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Akasaka H, Naora H. Revisiting the Use of Normal Saline for Peritoneal Washing in Ovarian Cancer. Int J Mol Sci 2023; 24:16449. [PMID: 38003636 PMCID: PMC10671679 DOI: 10.3390/ijms242216449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 11/09/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
The omentum is the predominant site of ovarian cancer metastasis, but it is difficult to remove the omentum in its entirety. There is a critical need for effective approaches that minimize the risk of colonization of preserved omental tissues by occult cancer cells. Normal saline (0.9% sodium chloride) is commonly used to wash the peritoneal cavity during ovarian cancer surgery. The omentum has a prodigious ability to absorb fluid in the peritoneal cavity, but the impact of normal saline on the omentum is poorly understood. In this review article, we discuss why normal saline is not a biocompatible solution, drawing insights from clinical investigations of normal saline in fluid resuscitation and from the cytopathologic evaluation of peritoneal washings. We integrate these insights with the unique biology of the omentum and omental metastasis, highlighting the importance of considering the absorptive ability of the omentum when administering agents into the peritoneal cavity. Furthermore, we describe insights from preclinical studies regarding the mechanisms by which normal saline might render the omentum conducive for colonization by cancer cells. Importantly, we discuss the possibility that the risk of colonization of preserved omental tissues might be minimized by using balanced crystalloid solutions for peritoneal washing.
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Affiliation(s)
| | - Honami Naora
- Department of Molecular and Cellular Oncology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Uno K, Iyoshi S, Yoshihara M, Kitami K, Mogi K, Fujimoto H, Sugiyama M, Koya Y, Yamakita Y, Nawa A, Kanayama T, Tomita H, Enomoto A, Kajiyama H. Metastatic Voyage of Ovarian Cancer Cells in Ascites with the Assistance of Various Cellular Components. Int J Mol Sci 2022; 23:4383. [PMID: 35457198 PMCID: PMC9031612 DOI: 10.3390/ijms23084383] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/10/2022] [Accepted: 04/12/2022] [Indexed: 12/16/2022] Open
Abstract
Epithelial ovarian cancer (EOC) is the most lethal gynecologic malignancy and has a unique metastatic route using ascites, known as the transcoelomic root. However, studies on ascites and contained cellular components have not yet been sufficiently clarified. In this review, we focus on the significance of accumulating ascites, contained EOC cells in the form of spheroids, and interaction with non-malignant host cells. To become resistant against anoikis, EOC cells form spheroids in ascites, where epithelial-to-mesenchymal transition stimulated by transforming growth factor-β can be a key pathway. As spheroids form, EOC cells are also gaining the ability to attach and invade the peritoneum to induce intraperitoneal metastasis, as well as resistance to conventional chemotherapy. Recently, accumulating evidence suggests that EOC spheroids in ascites are composed of not only cancer cells, but also non-malignant cells existing with higher abundance than EOC cells in ascites, including macrophages, mesothelial cells, and lymphocytes. Moreover, hetero-cellular spheroids are demonstrated to form more aggregated spheroids and have higher adhesion ability for the mesothelial layer. To improve the poor prognosis, we need to elucidate the mechanisms of spheroid formation and interactions with non-malignant cells in ascites that are a unique tumor microenvironment for EOC.
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Affiliation(s)
- Kaname Uno
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (K.U.); (S.I.); (K.K.); (K.M.); (H.F.); (Y.Y.); (H.K.)
- Division of Clinical Genetics, Department of Laboratory Medicine, Lund University, 223-62 Lund, Sweden
| | - Shohei Iyoshi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (K.U.); (S.I.); (K.K.); (K.M.); (H.F.); (Y.Y.); (H.K.)
- Spemann Graduate School of Biology and Medicine, University of Freiburg, 79104 Freiburg, Germany
| | - Masato Yoshihara
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (K.U.); (S.I.); (K.K.); (K.M.); (H.F.); (Y.Y.); (H.K.)
| | - Kazuhisa Kitami
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (K.U.); (S.I.); (K.K.); (K.M.); (H.F.); (Y.Y.); (H.K.)
| | - Kazumasa Mogi
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (K.U.); (S.I.); (K.K.); (K.M.); (H.F.); (Y.Y.); (H.K.)
| | - Hiroki Fujimoto
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (K.U.); (S.I.); (K.K.); (K.M.); (H.F.); (Y.Y.); (H.K.)
- Discipline of Obstetrics and Gynecology, Adelaide Medical School, Robinson Research Institute, University of Adelaide, Adelaide 5005, Australia
| | - Mai Sugiyama
- Bell Research Center, Department of Obstetrics and Gynecology Collaborative Research, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (M.S.); (Y.K.); (A.N.)
| | - Yoshihiro Koya
- Bell Research Center, Department of Obstetrics and Gynecology Collaborative Research, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (M.S.); (Y.K.); (A.N.)
| | - Yoshihiko Yamakita
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (K.U.); (S.I.); (K.K.); (K.M.); (H.F.); (Y.Y.); (H.K.)
- Bell Research Center, Department of Obstetrics and Gynecology Collaborative Research, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (M.S.); (Y.K.); (A.N.)
| | - Akihiro Nawa
- Bell Research Center, Department of Obstetrics and Gynecology Collaborative Research, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (M.S.); (Y.K.); (A.N.)
| | - Tomohiro Kanayama
- Department of Tumor Pathology, Graduate School of Medicine, Gifu University, Gifu 501-1194, Japan; (T.K.); (H.T.)
| | - Hiroyuki Tomita
- Department of Tumor Pathology, Graduate School of Medicine, Gifu University, Gifu 501-1194, Japan; (T.K.); (H.T.)
| | - Atsushi Enomoto
- Department of Pathology, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan;
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Graduate School of Medicine, Nagoya University, Nagoya 466-8560, Japan; (K.U.); (S.I.); (K.K.); (K.M.); (H.F.); (Y.Y.); (H.K.)
