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Items 1-16 of 16 |
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One page. |
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Malignant pericardial effusion.
Garcia-Riego A, Cuinas C, Vilanova JJ.
Department of Anatomic Pathology, Hospital de Cruces, Vizcaya, Spain.
OBJECTIVE: To examine the frequency and diagnostic implications of malignant pericardial effusions. STUDY DESIGN: The clinical and histologic records of pericardial effusions diagnosed cytologically as malignant were reviewed. We investigated the relationship between malignancy and type of tumor, interval between diagnosis of the primary tumor and development of the pericardial effusion, and length of survival after the onset of the effusion. RESULTS: There were 375 pericardial effusions among 23,592 effusions studied over 24 years; 65 of them were diagnosed as malignant. The mean age at onset was 53.6 years. In 92% of the cases the primary tumor was epithelial, lung the most frequent in males and breast in females. In 48% of cases the pericardial effusion constituted the first sign of malignancy. CONCLUSION: Diagnosis of a pericardial effusion as malignant carried an ominous prognosis: 86% of patients died within the first year and nearly one-third within the first month. Breast carcinomas were linked with the longest survival and longest interval of latency prior to the onset of the pericardial effusion. There were two effusions associated with lymphoblastic lymphomas; they have had no recurrence 10 and 17 years after the effusion, and the patients can be considered cured.
PMID: 11480719 [PubMed - indexed for MEDLINE]
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Bull's eye (target) inclusions in neoplastic cells in malignant serous effusions. A study of 289 cases.
Kumar PV, Eqbali S, Monabati A, Talei AR.
Department of Pathology, Shiraz Medical School, Shiraz University of Medical Sciences, Iran.
OBJECTIVE: To study the prevalence and significance of bull's eye (target) inclusions in neoplastic cells in malignant serous effusions. STUDY DESIGN: We reviewed malignant pleural, peritoneal and pericardial effusions from 289 patients who had proven cancer at known primary sites. The ages of the patients ranged from 5 to 72 years; 166 were male and 123 female. RESULTS: Bull's eye inclusions are an uncommon finding and appeared in only 13 cases of metastatic adenocarcinoma of the breast, stomach, colon, lung, ovary, pancreas and urinary bladder. They were positively stained with periodic acid-Schiff stain with diastase. The inclusions were not seen in cells of nonadenocarcinomatous neoplasms, such as squamous cell carcinoma, oat cell (small cell) carcinoma, neuroblastoma, lymphoma and germ cell tumors. CONCLUSION: Bull's eye inclusions are found in about 5% of malignant serous effusions containing cells of metastatic adenocarcinoma. The primary site of an adenocarcinoma cannot be deduced on the basis of the presence of inclusions.
PMID: 10934946 [PubMed - indexed for MEDLINE]
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Cytology of pericardial effusion: can color be a predictor of malignancy?
Peters K, Muller HA, Peters W.
Publication Types:
PMID: 9684604 [PubMed - indexed for MEDLINE]
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Cytology of pleural, peritoneal and pericardial fluids in children. A 40-year summary.
Wong JW, Pitlik D, Abdul-Karim FW.
Institute of Pathology, Case Western Reserve University, Cleveland, Ohio, USA.
OBJECTIVE: To determine the applicability of the cytologic examination of serous fluids in the management of malignant neoplasms in children. STUDY DESIGN: A review of the reports of all cytologic specimens of pleural, peritoneal and pericardial fluids from children examined in our laboratory during a 40-year period. A total of 226 specimens from 146 patients under 18 years old with a documented neoplasm were analyzed by diagnosis and fluid type. The data were tabulated and analyzed in a format that allowed comparison with the results of earlier studies. RESULTS: Eighty-eight specimens (39%) from 66 patients (45%) were suspicious or positive for malignancy. The positive specimens included lymphoma and leukemia (52%), neuroblastoma (14%), Wilms' tumor (9%), gonadal and extragonadal germ cell neoplasms (8%), bone and soft tissue sarcomas (7%), epithelial neoplasms (5%), Ewing's sarcoma (2%) and other neoplasms (3%). Positive results were obtained in 47% (66/139) of pleural fluids, 23% (15/65) of ascitic fluids, 27% (4/15) of peritoneal washings and 43% (3/7) of pericardial fluids. CONCLUSION: Cytologic examination of serous fluids is a simple and useful procedure in the management of pediatric neoplasms. This study showed a higher proportion of positive effusion cytology with lymphoma/leukemia and a lower proportion with sarcoma as compared with earlier reports. Pleural fluids were the most common specimen type and showed the highest proportion of positivity.
