Serous Cavity Fluid and Cerebrospinal Fluid Cytopathology (Essentials in Cytopathology Book 11)

Annotation Cytologic diagnosis by examination of exfoliated cells in serous cavity fluids is one of the most challenging areas in clinical cytopathology. Almost 20% of the effusions examined are directly or indirectly related to the presence of malignant disease, with carcinoma of the lung as the most common underlying culprit. This volume published in the Essentials in Cytopathology book series will fulfill the need for an easy-to-use and authoritative synopsis of site specific topics in cytopathology. These guide books fit into the lab coat pocket, ideal for portability and quick reference. Each volume is heavily illustrated with a full color art program, while the text follows a user-friendly outline format Serous Cavity Fluidand Cerebrospinal FluidCytopathology 3 Foreword 5 Series Preface 7 Contents 9 1: Introduction, Clinical and Technical Aspects 11 Background 11 Malignant Pleural Effusion – Pathogenesis 12 Malignant Neoplasms in Serous Cavity Fluids 12 Malignant Pleural Effusion – Prognosis 12 Technical Aspects 13 Ancillary Techniques for the Diagnosis of Serous Cavity Fluids 14 Cytochemical Stains 15 Immunoperoxidase (IPOX) Stains 16 Diagnostic Profile 16 Major Diagnostic Issues in Cytologic Interpretation of Serous Cavity Fluids 17 Selected Reading 18 2: Normal Cytology 20 Major Cell Types Commonly Seen in SCFs (Figs. 2.1 and 2.2) 20 Histiocytes (Figs. 2.3 and 2.4) 20 Lymphomononuclear Cells 22 Mesothelial Cells (Figs. 2.5 , 2.6 and 2.7) 22 3: Reactive Mesothelial Hyperplasia 27 Clinico -Cytopathologic Characteristics (Figs. 3.1 , 3.2 , 3.3 , 3.4 , 3.5 , 3.6 , 3.7 , 3.8 , 3.9 , 3.10 , 3.11 and 3.12) 27 Reactive Mesothelial Hyperplasia vs. Malignant Mesothelioma 39 Major Underlying Causes of Mesothelial Proliferation 39 p53 Immunostaining in Mesothelial Hyperplasia vs. Cancer 40 GLUT-1 Immunostaining in Mesothelial Hyperplasia vs. Cancer 41 Selected Reading 42 4: Malignant Mesothelioma 43 Malignant Mesothelioma vs. Adenocarcinoma 67 Etiologic Factors 45 Clinico-Radiologic Features 45 Therapeutic Approach and Prognostic Outcomes 46 Malignant Mesothelioma (Epithelioid type) (Figs. 4.1 , 4.2 , 4.3 , 4.4 , 4.5 , 4.6 , 4.7 , 4.8 , 4.9 , 4.10 , 4.11 , 4.12 , 4.13 , 4.14 , 4.15 , 4.16 , 4.17 , 4.18 , 4.19 , 4.20 , 4.21 , 4.22 and 4.23) 46 Malignant Mesothelioma – Other Cytomorphologic Features 66 Malignant Mesothelioma (Epithelioid type) – Differential Diagnosis 67 Types of Mucins and Staining Results (Figs. 4.24 and 4.25) 68 Disadvantages of Performing Special Cytochemical Stains 70 Mesothelioma vs. Adenocarcinoma – Immunoperoxidase Markers (Figs. 4.26 , 4.27 , 4.28 , 4.29 and 4.30) 71 Cytoskeletal Proteins – Intermediate Filaments 75 Cytokeratins, Vimentin – Diagnostic Utility 76 Cell Surface Glycoproteins 76 Epithelial Membrane Antigen (EMA) 76 Monoclonal Antibody B72.3 77 Monoclonal Antibody Ber-EP4 77 Oncoplacental Antigens 77 Carcinoembryonic Antigen (CEA) 77 Placental Alkaline Phosphatase (PLAP) 78 Myelomonocytic Antigens 78 LeuM1 (CD15) 78 Intracytoplasmic Ca++− Binding Proteins 78 Calretinin 79 S-100 protein 79 Combined E-Cadherin and Calretinin Immunostaining 79 Other Mesothelioma Markers 80 CK 5/6 80 D2-40 80 WT-1 80 Role of CK 7 and CK 20 81 Mesothelioma vs. Adenocarcinoma – Johns Hopkins Cytopathology Lab Immunopanel 81 Cytogenetic Analysis of Effusions from Malignant Mesothelioma 81 FISH Analysis of Effusions from Malignant 82 Selected Reading 82 5: Metastatic Cancers 84 Adenocarcinoma (Figs. 5.1 , 5.2 , 5.3 , 5.4 , 5.5 , 5.6 , 5.7 , 5.8 , 5.9 , 5.10 , 5.11 , 5.12 , 5.13 , 5.14 , 5.15 , 5.16 , 5.17 , 5.18 , 5.19 , 5.20 , 5.21 , 5.22 , 5.23 and 5.24) 84 Adenocarcinoma – Differential Diagnosis 106 Squamous Cell Carcinoma (Figs. 5.25 , 5.26 and 5.27) 107 Small-Cell Carcinoma (Figs. 5.28 , 5.29 , 5.30 , 5.31 , 5.32 , 5.33 and 5.34) 