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Kataria N, Hacking S, Abdelwahed M, Burke A, Karam P, Gimenez C, Das K, Khutti S. The role of cytology as an effective tool in management of omental and peritoneal lesions: Experience of a large health care system. Diagn Cytopathol 2021; 50:57-63. [PMID: 34870898 DOI: 10.1002/dc.24911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 09/25/2021] [Accepted: 11/26/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND The aim of this study is to assess the efficacy of cytology in omental or peritoneal lesions. METHODS A retrospective review of the pathology database for cytology cases of peritoneal or omental nodules over a 3-year period (2016-2018) was conducted. The cases consisted of either FNA only (FO); FNA and Core biopsy (FCB) or Touch prep and core biopsy (TCB). Cases were further divided based on the prior history of carcinoma. Concordance rates of cytologic diagnosis with histologic diagnosis were studied. RESULTS Out of 104 cytology cases reviewed, 60 (57.7%) had prior history of cancer (PHC) and 44 (42.3%) had no prior history of cancer (NPHC). Of the cases with PHC, 43(71.66%) were recurrence, 10 (16.66%) were second cancer, and 7 (11.66%) were non-neoplastic lesions. Of the cases with NPHC, 38 (86.4%) had a second cancer diagnosis, while 6 (13.6%) were non-neoplastic. For FO only cases, 11 of 35 (31.4%) had follow up and 9 of 11 (81.8%) were concordant. For FCB cases, 6 out of 39 (15.4%) had follow up and 6 (100%) were concordant. For TCB cases, 9 out of 30 (30%) had follow up and 9 (100%) were concordant. A definite diagnosis was reached in 30/35, 39/39, and 29/30 cases in FO, FCB, and TCB, respectively. CONCLUSION In summary, cytologic evaluation of omental lesions is an effective tool in providing accurate diagnosis and guiding further management. Also, the results based on our study show that the combined techniques are superior at reaching a definitive diagnosis.
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Affiliation(s)
- Nidhi Kataria
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Greenvale, New York, USA
| | - Sean Hacking
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Greenvale, New York, USA
| | - Mohammed Abdelwahed
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Greenvale, New York, USA
| | - Alexander Burke
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Greenvale, New York, USA
| | - Priyanka Karam
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Greenvale, New York, USA
| | - Cecilia Gimenez
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Greenvale, New York, USA
| | - Kasturi Das
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Greenvale, New York, USA
| | - Seema Khutti
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Greenvale, New York, USA
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Kanber Y, Pusztaszeri M, Auger M. Immunocytochemistry for diagnostic cytopathology-A practical guide. Cytopathology 2021; 32:562-587. [PMID: 34033162 DOI: 10.1111/cyt.12993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 11/29/2022]
Abstract
Cytological specimens, which are obtained by minimally invasive methods, are an excellent source of diagnostic material. Sometimes they are the only material available for diagnosis as well as for prognostic/predictive markers. When cytomorphology is not straightforward, ancillary tests may be required for a definitive diagnosis to guide clinical management. Immunocytochemistry (ICC) is the most common and practical ancillary tool used to reach a diagnosis when cytomorphology is equivocal, to differentiate entities with overlapping morphological features, and to determine the cell lineage and the site of origin of a metastatic neoplasm. Numerous immunomarkers are available, and some are expressed in multiple neoplasms. To rule out entities within a differential diagnosis, the use of more than one marker, sometimes panels, is necessary. ICC panels for diagnostic purposes should be customised based on the clinical context and cytomorphology, and the markers should be used judiciously to preserve material for additional tests for targeted therapies in the appropriate setting. This review offers a practical guide for the use of ICC for diagnostic cytopathology, covering the most commonly encountered non-hematolymphoid diagnostic scenarios in various body sites.
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Affiliation(s)
- Yonca Kanber
- Department of Pathology, McGill University Health Center, McGill University, Montreal, QC, Canada
| | - Marc Pusztaszeri
- Department of Pathology, Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Manon Auger
- Department of Pathology, McGill University Health Center, McGill University, Montreal, QC, Canada
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5
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Razack R, Mohosho MM, Barnardt P, Schubert PT. Effusion cytology of a mucinous borderline ovarian tumour: Pitfall or controversy? A case report with insight into the newly proposed International System for Reporting Serous Fluid Cytology. Cytopathology 2020; 32:253-256. [PMID: 33090547 DOI: 10.1111/cyt.12926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Rubina Razack
- Division of Anatomical Pathology, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Mokoena Martins Mohosho
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Pieter Barnardt
- Department of Radiation Oncology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa
| | - Pawel Tomasz Schubert
- Division of Anatomical Pathology, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Academic Hospital, Cape Town, South Africa
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Hou T, Landon G, Stewart J, Roy-Chowdhuri S. The value of a tiered cytology diagnostic reporting system in assessing the risk of malignancy in indeterminate serous effusions. Cancer Cytopathol 2020; 129:75-82. [PMID: 32809259 DOI: 10.1002/cncy.22345] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The International System for Reporting Serous Fluid Cytopathology was recently proposed as a tiered structure to provide consistent reporting terminology for serous effusions. Because of the variation in reporting practices for indeterminate serous effusions, namely, the atypia of undetermined significance (AUS) and suspicious for malignancy (SFM) groups, the authors retrospectively reviewed cases in these 2 categories at their institution and determined the associated risk of malignancy (ROM). METHODS Pleural, peritoneal, and pericardial effusions that were reported as AUS or SFM over a 1-year period were reviewed, and their associated ROMs were calculated based on confirmation of malignancy by previous and/or subsequent fluid and/or tissue biopsy specimens from the same general location. RESULTS In total, 145 AUS and 98 SFM serous effusion cases were identified. The AUS category was used when the cells in question lacked the requisite quantitative (cell number) and/or qualitative (morphologic) features for a definitive diagnosis. Immunohistochemistry (IHC) or flow cytometry (FCM) was available in 15% of cases (n = 22) with inconclusive results. The ROM based on 69 cases with available follow-up results was 39%. In contrast, the SFM category demonstrated cells that were morphologically suspicious for malignancy but sparse, precluding IHC or FCM (n = 63; 64%) or yielding inconclusive results (n = 35; 36%). The ROM in the SFM category, based on follow-up results of 61 cases, was 64%. CONCLUSIONS The ROM for SFM was significantly higher than that for AUS (P < .01), supporting separate diagnostic categories for these 2 groups.