Publication Types:
PMID: 9100782 [PubMed - indexed for MEDLINE]
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Small noncleaved cell lymphoma presenting as a massive pericardial effusion. A case report.
Dunphy CH, Ramos RR, Galindo LM.
Department of Pathology, St. Louis University Health Sciences Center, Missouri, USA.
BACKGROUND: Non-Hodgkin's lymphoma (NHL) is commonly associated with cardiac involvement, especially in cases of advanced stages with mediastinal involvement. Much rarer is the initial presentation of NHL as a pericardial effusion; there are only 12 cases reported. In addition, only 5 of these 12 cases were correctly diagnosed based on examination of pericardial fluid prior to death: 3 were based on routine cytology; 1 on immunoperoxidase staining and 1 on an immunofluorescent slide method. CASE: A 71-year-old, white female presented with a massive pericardial effusion. Small noncleaved cell lymphoma was expeditiously diagnosed by cytologic examination combined with flow cytometric immunophenotyping. No further diagnostic tissue was obtained; the patient was staged and offered treatment with a protocol for high grade lymphoma. CONCLUSION: Combining cytomorphology and flow cytometric immunophenotyping in such cases results in an expeditious, nonsurgical diagnosis, upon which therapeutic decision making may be based.
PMID: 8842182 [PubMed - indexed for MEDLINE]
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Diagnosis of primary cardiac lymphoma. Report of a case with cytologic examination of pericardial fluid and imprints of transvenously biopsied intracardiac tissue.
Chao TY, Han SC, Nieh S, Lan GY, Lee SH.
Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
BACKGROUND: Primary cardiac lymphoma (PCL) is a treatable disease when appropriately diagnosed. Therefore, a prompt, safe method with high diagnostic accuracy is prerequisite to successful therapy for PCL. CASE: A 57-year-old male presented with exertional dyspnea and atrial fibrillations. A pericardial effusion (PE) and several tumor masses occupying both atria were found. Cytologic examinations of PE and of imprints of the tissues obtained by transvenous biopsy of the cardiac tumors revealed numerous small, round tumor cells and lymphoglandular bodies, suggestive of malignant lymphoma. This cytologic impression was confirmed by immunocytochemical studies on the same cytologic material. Histologic studies reaffirmed the diagnosis of B-cell lymphoma. The patient received eight courses of chemotherapy, with complete remission of the illness. CONCLUSION: Cardiac lymphoma can be quickly and safely diagnosed by cytologic examination of PE or transvenously biopsied cardiac tissue, with confirmation by immunocytochemical studies. Exploratory thoracotomy for biopsy can be avoided.
PMID: 7571977 [PubMed - indexed for MEDLINE]
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Cytology of fluids from pleural, peritoneal and pericardial cavities in children. A comprehensive survey.
Hallman JR, Geisinger KR.
Department of Pathology, Bowman Gray School of Medicine, Winston-Salem, North Carolina.
We reviewed all cytologic specimens of pleural, peritoneal and pericardial fluids examined in our laboratory from patients aged 0-17 years during a 12-year period. A total of 103 specimens were studied: 45 pleural, 54 peritoneal and 4 pericardial. Twenty-two of the 103 specimens were peritoneal washes. Eleven of the 81 (14%) serous effusion specimens contained tumor cells: 8 lymphomas, 1 leukemia, 1 abdominal desmoplastic small round cell tumor and 1 Wilms' tumor. Two false-positive diagnoses were made in patients presenting with ascites with an unknown case. Both cases were complicated by the presence of atypical mononuclear cells and illustrate a potential pitfall in the evaluation of pediatric serous effusions. We conclude: (1) Almost all pediatric effusions are benign. (2) Malignant pediatric effusions are usually caused by neoplasms of the small cell type, mostly lymphoreticular. (3) The major diagnostic difficulty in interpreting pediatric effusion cytology is in distinguishing neoplasms of the small cell type from mononuclear inflammatory cells. (4) The usefulness of peritoneal washings in pediatric patients is similar to that in adults.
