High amylase content of neoplastic pleural and pericardial effusion probably secondary to amylase producing tumor cells: report of 2 cases

We report two cases of malignant pleural and pericardial effusion respectively secondary to bronchogenic carcinomas. In both effusions, a significant elevation of the Salivary-type-amylase fraction was found, while the corresponding values were normal in serum and urine. Electronmicroscopy of the malignant tumor cells from the pleural effusion showed typical electron-dense granules, suggesting zymogen granules. It is concluded that the high amylase content of the effusions was due to secretion of S-type-isoamylase by the tumor cells.

[Clinical values of cytological evaluation of pleural and peritoneal fluids]

We reviewed retrospectively the data obtained from our Department of Clinical Cytology, National Cancer Center in the period of 1964 and 1981, which clearly showed an increasing clinical importance of cytological evaluation of pleural and peritoneal fluids for greater diagnostic efficacy. For example, existence of tumor cells could predict a possibility of local infiltration. Cytological examination could also provide significant information for planning the treatment protocols prior to the initiation of the treatment as well as for predicting efficacy of the treatment using characteristics in particular of lymphocytes, phagocytes and granulocytes. Furthermore, accurate interpretation of cytological examination of pleural and peritoneal fluids seem to be clinically highly suggestive for diagnostic efficacy and also could be a helpful means for evaluation of cancer therapy.

[Morphofunctional study of human pericardial macrophages]

Human pericardial macrophages have been studied with the light and electron microscope. The cells showed high activities of acid phosphatase and of non-specific and acid esterases. The macrophages are able to pinocytosis the extracellular space marker--horseradish peroxidase. The network of intracytoplasmic cavities, continuous with the extracellular space, has been documented by applying two different methods of visualization of the cellular surface. A possible role of these cavities in pinocytosis is discussed.

The role of cytology in neoplastic cardiac tamponade

Over a 16-year period, 47 samples of pericardial fluid from 34 patients at Hines Veterans Administration Hospital were cytologically evaluated, constituting approximately 0.1% of the total work load in our cytology laboratory. Eleven cellular samples from nine of the patients were positively identified as containing malignant cells that were histologically classifiable. Correlation with the surgical pathology and/or postmortem findings proved no false positives. Two false-negative cases probably represented inadequate sampling. In three patients, the diagnosis of cancer was initially established by the cytologic examination. In all instances, the pericardial fluid cytology helped determine the prognosis and mode of therapy.

Pericardial disease in patients with cancer. The differentiation of malignant from idiopathic and radiation-induced pericarditis

Pericardial disease developed in 31 patients with a variety of malignancies. Half of the patients (58 percent) were found to have malignant pericardial involvement, 32 percent idiopathic pericarditis and 10 percent radiation-related pericarditis. Facial swelling, cardiac arrhythmias and pericardial tamponade occurred frequently in the patients with malignant pericardial disease. Fever, pericardial friction rub and improvement with nonsteroidal anti-inflammatory drugs characterized the patients with idiopathic pericarditis. Effusive-constrictive pericarditis requiring pericardiectomy was noted in patients with radiation-induced disease. Pericardiocentesis documented malignant pericardial disease in 85 percent of patients studied, while 15 percent required open biopsy for diagnosis. Specific therapy directed at malignant pericardial disease may contribute to survival up to one year in 25 percent of patients. In 40 percent of patients with idiopathic pericarditis and in the majority of patients with radiation-induced pericarditis, survival was one year with specific therapy. A systematic evaluation of pericardial disease will benefit a subset of cancer patients with idiopathic pericarditis and radiation-induced pericarditis who can be managed conservatively.

Surgical management of pericardial tamponade as a presenting manifestation of acute leukemia

Two patients with acute leukemia presented with symptomatic acute pericarditis and rapidly developed cardiac tamponade. Conservative management was not possible in either patient due to mechanical problems with fluid removal. Thoracotomy with pericardial decompression resulted in permanent relief of symptoms in both cases. Management of cardiac tamponade in acute leukemia by surgical decompression even in severely immunocompromised hosts is a feasible alternative and should be considered when more conservative measures fail or are not possible.

