow cytometry. 45 samples had a known history of NHL/leukemia, and 33 (73.3%) were positive for NHL/ leukemia by flow cytometry. The remaining 280 samples had no reported history of NHL/leukemia, and 24 (8.7%) were positive by flow cytometry. Of the cytology reports for these 24 cases, 8 (33.3%) mentioned atypical cells, and 9 (37.5%) were consistent with NHL or leukemia. The remaining cases describe a monotonous population of small lymphocytes. Conclusions: Flow cytometry analysis for pleural fluids is of little utility, as we found only 8.7% of cases without known histories were positive for NHL/leukemia. Of these positive cases, many had atypical cells that suggested a diagnosis of hematologic malignancy. Conversely, in cases with a known history, 73.3% were positive for NHL/leukemia. Our study suggests that the utility of flow cytometry for pleural fluids is low except in cases with atypical cytologic features or known history. Future directions include identifying potential cytologic indicators to suggest NHL in pleural fluids without atypical features or known history. 16 Effusions Are Not Always What They Seem; Don’t Judge a Fluid by its Cover (Slip) Tamar Brandler, MD, MS1, Melissa Klein, CT(ASCP)2, Oana Rafael, MD3, Mohamed Aziz, MD2. 1Hofstra North Shore-Long Island Jewish, New Hyde Park, New York; 2North Shore-Long Island Jewish Health System, Lake
Cytopathology Morphological Impression
Final Diagnosis Positive Negative Immunostains Immunostains
44/M Peritoneal Adenocarcinoma Malignant implant/ mesothelioma Ascites
67/M
92/F
74/F
77/F
60/F
42/F
Calretinin, MOC31, WT1, BerEP4, CK5/6, Glut1 TTF-1, PAX8, CEA Pleural Mesothelioma Adenocarcinoma MOC31, TTF-1, fluid BerEP4, CK7 CK 5/6, WT1, Calretinin, D2-40, S100 MOC31, CD163, Pleural Malignant Reactive BerEP4, CK 5/6 fluid Neoplasm macrophage TTF-1, (focal), and CK20, CK7, mesothelial Napsin, Calretinin, cells PAX8, Vimentin Mucin, S100 CK20, Adenocarcinoma Mucin, Ascites Malignant PAX8, MOC31, (Mixed Wt1, CK7 Features CK5/6, Adenocarcinoma ER, & Mesothelioma) CA19-9 CD163, WT1 CK5/6, Pericardial Malignant Reactive MOC31, fluid macrophage BerEP4, and TTF-1 mesothelial cells Pericardial Atypical Adenocarcinoma CK7, CK20, fluid P53, CEA ER, PAX8, TTF-1, Napsin, CAm5-2, CK5/6, WT1, Calretinin, MOC31, BerEP4, CD163 Pleural Mesothelioma Adenocarcinoma MOC31, CK 5/6, fluid BerEP4, calretinin, and WT1 PAX-8, Ca 19.9, CD 163 (stains histiocytes), CEA (variable)
S15 Success, New York; 3North Shore LIJ - Lenox Hill Hospital, New York, New York
Figure 1
Introduction: Effusions may serve as the initial presentation of malignancy. A majority of malignant effusions are metastatic adenocarcinomas from known or unknown primary tumors. Evaluation of cytomorphologic features is the most important initial step in formulating a diagnosis, followed by utilizing immunohistochemical studies to finalize a proper diagnosis. Materials and Methods: We present seven fluid cases from different sites in which immunohistochemistry was critical to determine the accurate diagnoses and thus the proper course of treatment, despite conflicting cytomorphology (Table 1). Results: Four of the seven cases (two ascites and two pleural effusions) involved distinguishing between adenocarcinoma and mesothelioma; the cytomorphologic impression was contradicted by the immunoprofile. Three cases were determined to be adenocarcinoma after utilization of a full immunopanel, despite the classic mesothelioma intracellular windows, cell microvilli and skirts (Figures 1-3) (although morphologically one case had mixed adenocarcinoma and mesothelioma features). The fourth case appeared to form cell clusters, giving a glandular impression, with classic smooth community borders; a full immunopanel and surgical follow-up confirmed mesothelioma. Three of the seven cases (two pericardial and one Table 1 Effusions cases with contradictory morphological impressions and final diagnoses, and immunoprofiles