109 Small-Cell Carcinoma – Differential Diagnosis 116 Miscellaneous Other Cancers (Figs. 5.26 , 5.27 , 5.28 , 5.29 , 5.30 , 5.31 , 5.32 , 5.33 , 5.34 , 5.35 , 5.36 , 5.37 , 5.38 , 5.39 , 5.40 , 5.41 , 5.42 , 5.43 , 5.44 , 5.45 , 5.46 , 5.47 , 5.48 , 5.49 , 5.50 , 5.51 , 5.52 , 5.53 , 5.54 , 5.55 , 5.56 , 5.57 , 5.58 , 5.59 and 5.60) 116 Malignant Melanoma 117 Malignant Melanoma – Differential Diagnosis 118 Sarcomas 131 Sarcomatous Effusions – Some Facts 131 Sarcomas – Cytomorphologic Characteristics 131 Selected Reading 137 6: Effusions in Children 139 Malignant Effusions in Children 140 Malignant Effusions in Children – Cytomorphologic Findings (Figs. 6.1 , 6.2 , 6.3 , 6.4 , 6.5 , 6.6 , 6.7 , 6.8 , 6.9 , 6.10 , 6.11 , 6.12 , 6.13 , 6.14 and 6.15) 140 Selected Reading 155 7: Abdominopelvic Washings 157 Benign Diseases (Figs. 7.1 , 7.2 , 7.3 , 7.4 , 7.5 , 7.6 , 7.7 , 7.8 , 7.9 , 7.10 , 7.11 and 7.12) 158 Endometriosis 160 Endosalpingiosis 162 Malignant Diseases (Figs. 7.13 , 7.14 , 7.15 , 7.16 , 7.17 , 7.18 , 7.19 , 7.20 , 7.21 , 7.22 , 7.23 , 7.24 , 7.25 , 7.26 and 7.27) 167 Serous Borderline Tumors of the Ovary 167 Micropapillary Serous Carcinoma of the Ovary 168 High-Grade Papillary Serous Carcinoma of the Ovary 174 Psammomatous Effusions 175 Psammomatous Effusions 178 Selected Reading 183 8: Lymphocytic Effusions 185 Chronic Inflammatory Process vs. Lymphoma/Leukemia (Figs. 8.1 , 8.2 , 8.3 , 8.4 , 8.5 , 8.6 and 8.7) 186 Role of Flow Cytometry as an Adjunct to Cytomorphologic Analysis 192 Malignant Effusions (Figs. 8.8 , 8.9 , 8.10 , 8.11 , 8.12 , 8.13 , 8.14 , 8.15 , 8.16 , 8.17 , 8.18 , 8.19 , 8.20 , 8.21 , 8.22 , 8.23 , 8.24 , 8.25 and 8.26) 192 Selected Reading 209 9: Benign Inflammatory and Other Uncommon Conditions 211 Benign Diseases with Specific Cellular Patterns (Figs. 9.1 , 9.2 , 9.3 , 9.4 , 9.5 , 9.6 , 9.7 , 9.8 , 9.9 , 9.10 , 9.11 , 9.12 , 9.13 , 9.14 , 9.15 , 9.16 and 9.17) 211 Significance of Background Cellular Composition 227 Pulmonary Infarct 228 Pleural Effusions in HIV-Positive Patients 228 Pleural Effusions with Specific Infectious Etiology 228 Tuberculous Pleuritis/Peritonitis 229 Rheumatoid Pleuritis/Ascites 229 Systemic Lupus Erythematosus (SLE) 230 Selected Reading 230 10: Cerebrospinal Fluid 232 Anatomy and Physiology 232 Obtaining and Preparing the Specimen 233 Reporting Terminology 234 Accuracy 235 Normal Elements 236 Abnormal Inflammatory Cells 241 Nonneoplastic Disorders 243 Acute Bacterial Meningitis 243 Aseptic Meningitis 244 Cryptococcal Meningitis 247 Toxoplasmosis 247 Cysticercosis 248 Angiostrongyliasis 249 Primary Amebic Meningoencephalitis 249 Neoplasms 250 Metastatic Solid Tumors 252 Carcinoma of the Lung 252 Carcinoma of the Breast 255 Melanoma 257 Leukemia 258 Acute Lymphoblastic Leukemia 258 Acute Myeloid Leukemia 260 Chronic Lymphocytic Leukemia 262 Myeloproliferative Neoplasms 263 Malignant Lymphoma 263 Primary CNS Tumors 265 Primary CNS Lymphoma 266 Medulloblastoma 268 Astrocytomas and Glioblastoma 269 Ependymoma 270 Oligodendroglioma 271 Atypical Teratoid/Rhabdoid Tumor 272 Choroid Plexus Tumors 273 Pineal Tumors 275 Germ Cell Tumors 275 Other Tumors of the CNS 276 Selected References 276 Index 283 Front Matter....Pages i-ix Introduction, Clinical and Technical Aspects....Pages 1-9 Normal Cytology....Pages 11-17 Reactive Mesothelial Hyperplasia....Pages 19-34 Malignant Mesothelioma....Pages 35-75 Metastatic Cancers....Pages 77-131 Effusions in Children....Pages 133-150 Abdominopelvic Washings....Pages 151-178 Lymphocytic Effusions....Pages 179-204 Benign Inflammatory and Other Uncommon Conditions....Pages 205-225 Cerebrospinal Fluid....Pages 227-277 Back Matter....Pages 279-287 This volume offers an easy-to-use and authoritative synopsis of site specific topics in cytopathology. This compact, heavily illustrated guide book fits into a lab coat pocket, making it an ideal quick reference.