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Affiliation(s)
- Tieying Hou
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gene Landon
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John Stewart
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sinchita Roy-Chowdhuri
- Department of Anatomical Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Díaz Del Arco C, Saiz-Pardo Sanz M, Ortega Medina L, Fernández Aceñero MJ. Ber-EP4 staining in effusion cytology: A potential source of false positives. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2020; 54:114-122. [PMID: 33726887 DOI: 10.1016/j.patol.2020.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/21/2020] [Accepted: 04/25/2020] [Indexed: 10/23/2022]
Abstract
The distinction between reactive mesothelium and carcinoma in serous effusions can be very difficult. Immunocytochemistry (ICC) is the most widely used tool to improve the diagnostic accuracy of body fluid cytology, with several ICC markers being proposed. Ber-EP4 antibody has shown high sensitivity and specificity rates for diagnosing metastatic carcinoma. In our department, we have detected Ber-EP4 positivity in mesothelium in some cytological specimens. We reviewed all articles on Ber-EP4 staining in effusion cytology, summarized current findings and analyzed the staining pattern of all cases expressing Ber-EP4. Some cases showing Ber-EP4 positivity in mesothelium have been reported, most of which showed only weak Ber-EP4 staining or staining of less than 50% of mesothelial cells. However, some cases may show strong positivity both in cytological and histological specimens. Clinicians and pathologists should be aware of this source of misdiagnosis, and ICC results in mesothelium should be always interpreted cautiously and correlated with clinical tests, other ICC markers and patient's previous history.
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Affiliation(s)
| | | | - Luis Ortega Medina
- Department of Surgical Pathology, Hospital Clínico San Carlos, Madrid, Spain
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Hou Y, Bruehl FK, McHugh KE, Reynolds JP. Primary tumor types and origins in positive abdominopelvic washing cytology, a single institution experience. J Am Soc Cytopathol 2020; 9:89-94. [PMID: 31734259 DOI: 10.1016/j.jasc.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/16/2019] [Accepted: 10/09/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Abdominopelvic washing cytology is a common specimen evaluated for ovarian, fallopian tubal, and peritoneal cancer staging or other nongynecologic malignancies presented as metastases. We reviewed our experience in diagnosing abdominopelvic washing specimens and assessing the primary tumor types and origins of the positive abdominopelvic washings. MATERIALS AND METHODS A pathology archive database search was performed for abdominopelvic washing specimens from 2007 to 2018. The corresponding cytologic diagnoses, results of ancillary studies, clinical histories, and surgical follow-up were reviewed. The primary sites were determined based on the synoptic reports, when available. RESULTS A total of 5.8% (350 of 6023) of cases were positive for malignancy or neoplasm. Additionally, 1.3% (78 of 6023) were diagnosed as atypical cells. Of the 350 positive cases, 93.4% were müllerian tumors. The frequency of primary sites for müllerian tumors in descending order were: ovary, uterus, fallopian tube, peritoneum, and uncertain müllerian sites. The common ovarian tumors identified in pelvic washing in descending order were: high-grade serous carcinoma, serous borderline tumor, clear cell carcinoma, low-grade serous carcinoma, and endometrioid carcinoma. Gastrointestinal, breast, bladder, and lymphoma primaries were the 23 nongynecologic tumors identified in pelvic washings. CONCLUSIONS Positive findings in abdominopelvic washing cytology is rare. The majority of the positive cases were from müllerian origins, with ovary and uterus as the most common sites. Endometrial adenocarcinoma, endometrioid type and ovarian high-grade serous carcinoma were the most common tumor types. Knowing prior history of malignancy, morphologic comparison with concurrent surgical cases, and performing ancillary studies are keys to improve diagnostic accuracy of abdominopelvic washings.
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Affiliation(s)
- Yanjun Hou
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Frido K Bruehl
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Kelsey E McHugh
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jordan P Reynolds
- Department of Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
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Strandby RB, Svendsen LB, Ambrus R, Rostved AA, Hasselby JP, Achiam MP. The Incidence of Free Peritoneal Tumor Cells before and after Neoadjuvant Chemotherapy in Gastroesophageal Junction Cancer. J Cytol 2019; 37:40-45. [PMID: 31942097 PMCID: PMC6947737 DOI: 10.4103/joc.joc_164_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 03/01/2019] [Accepted: 10/24/2019] [Indexed: 01/07/2023] Open
Abstract
Context The utility of peritoneal washing cytology in patients with gastroesophageal junction cancer has not been thoroughly evaluated. Aims The study aimed to determine the incidence of free peritoneal tumor cells by peritoneal washing cytology before and after neoadjuvant chemotherapy using conventional cytopathological methods and immunohistochemical staining for the analysis of peritoneal washings. Settings and Design A prospective study conducted at a single tertiary referral hospital. Materials and Methods Patients with gastroesophageal junction cancer and without suspicion of intra- or extraabdominal metastases before the staging laparoscopy were prospectively and consecutively enrolled. Peritoneal washing cytology was performed at staging laparoscopy (primary cytology) and after neoadjuvant chemotherapy during robot-assisted or open resection (secondary cytology). Peritoneal fluid samples were analyzed by conventional cytology and an immunohistochemical panel. Results Overall, 81 patients met the primary inclusion criteria. During primary cytology, positive cytology without overt metastases (C1M0) was detected in three patients (3.8%) while five patients (6.3%) had overt intra-abdominal metastases but negative cytology (C0M1). None of the patients with C1M0 underwent surgery due to extra-abdominal (n = 1) or intra-abdominal metastases (n = 2), and the overall survival was 4, 7, and 14 months. During secondary cytology, no patients with free peritoneal tumor cells were identified, but seven patients were classified as C0M1 (10.9%). Conclusions The incidence of C1M0 was 3.8% and 0% before and after neoadjuvant chemotherapy, respectively in patients with gastroesophageal junction cancer. Free peritoneal tumor cells were not identified in several patients with intra-abdominal metastases suggesting that peritoneal washing cytology with conventional cytology and immunohistochemical staining lack sensitivity.