Cytopathology of pericardial effusions

During a period of four years, 158 cytologic specimens obtained from pericardial effusions of 120 patients were examined. Malignant neoplastic cells were identified in 90 (57%) specimens from 72 (60%) patients. Eighty percent of the neoplasms were epithelial, and 20% were nonepithelial in origin. The most common epithelial tumors were pulmonary (56%) and mammary (39%) neoplasms, and most were adenocarcinomas. In general, the cytologic smears were moderately cellular, with blood and occasional atypical mesothelial cells in the background. There were few reactive cells, such as histiocytes and lymphocytes, in cytologically positive specimens. Pleomorphic nuclei and prominent nucleoli were dominant features of pulmonary adenocarcinomas. Tumor cells of mammary carcinoma were more uniform and often formed cell balls. Epidermoid carcinomas were characteristically poorly differentiated, having a striking resemblance to adenocarcinoma. In most instances, several months elapsed between initial diagnosis of the primary neoplasm and a positive pericardial cytologic finding. The majority of the patients died within ten months after malignant tumor cells were recovered from pericardial effusion. Because of the serious clinical implications, a cytologic diagnosis of cancer in pericardial effusions must never be based on scanty or equivocal evidence. If necessary, any doubt should be resolved by examination of additional material.

Procainamide-induced lupus erythematosus pericarditis encountered during coronary bypass sugery

Procainamide is probably the most common offending drug responsible for the drug-induced lupus erythematosus syndrome today. Pericarditis has been reported to occur in from 14 to 18 per cent of the cases of procainamide-induced lupus erythematosus, and occasional reports of massive pericardial effusion, pericardial tamponade and constrictive pericarditis have appeared in the literature. We describe a patient who presented with features of procainamide-induced lupus erythematosus without any clinical evidence of pericarditis. He underwent coronary bypass surgery 12 days after administration of the drug was stopped and was found to have a significant pericardial effusion at the time of surgery; histologic examination of pericardial tissue and pericardial fluid confirmed that the pericardial effusion was related to the procainamide-induced lupus syndrome. The incidence of pericarditis in procainamide-induced lupus erythematosus may be higher than presently accepted figures would indicate. Symptoms and signs related to procainamide-induced lupus pericarditis may cause diagnostic confusion with common postoperative bypass complications; the full implications of this disease entity to the patient undergoing coronary bypass are unknown.

Granulocytic sarcoma preceding acute leukemia: a report of six cases

An unusual case of granulocytic sarcoma presenting in a pericardial effusion following trauma and preceding acute myelogenous leukemia (AML) by 8 months is presented. Five additional cases of granulocytic sarcoma preceding leukemia collected by the author are also tabulated. Granulocytic sarcoma in a nonautopsy population of myelogenous leukemic patients was found to be 2.9%. When presenting in an extramedullary site, especially preceding peripheral blood and bone marrow manifestations of leukemia, a misdiagnosis of histiocytic lymphoma may result. In questionable cases, other techniques including the naphthol-ASD-chloroacetate stain, touch imprints, immunoperoxidase stain for lysozyme, and electron microscopy should be utilized. Although only a small series, the most recent cases have shown induction/remission and survival characteristics of AML patients without granulocytic sarcoma.

Granulocytic sarcoma preceding acute leukemia: a report of six cases

An unusual case of granulocytic sarcoma presenting in a pericardial effusion following trauma and preceding acute myelogenous leukemia (AML) by 8 months is presented. Five additional cases of granulocytic sarcoma preceding leukemia collected by the author are also tabulated. Granulocytic sarcoma in a nonautopsy population of myelogenous leukemic patients was found to be 2.9%. When presenting in an extramedullary site, especially preceding peripheral blood and bone marrow manifestations of leukemia, a misdiagnosis of histiocytic lymphoma may result. In questionable cases, other techniques including the naphthol-ASD-chloroacetate stain, touch imprints, immunoperoxidase stain for lysozyme, and electron microscopy should be utilized. Although only a small series, the most recent cases have shown induction/remission and survival characteristics of AML patients without granulocytic sarcoma.