15
Age/ SITE Sex
Utility of Flow Cytometry Analysis for Pleural Fluids Maren Fuller, MD, Michael Thrall, MD. Houston Methodist Hospital, Houston, Texas Introduction: Pleural fluid samples with many lymphocytes are commonly received in the cytology laboratory. However, it is difficult to distinguish reactive lymphocytes from Non-Hodgkin’s Lymphoma (NHL) based on morphology alone. Flow cytometry can be a useful test to identify NHL in pleural fluids, however literature on this subject is limited. We aim to address the utility of sending pleural fluid specimens for flow cytometry analysis. Materials and Methods: This study is a 5 year retrospective review of 325 pleural fluid samples from 298 patients with corresponding flow cytometry analysis. The flow cytometry results were correlated with the cytologic findings and clinical data. Results: Of 4,158 pleural fluids received over 5 years, 325 (7.8%) had corresponding flow cytometry analysis. Of these 325 samples, 57 (17.5%) were positive for NHL/leukemia by flow cytometry. 45 samples had a known history of NHL/leukemia, and 33 (73.3%) were positive for NHL/ leukemia by flow cytometry. The remaining 280 samples had no reported history of NHL/leukemia, and 24 (8.7%) were positive by flow cytometry. Of the cytology reports for these 24 cases, 8 (33.3%) mentioned atypical cells, and 9 (37.5%) were consistent with NHL or leukemia. The remaining cases describe a monotonous population of small lymphocytes. Conclusions: Flow cytometry analysis for pleural fluids is of little utility, as we found only 8.7% of cases without known histories were positive for NHL/leukemia. Of these positive cases, many had atypical cells that suggested a diagnosis of hematologic malignancy. Conversely, in cases with a known history, 73.3% were positive for NHL/leukemia. Our study suggests that the utility of flow cytometry for pleural fluids is low except in cases with atypical cytologic features or known history. Future directions include identifying potential cytologic indicators to suggest NHL in pleural fluids without atypical features or known history. 16 Effusions Are Not Always What They Seem; Don’t Judge a Fluid by its Cover (Slip) Tamar Brandler, MD, MS1, Melissa Klein, CT(ASCP)2, Oana Rafael, MD3, Mohamed Aziz, MD2. 1Hofstra North Shore-Long Island Jewish, New Hyde Park, New York; 2North Shore-Long Island Jewish Health System, Lake
Cytopathology Morphological Impression
Final Diagnosis Positive Negative Immunostains Immunostains
44/M Peritoneal Adenocarcinoma Malignant implant/ mesothelioma Ascites
67/M
92/F
74/F
77/F
60/F
42/F
Calretinin, MOC31, WT1, BerEP4, CK5/6, Glut1 TTF-1, PAX8, CEA Pleural Mesothelioma Adenocarcinoma MOC31, TTF-1, fluid BerEP4, CK7 CK 5/6, WT1, Calretinin, D2-40, S100 MOC31, CD163, Pleural Malignant Reactive BerEP4, CK 5/6 fluid Neoplasm macrophage TTF-1, (focal), and CK20, CK7, mesothelial Napsin, Calretinin, cells PAX8, Vimentin Mucin, S100 CK20, Adenocarcinoma Mucin, Ascites Malignant PAX8, MOC31, (Mixed Wt1, CK7 Features CK5/6, Adenocarcinoma ER, & Mesothelioma) CA19-9 CD163, WT1 CK5/6, Pericardial Malignant Reactive MOC31, fluid macrophage BerEP4, and TTF-1 mesothelial cells Pericardial Atypical Adenocarcinoma CK7, CK20, fluid P53, CEA ER, PAX8, TTF-1, Napsin, CAm5-2, CK5/6, WT1, Calretinin, MOC31, BerEP4, CD163 Pleural Mesothelioma Adenocarcinoma MOC31, CK 5/6, fluid BerEP4, calretinin, and WT1 PAX-8, Ca 19.9, CD 163 (stains histiocytes), CEA (variable)