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Affiliation(s)
- Rune B Strandby
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Lars B Svendsen
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Rikard Ambrus
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Andreas A Rostved
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Jane P Hasselby
- Department of Pathology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Michael P Achiam
- Department of Surgical Gastroenterology, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
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Abstract
In pathological diagnostics, monoclonal antibodies (mAb) are mainly used for immunhistochemical analysis. After an initial histological evaluation, a precise panel of antibodies is selected in order to stain the slides by using an indirect immune method. The most frequent issues include localisation of the primary tumor in cases of metastases, determination of undifferentiated tumors, subtyping of lympho-proliferative diseases and soft tissue tumors, as well as the assessment of proliferation via Ki-67. Increasing importance in mAb-based diagnostics is attributed to the analysis of predictive biomarkers such as hormone receptors, mismatch repair proteins (MMR) and programmed death ligand 1 (PD-L1). Their evaluation is performed by using different scores, which the clinical physician needs to be aware of due to their direct therapeutic implications.
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Affiliation(s)
- S Förster
- Institut für Pathologie, Berufsgenossenschaftliches Universitätskliniken Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland.
| | - A Tannapfel
- Institut für Pathologie, Berufsgenossenschaftliches Universitätskliniken Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
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11
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Pai RR, Shenoy KD, Minal J, Suresh PK, Chakraborti S, Lobo FD. Use of the term atypical cells in the reporting of ascitic fluid cytology: A caveat. Cytojournal 2019; 16:13. [PMID: 31367221 PMCID: PMC6628729 DOI: 10.4103/cytojournal.cytojournal_37_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/17/2018] [Indexed: 02/07/2023] Open
Abstract
Background Abdominal paracentesis is a routine diagnostic procedure for assessment of patients with recent onset or worsening of ascites. Objectives The objective of the study is to (1) review clinically confirmed cases of malignancy with negative, atypical, and suspicious cytology reports and provide reasoning for discrepancies and (2) recalculate sensitivity, specificity, and predictive values after review. Materials and Methods Papanicolaou smears of ascitic fluid paracentesis samples received over one calendar year were reviewed retrospectively by an expert in cytopathology blinded to the final clinical and/or histopathological diagnoses. Cases with discrepancies after review were noted. Sensitivity, specificity, and predictive values were calculated before and after review of slides. Data were analyzed using SPSS version 16. Results Malignant etiology was identified in 49/115 cases (42.6%) with female genital tract being the most common site of malignancy (22, 44.8%). The remaining 66 (57.4%) had a benign etiology with hepatic cirrhosis in 42 cases (63.6%). A review revealed discrepancies in five cases, three of which were earlier called negative for malignant cells (one case each of ovarian adenocarcinoma, cecal adenocarcinoma, and cholangiocarcinoma). Two cases of ovarian adenocarcinoma that were reported as atypical/reactive mesothelial hyperplasia showed malignant cells upon review. Sensitivity and specificity after review were 69.4% and 100%, respectively, with 100% positive predictive value. Conclusion Being a minimally invasive procedure, abdominal paracentesis continues to be an important diagnostic tool in guiding patient management. A proper morphological assessment with adequate clinical information and correlation with other investigations can be used to arrive at a definitive diagnosis in most cases. The term "atypical" can be misleading and is often used for want of clinical information and is best avoided.
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Affiliation(s)
- Radha Ramachandra Pai
- Address: Department of Pathology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Krithika Damodar Shenoy
- Address: Department of Pathology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Jessica Minal
- Pathologist and Section Head, Division of Cytogenetics and FISH, Strand Life Sciences Private Limited, Health Care Global Hospital, Bengaluru, Karnataka, India
| | - Pooja K Suresh
- Address: Department of Pathology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shrijeet Chakraborti
- Department of Histopathology, Leighton Hospital, Mid Cheshire NHS Hospitals Foundation Trust, Cheshire, United Kingdom
| | - Flora D Lobo
- Address: Department of Pathology, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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12
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Cantley RL, Yoxtheimer L, Molnar S. The role of peritoneal washings in the diagnosis of endometriosis. Diagn Cytopathol 2018; 46:447-451. [DOI: 10.1002/dc.23876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 11/22/2017] [Accepted: 11/29/2017] [Indexed: 12/13/2022]
Affiliation(s)
| | - Lorene Yoxtheimer
- Department of Pathology; University of Toledo Medical Center; Toledo OH
| | - Stacy Molnar
- Department of Pathology; University of Toledo Medical Center; Toledo OH
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Zhang X, Chen L, Liu Y, Xu Y, Zhang X, Shi Y, Wang C, Zhang PL, Liu Y. Improving the cytological diagnosis of high-grade serous carcinoma in ascites with a panel of complementary biomarkers in cell blocks. Cytopathology 2017; 29:247-253. [PMID: 29280203 DOI: 10.1111/cyt.12514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2017] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Precise cytological diagnosis of pelvic high-grade serous carcinoma (HGSC) in ascites is important for tumour staging, therapeutic decision-making and prognostic evaluation. However, it can often be difficult to distinguish metastatic HGSC cells from reactive mesothelial cells based on morphology alone. Immunocytochemical analysis of ascites cell blocks has been used to obtain accurate diagnosis and provide a reliable basis for treatment decisions in the clinic. This study was performed to determine whether a panel of antibodies is necessary to achieve high specificity and sensitivity for the identification of HGSC cells. METHODS Ascites samples from 70 cases (70/253, 27.7%) of histologically confirmed HGSC were postoperatively collected from 2012 to 2015 and were immunocytochemically analysed. RESULTS The sensitivity and specificity of Ber-EP4 (a marker of HGSC) for detecting HGSC was 85.7% and 82.1%, respectively, whereas the sensitivity and specificity of HBME-1 for identifying mesothelial cells was 100% and 68.3%, respectively. To improve the rate of detection further of HGSC, 29 cases of ascites were also stained for E-cadherin (a marker of HGSC) and calretinin (a marker of mesothelial cells). The combination of Ber-EP4 and E-cadherin as markers of adenocarcinoma cells increased the sensitivity and specificity for HGSC detection to 100% and 88.9%, respectively. Meanwhile, the sensitivity and specificity for mesothelial cell identification increased to 100% and 90%, respectively, when HBME-1 and calretinin were combined. CONCLUSION This panel of complementary biomarkers is valuable and ideal for the differential diagnosis of HGSC based on ascites cytology.