Cytodiagnosis of viral infections in body cavity fluids

Pleural and pericardial fluid specimens have been studied in seven patients with diagnosis of viral infection. Intranuclear inclusions, multinucleated giant cells with gelatinous nuclear changes and atypical mesothelial cells were observed. These observations suggest that viral involvement of the mesothelium produces cellular changes which can be detected cytologically in routine Papanicolaou-stained body cavity fluid specimens.

The use of cytology to evaluate pericardial effusions

Pericardial effusions from 27 patients were examined cytologically during the five-year period of 1973-1977. Malignant cells were found in eight cases (30 percent). In three of these patients malignancy was unsuspected clinically, and this was the first time the cancer was diagnosed. In addition, cytology often suggested the specific histological types and possible primary sites to be determined. Special stains were also found helpful. There were no false positive reports. Although the pericardial effusions from the remaining 19 patients were negative for tumor cells, metastatic carcinoma to the pericardium was discovered at autopsy in two of these cases. Thus, cytologic examination of pericardial fluid is an important tool in the diagnosis of malignancy, but false negative results may occur.

Long-term human breast carcinoma cell lines of metastatic origin: preliminary characterization

Nineteen human breast carcinoma cell lines have been established as continuous cultures during the past 6 years in our laboratory. This preliminary report is designed to list the lines by their designated code numbers (MDA-MB) and present a brief summary of their morphological, cytogenetic and biochemical characteristics. Sixteen of our lines were obtained from pleural effusions, two from brain metastases, and one from pericardial fluid. All lines have been shown to be distinct entities and are uncontaminated by HeLa cells or each other. A lq marker chromosome is present in all but one of the lines examined.

Tissue culture of cells in serous effusions. Evaluation as an adjunct to cytology

Cell pellets from peritoneal, pleural and pericardial effusions from thirty-six patients were incubated in tissue culture medium. Both the culture supernatants and the cell monolayers in the flasks were examined for malignant cells. Of the ten cases diagnosed as positive for malignant cells by the conventional cytologic smears, eight were positive on examination of the tissue culture supernatants and only six were positive by analysis of the monolayers. All the cases diagnosed as positive from the culture supernatants and from the monolayers were also positive by the conventional smear method. Hence, tissue culture of cells in serous effusions is not helpful as an adjunct to routine diagnostic cytology techniques.

False-positive Sternberg-Reed cells present in pericardial effusion. Report of a case

Recent reviews have emphasized the value of cytodiagnosis in the evaluation of malignant effusions from patients with lymphoproliferative disorders. We present a case in which the presence of Sternberg-Reed-like cells in pericardial fluid was related to prior radiotherapy and not to recurrent Hodgkin's disease.

Cytologic detection of malignant mesothelioma of the pericardium

We have reported a very rare case, malignant mesothelioma of the pericardium, with the initial diagnosis made by cytology from the smears of the pericardial fluid. There were numerous large clusters in the smears, in which two types of cells were mixed: adenocarcinoma-like round cells and fibrosarcoma-like spindly cells. Some round cells very much resembled benign mesothelial cells. Central collagenous stalks and brush borders with long microvilli in the round cell aggregates were specific for carcinomatous mesothelioma and differentiated the round cells from adenocarcinoma cells. On the other hand, the spindly and pleomorphic tumor cells, present both singly and in clusters, implied malignancy. Therefore, a preliminary cytologic diagnosis of probable mixed malignant mesothelioma was made. Histopathologic and electron microscopic examinations confirmed the cytologic description that this tumor was a malignant mesothelioma.

Recurrent cardiac tamponade and large pericardial effusions: management with an indwelling pericardial catheter

A new technique, using an atraumatic indwelling catheter, has been developed for short-term management of large or rapidly reaccumulating pericardial effusions. This technique (1) permits continuous pericardial fluid drainage, obviating repeated aspirations; (2) provides a convenient route for intrapericardial instillation of chemotherapeutic agents; and (3) enables one to await the results of diagnostic studies without subjecting a patient to thoracotomy. Experience in three patients suggests that in some cases the use of this catheter may eliminate the need for surgery; in others, it may serve as a valuable temporary measure to achieve stabilization of the patient's condition.