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Affiliation(s)
- X Zhang
- Department of Cytology, Tianjin Medical University Clinical Hospital of Gynecology Obstetrics, Tianjin, China
| | - L Chen
- Department of Pathology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
| | - Y Liu
- Department of Cytology, Tianjin Medical University Clinical Hospital of Gynecology Obstetrics, Tianjin, China.,Department of Pathology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
| | - Y Xu
- Department of Cytology, Tianjin Medical University Clinical Hospital of Gynecology Obstetrics, Tianjin, China
| | - X Zhang
- Department of Cytology, Tianjin Medical University Clinical Hospital of Gynecology Obstetrics, Tianjin, China
| | - Y Shi
- Department of Pathology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
| | - C Wang
- Department of Pathology, QEII Capital Health, Dalhousie University, Halifax, NS, Canada
| | - P L Zhang
- Department of Anatomic Pathology, William Beaumont Hospital, Royal Oak, MI, USA
| | - Y Liu
- Department of Cytology, Tianjin Medical University Clinical Hospital of Gynecology Obstetrics, Tianjin, China.,Department of Pathology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
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Assessment of False-negative Ascites Cytology in Epithelial Ovarian Carcinoma: A Study of 313 Patients. Am J Clin Oncol 2017; 40:175-177. [PMID: 25198110 DOI: 10.1097/coc.0000000000000119] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective was to determine how often peritoneal cytology is positive for malignancy in women with known ovarian cancer. Knowing this fact would help determine the usefulness of diagnostic paracentesis. METHODS Records of all women diagnosed with invasive epithelial ovarian cancer from 2004 to 2012 were examined to correlate presence of ascites, cytologic, and pathologic findings. RESULTS A total of 313 patients were included in analysis. A total of 210 of 313 patients (67.1%) with ascites had cytology positive for malignancy. This left 103 patients with ascites and cancer without malignant cells found in the ascites removed at the time of surgery. CONCLUSIONS Except in a few cases, paracentesis is not recommended for the diagnosis of ovarian cancer because of the potential spreading of cancer. Furthermore, with only just over two thirds of cases of known cancer and ascites having cytology positive for malignancy, the value of paracentesis for diagnosis of ovarian cancer is minimal.
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15
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Miceli R, Scognamiglio G, Camerlingo R, Rea G, Lettiero A, Cantile M, Greggi S, Losito NS, Pirozzi G, Botti G. New cell block containing agarose for cytopathological diagnosis of tumor samples. Diagn Cytopathol 2017; 45:1057-1060. [PMID: 28664554 DOI: 10.1002/dc.23778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/13/2017] [Accepted: 06/15/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Roberta Miceli
- Department of Experimental Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | - Giosuè Scognamiglio
- Pathology Unit, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | - Rosa Camerlingo
- Department of Experimental Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | - Giuseppina Rea
- Department of Experimental Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | - Antonio Lettiero
- Pathology Unit, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | - Monica Cantile
- Pathology Unit, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | - Stefano Greggi
- Division of Medical Oncology, Department of Uro-Gynaecological Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | - Nunzia Simona Losito
- Pathology Unit, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | - Giuseppe Pirozzi
- Department of Experimental Oncology, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy
| | - Gerardo Botti
- Pathology Unit, Istituto Nazionale Tumori "Fondazione G. Pascale" - IRCCS, Naples, Italy
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16
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O DF, Roskams T, Van den Eynde K, Vanhie A, Peterse DP, Meuleman C, Tomassetti C, Peeraer K, D'Hooghe TM, Fassbender A. The Presence of Endometrial Cells in Peritoneal Fluid of Women With and Without Endometriosis. Reprod Sci 2016; 24:242-251. [PMID: 27324432 DOI: 10.1177/1933719116653677] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To reinforce Sampson's theory of retrograde menstruation in the pathogenesis of endometriosis, proof should be provided that during menstruation endometrial cells are present in peritoneal fluid (PF). We hypothesize that the prevalence of PF samples containing endometrial cells is higher in patients with endometriosis than in controls without endometriosis during menstruation. We selected from our biobank PF samples of 17 reproductive-age women with (n = 9) or without (n = 8) endometriosis who had received a diagnostic laparoscopy for investigation of pain/infertility. Peritoneal fluid had been collected during laparoscopy in the menstrual phase of the cycle, centrifuged, and the resulting pellet was stored at -80°C. About 5-μm sections of frozen PF pellets were stained using the Dako Envision Flex system with primary antibodies against epithelial cell adhesion molecule (Ep-CAM; endometrial epithelial cells), CD10 (endometrial stromal cells), prekeratin (epithelial/mesothelial cells), vimentin (endometrial/mesothelial/immune cells), calretinin (mesothelial cells), and CD68 (macrophages). The PF cells positive for Ep-CAM were detected in 5 of 9 patients with endometriosis and 6 of 8 controls ( P = .62). CD10 stained positively in 6 of the 9 patients with endometriosis and 3 of the 8 controls ( P = .35). Calretinin and prekeratin staining showed the presence of mesothelial cells in all pellets. Vimentin stained approximately 100% of the PF cells. CD68+ macrophages represented >50% of cells in all pellets. The prevalence of PF samples containing endometrial epithelial and stromal cells was not higher in patients with endometriosis than in controls without endometriosis during menstruation. Our findings question the relevance of endometrial cells in PF for the pathogenesis of endometriosis and support the importance of other mechanisms such as immune dysfunction and/or endometrial stem cells.
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Affiliation(s)
- Dorien F O
- 1 Department of Development and Regeneration, Organ systems, KU Leuven, Leuven, Belgium.,2 Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Leuven, Belgium
| | - Tania Roskams
- 3 Department of Imaging and Pathology, KU Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Kathleen Van den Eynde
- 3 Department of Imaging and Pathology, KU Leuven and University Hospitals Leuven, Leuven, Belgium
| | - Arne Vanhie
- 1 Department of Development and Regeneration, Organ systems, KU Leuven, Leuven, Belgium.,2 Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Leuven, Belgium
| | - Daniëlle P Peterse
- 1 Department of Development and Regeneration, Organ systems, KU Leuven, Leuven, Belgium.,2 Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Leuven, Belgium
| | - Christel Meuleman
- 2 Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Leuven, Belgium
| | - Carla Tomassetti
- 2 Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Leuven, Belgium
| | - Karen Peeraer
- 2 Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Leuven, Belgium
| | - Thomas M D'Hooghe
- 1 Department of Development and Regeneration, Organ systems, KU Leuven, Leuven, Belgium
| | - Amelie Fassbender
- 1 Department of Development and Regeneration, Organ systems, KU Leuven, Leuven, Belgium.,2 Department of Obstetrics and Gynaecology, Leuven University Fertility Centre, University Hospital Leuven, Leuven, Belgium
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A specimen volume of ≥80 mL improves cytologic sensitivity for malignant ascites: a retrospective analysis of 2665 cases. J Am Soc Cytopathol 2016; 5:301-305. [PMID: 31042507 DOI: 10.1016/j.jasc.2016.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/14/2016] [Accepted: 04/14/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Although paracentesis simultaneously allows cytologic evaluation of peritoneal fluid and symptomatic relief, its utility is limited by a paltry 50% to 60% sensitivity for malignancy. Specimen volume has recently been shown to affect cytologic diagnosis in other body fluids, but its role has never been examined in ascites. This study evaluates how specimen volume impacts cytologic diagnosis of malignant ascites. MATERIALS AND METHODS We identified 2665 consecutive paracentesis specimens with documented numeric volumes collected at our institution between 1994 and 2013. We separated the cases into 10 bins of roughly equivalent sample size and compared the percentage of cases that received malignant diagnoses across each cutoff volume. When follow-up pathology was available, we also compared the sensitivity of cytology with the gold standard of surgical pathology. RESULTS The peritoneal fluids had a mean volume of 760.2 mL (range: 1-10,000). Just 11.3% of specimens with volumes <80 mL were diagnosed as malignant, while 20.1% were malignant at volumes ≥80 mL (P < 0.001, OR = 0.51, 95% CI = 0.39-0.64). Lower volume specimens also had more indeterminate and nondiagnostic results. Cytologic sensitivity increased from 56.7% for specimens <80 mL to 75.4% for volumes ≥80 mL (P = 0.03, OR = 0.43, 95% CI = 0.19-0.94). CONCLUSIONS A specimen volume of ≥80 mL is associated with increased cytologic sensitivity for malignant ascites and a higher rate of malignant diagnoses. The disparate sensitivity at lower volumes likely stems from inadequate sampling of larger specimens. Although fluids should not be summarily rejected based on volume, a specimen volume of ≥80 mL minimizes the influence of specimen size on diagnostic adequacy in paracentesis specimens.
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18
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Ascites in Ovarian Carcinoma - Reliability and Limitations of Cytological Analysis. W INDIAN MED J 2015; 64:236-40. [PMID: 26426176 DOI: 10.7727/wimj.2014.230] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 12/11/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The objective of this study was to examine the validity of ascitic fluid cytology in the detection of pathological findings, to examine the percentage of false positive and false negative results in the cytology of ascitic fluid and to determine the validity of peritoneal cytology in relation to the histopathological type of the ovarian tumour. METHODS This retrospective study included 170 peritoneal cytology findings. The study was conducted from January 2010 to December 2012. The experimental group included 76 cytology findings obtained from patients diagnosed with ovarian carcinoma, whereas the control group was composed of 94 cytology findings of benign ovarian tumours and liver cirrhosis ascites. The patients with ovarian carcinoma had grades III, as well as grades I and IIc but only in cases where operative and pathological finding indicated a ruptured or perforated tumour capsule. RESULTS The sensitivity of peritoneal cytology is 68.92%, specificity is 93.61%, positive predictive value is 89.65% and negative predictive value is 78.57%. In 30.02% of patients, the peritoneal cytology showed false negative results, while in 6.38%, the results were false positive. The highest percentage of false negative findings was 77%, found in endometrioid carcinoma. CONCLUSION Peritoneal cytology of ascitic fluid is highly specific but has relatively low sensitivity, particularly in the case of endometrioid ovarian carcinoma. In order to increase sensitivity, peritoneal cytology should be combined with monoclonal antibodies and other biochemical and immunohistochemical markers.
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19
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DiVincenti L, Westcott R, Lee C. Sheep (Ovis aries) as a model for cardiovascular surgery and management before, during, and after cardiopulmonary bypass. JOURNAL OF THE AMERICAN ASSOCIATION FOR LABORATORY ANIMAL SCIENCE 2015; 35:131-2. [PMID: 25255065 DOI: 10.1002/clc.21952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 11/22/2011] [Indexed: 12/20/2022]
Abstract
Because of its similarity to humans in important respects, sheep (Ovis aries) are a common animal model for translational research in cardiovascular surgery. However, some unique aspects of sheep anatomy and physiology present challenges to its use in these complicated experiments. In this review, we discuss relevant anatomy and physiology of sheep and discuss management before, during, and after procedures requiring cardiopulmonary bypass to provide a concise source of information for veterinarians, technicians, and researchers developing and implementing protocols with this model.
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Affiliation(s)
- Louis DiVincenti
- Department of Comparative Medicine, University of Rochester Medical Center, Rochester, New York, USA.
| | - Robin Westcott
- Division of Laboratory Animal Medicine, University of Rochester Medical Center, Rochester, New York, USA
| | - Candice Lee
- Department of Surgery, University of Rochester Medical Center, Rochester, New York, USA
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20
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Tambouret R. Female genital tract. Cancer Treat Res 2014; 160:241-272. [PMID: 24092373 DOI: 10.1007/978-3-642-38850-7_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Rosemary Tambouret
- Department of Pathology, Massachusetts General Hospital, Warren 105/55 Fruit Street, Boston, MA, 02114, USA,
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21
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Stewart CJR, Doherty DA, Havlat M, Koay MHE, Leung YC, Naran A, O'Brien D, Ruba S, Salfinger S, Tan J. Transtubal spread of endometrial carcinoma: correlation of intra-luminal tumour cells with tumour grade, peritoneal fluid cytology, and extra-uterine metastasis. Pathology 2013; 45:382-7. [PMID: 23635815 DOI: 10.1097/pat.0b013e328360b6e7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIMS To assess the significance of intra-luminal tumour cells (ILTC) within the fallopian tubes of patients with endometrial carcinoma, with emphasis on high grade histological subtypes. METHODS Complete histological examination of fallopian tube tissue was performed in 36 low grade endometrioid adenocarcinomas and in a consecutive series of 226 high grade endometrial malignancies including 92 serous carcinomas, 64 grade 3 endometrioid carcinomas, 26 carcinosarcomas, 25 undifferentiated/dedifferentiated carcinomas, and 19 clear cell carcinomas. The presence of ILTC was correlated with peritoneal fluid cytology, histologically confirmed peritoneal tumour spread, and lymph node metastases. RESULTS ILTC were identified in 26% and 3% of high and low grade carcinomas, respectively. The presence of ILTC correlated strongly with positive peritoneal fluid cytology and with peritoneal metastasis in high grade tumours (both p < 0.001), and there was also a correlation with lymph node metastasis (p = 0.049). ILTC were more common in serous and undifferentiated carcinomas (>30%) but the differences between the high grade tumour subtypes were not statistically significant. CONCLUSIONS These findings suggest that ILTC associated with high grade endometrial cancers have the capacity to implant and invade the peritoneal cavity. Positive cytology in such cases may be more significant than in low grade tumours. Complete tubal examination may provide additional prognostic information in high grade endometrial carcinoma.
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Affiliation(s)
- C J R Stewart
- Department of Histopathology, King Edward Memorial Hospital, Perth, WA, Australia.
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22
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Sneige N, Dawlett MA, Kologinczak TL, Guo M. Endosalpingiosis in peritoneal washings in women with benign gynecologic conditions: thirty-eight cases confirmed with paired box-8 immunohistochemical staining and correlation with surgical biopsy findings. Cancer Cytopathol 2013; 121:582-90. [PMID: 23674372 DOI: 10.1002/cncy.21302] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 03/27/2013] [Accepted: 03/27/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND To better define the cytomorphologic spectrum of endosalpingiosis in peritoneal washings (PWs) and thereby facilitate their distinction from well differentiated serous carcinoma, the authors examined PWs from women who underwent surgery and pathologic staging of lesions other than Mullerian malignancies and correlated the findings with surgical specimens. METHODS This was a retrospective review of medical records and PW specimens from 100 consecutive patients who had PWs coded as both "endosalpingiosis" and "negative for carcinoma" between 2002 and 2012. Thirty-eight of these patients had no gynecologic malignancies. Specimens had been prepared using cytocentrifugation and were stained using the Papanicolaou method. The cytologic findings evaluated were cell arrangement, number of cell groups per case, cellular atypia, and psammoma bodies. Smears also were assessed for paired box-8 (PAX8) immunostaining. The authors compared patients' staging biopsy findings with the findings from a review of the PWs. RESULTS PW specimens from 35 of 38 patients (92%) exhibited classic endosalpingiosis features: tubular or small branching papillary structures, some with psammoma bodies. Specimens from the 3 remaining patients displayed nonclassic features consistent with dislodged fallopian tube epithelium or endometriosis. From 2 to 20 clusters per slide and from 4 to 50 groups per case were identified. In a few cases, some cell clusters exhibited up to moderate cytologic atypia. Surgical findings included endometriosis, endosalpingiosis, both endometriosis and endosalpingiosis (12 patients; 31.6%), and a variety of unrelated pelvic lesions. All cases were PAX8-positive, confirming their Mullerian origin. CONCLUSIONS Endosalpingiosis in PWs can be diagnostically challenging. Awareness of intraoperative techniques and correlation with surgical biopsy findings are necessary to avoid a misdiagnosis of malignancy.
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Affiliation(s)
- Nour Sneige
- Department of Pathology, Section of Cytology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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23
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Jiang H, Gupta R, Somma J. EZH2, a unique marker of malignancy in effusion cytology. Diagn Cytopathol 2013; 42:111-6. [DOI: 10.1002/dc.22999] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 03/19/2013] [Indexed: 01/09/2023]
Affiliation(s)
- Huimiao Jiang
- Department of Pathology; SUNY Downstate Medical Center; Brooklyn New York
| | - Raavi Gupta
- Department of Pathology; SUNY Downstate Medical Center; Brooklyn New York
| | - Jonathan Somma
- Department of Pathology; SUNY Downstate Medical Center; Brooklyn New York
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24
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Chowdhuri SR, Fetsch P, Squires J, Kohn E, Filie AC. Adenocarcinoma cells in effusion cytology as a diagnostic pitfall with potential impact on clinical management: a case report with brief review of immunomarkers. Diagn Cytopathol 2012; 42:253-8. [PMID: 23161830 DOI: 10.1002/dc.22915] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 05/31/2012] [Accepted: 07/20/2012] [Indexed: 11/05/2022]
Abstract
Distinguishing metastatic carcinoma cells from reactive mesothelial cells in effusion samples is often challenging based on morphology alone. Metastatic carcinoma cells in fluid samples may mimic reactive mesothelial cells due to overlapping cytological features. We report a case of a pleural effusion in a 51-year-old female patient with a medical history significant for bilateral ovarian tumors and peritoneal implants diagnosed as serous tumor of borderline malignant potential. The effusion was composed almost entirely of adenocarcinoma cells that morphologically mimicked reactive mesothelial cells. The diagnosis of metastatic adenocarcinoma was made after a wide immunostaining panel of antibodies. Recognizing metastatic adenocarcinoma cells in effusion samples can be challenging and an accurate diagnosis may have significant impact on clinical management as demonstrated by this case.
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Affiliation(s)
- Sinchita Roy Chowdhuri
- Cytopathology Section, Laboratory of Pathology, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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25
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Wang C, Chu P, Duggan MA. Reactive tubal epithelium mimicking Mullerian serous carcinoma: pitfalls in the evaluation of pelvic wash specimens. Cytopathology 2011; 23:338-9. [PMID: 21883540 DOI: 10.1111/j.1365-2303.2011.00918.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C Wang
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
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26
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Piaton E, Villeneuve L, Maurice C, Paulin C, Cottier M, Fontanière B, Salle M, Seigneurin D, Vancina S, Decullier E, Gilly FN, Cotte E. Intraperitoneal free cancer cells in non-gynaecological adenocarcinomas: a reproducibility study. Cytopathology 2011; 23:242-9. [PMID: 21736645 DOI: 10.1111/j.1365-2303.2011.00889.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE In recent years, therapeutic approaches including cytoreductive surgery followed by intraperitoneal chemotherapy have proven effective in peritoneal carcinomatosis of colorectal origin. If cytology is to be used to include patients in aggressive treatment regimens, it is necessary to evaluate its performance, particularly in terms of specificity. The aim of this study was to assess interobserver agreement for the detection of intraperitoneal free cancer cells (IFCCs) in patients with non-gynaecological adenocarcinomas. METHODS Over a 5-year period, 1223 patients were recruited in 19 French surgery departments. Peritoneal samples were examined in 14 dispersed pathology laboratories. Giemsa-stained slides were sent to a control reader blind to the previous diagnosis. Discordant cases, concordant positive results and a random selection of negative concordant cases were reviewed by a panel of seven cytopathologists. The 'final diagnosis' was that of the consensus meetings but took into account locally-processed slides. RESULTS Gathering dubious cases with negative results, a 95.6% concordance was achieved between local readers and the control reader. IFCCs were ascertained by the panel in 85 cases (7.0%). Eight of 873 colorectal cancers cases viewed locally were falsely positive (0.9%). Radiotherapy and neoadjuvant therapy had no impact on the false-positive rate as assessed by final validation by the panel (P > 0.05). Samples initially considered as dubious were reclassified as negative by the panel in 24 of 25 cases (96.0%). CONCLUSIONS The panel consensus allowed reclassification of most dubious/equivocal peritoneal cytology cases, whereas clearcut distinction between benign and malignant cases was correctly achieved in almost all cases.
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Affiliation(s)
- E Piaton
- Hospices Civils de Lyon, Centre de Pathologie Est, Bron Université Lyon 1, Lyon, France.
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28
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Lestuzzi C. Neoplastic pericardial disease: Old and current strategies for diagnosis and management. World J Cardiol 2010; 2:270-9. [PMID: 21160603 PMCID: PMC2999066 DOI: 10.4330/wjc.v2.i9.270] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 07/07/2010] [Accepted: 07/14/2010] [Indexed: 02/06/2023] Open
Abstract
The prevalence of neoplastic pericardial diseases has changed over time and varies according to diagnostic methods. The diagnostic factor is usually the detection of neoplastic cells within the pericardial fluid or in specimens of pericardium, but the diagnosis may be difficult. Accurate sampling and cytopreparatory techniques, together with ancillary studies, including immunohistochemical tests and neoplastic marker dosage, are essential to obtain a reliable diagnosis. The goals of treatment may be simply to relieve symptoms (cardiac tamponade or dyspnea), to prevent recurrent effusion for a long-term symptomatic benefit, or to treat the local neoplastic disease with the aim of prolonging survival. Immediate relief of symptoms may be obtained with percutaneous drainage or with a surgical approach. For long term prevention of recurrences, various approaches have been proposed: extended drainage, pericardial window (surgical or percutaneous balloon pericardiostomy), sclerosing local therapy, local and/or systemic chemotherapy or radiation therapy (RT) (external or with intrapericardial radionuclides). The outcomes of various therapeutic approaches vary for different tumor types. Lymphoma and leukemias can be successfully treated with systemic chemotherapy; for solid tumors, percutaneous drainage and the use of systemic and/or local sclerosing and antineoplastic therapy seems to offer the best chance of success. The use of "pure" sclerosing agents has been replaced by agents with both sclerosing and antineoplastic activity (bleomycin or thiotepa), which seems to be quite effective in breast cancer, at least when associated with systemic chemotherapy. Local chemotherapy with platinum, mitoxantrone and other agents may lead to good local control of the disease, but the addition of systemic chemotherapy is probably relevant in order to prolong survival. The surgical approach (creation of a pericardial window, even with the mini-invasive method of balloon pericardiostomy) and RT may be useful in recurring effusions or in cases that are refractory to other therapeutic approaches.
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Affiliation(s)
- Chiara Lestuzzi
- Chiara Lestuzzi, Department of Cardiology, Centro di Riferimento Oncologico, IRCCS, National Cancer Institute, Via F. Gallini 2, 33081 Aviano (PN), Italy
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