PMID: 8147212 [PubMed - indexed for MEDLINE]
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The diagnostic value of pericardial cytology. An analysis of 95 cases.
Wiener HG, Kristensen IB, Haubek A, Kristensen B, Baandrup U.
University Institute of Pathology, Aarhus Civic Hospital, University of Aarhus, Denmark.
Cytologic specimens of 105 pericardial fluids collected from 95 cases during a seven-year period were reviewed. Clinical reports and descriptions of the histologic antemortem and postmortem specimens were correlated with the cytologic diagnoses, and the interobserver variation was estimated. Of the collected material, 48.4% was from patients suspected of having nonmalignant disorders, 40.0% was from patients with previously diagnosed carcinomas and 11.6% was from cases in which the etiology was unknown at the time of pericardiocentesis. Cytologic examination of the pericardial fluids revealed tumor cells in a sample from one patient suspected of having a heart disorder and in a sample from another patient with an obscure disease. Of the pericardial fluids from the cancer patients, 66.7% contained malignant cells; the most frequent primary site in these cases was the lung. Correlated with the histologic diagnosis, the specificity of cytology was 100%. The results prove that, in experienced hands, pericardial cytology is a valuable diagnostic tool.
PMID: 2028688 [PubMed - indexed for MEDLINE]
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Cytopathology of malignant pericardial effusions.
Di Bonito L, Patriarca S, Falconieri G.
Istituto di Anatomia Patologica, Universita di Trieste, Ospedale Maggiore, Italy.
PMID: 2375228 [PubMed - indexed for MEDLINE]
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Malignant pericardial effusion and cardiac tamponade.
Pinto MM.
Cardiac tamponade due to malignant effusion, though rarely the initial manifestation of malignancy, is usually secondary to adenocarcinoma of the lung. Two cases are reported. One patient presented with cardiac tamponade; the other had diffuse cutaneous involvement of the left neck and shoulder two months before he presented with cardiac tamponade. Cytologic examination of both fluids revealed adenocarcinoma. Ultrastructural examination showed poorly differentiated adenocarcinoma in the first patient and bronchioloalveolar carcinoma in the second; carcinoembryonic antigen levels in the fluids were 9.4 ng/mL and over 60 ng/mL, respectively. The computed tomographic (CT) scans of both patients revealed mediastinal fullness with no lung involvement. Even in the absence of a pulmonary mass, lung carcinoma may be the likely primary in patients with malignant pericardial effusions.
PMID: 3024432 [PubMed - indexed for MEDLINE]
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The role of cytology in neoplastic cardiac tamponade.
Reyes CV, Strinden C, Banerji M.
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.
PMID: 6954811 [PubMed - indexed for MEDLINE]
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Cytopathology of pericardial effusions.
Yazdi HM, Hajdu SI, Melamed MR.
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.
PMID: 6933801 [PubMed - indexed for MEDLINE]
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Cytologic detection of malignant mesothelioma of the pericardium.
Kobayashi Y, Takeda S, Yamamoto T, Goi S.
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.
PMID: 281843 [PubMed - indexed for MEDLINE]
Metastatic squamous-cell carcinoma in pericardial effusion: report of four cases, two with cardiac tamponade.
Hoda RS, Cangiarella J, Koss LG.
Department of Pathology, Albert Einstein College of Medicine, Bronx, New York.
For reasons unknown, metastatic squamous-cell carcinoma is a rare cause of pleural effusions and is even less common in pericardial effusions. A review of all pericardial effusions examined in the Cytology Service at Montefiore Medical Center over a 15-year (1980-1994) period was undertaken (N = 251). Four cases with metastatic squamous-cell carcinoma were identified among 39 malignant effusions. Two patients with metastatic squamous-cell carcinoma presented with cardiac tamponade, and the other two cases had progressive cardiac failure. The diagnostic cells on cytology evaluation were scant in all four cases but exhibited classical features of metastatic squamous carcinoma, such as cytoplasmic keratinization, intercellular bridges, and occasional "pearl" formation. Pericardial biopsies available in three patients, two with cardiac failure and one with cardiac tamponade, were negative. In all four cases the primary tumor was a bronchogenic carcinoma. Metastatic squamous-cell carcinoma is an uncommon cause of pericardial effusion and usually indicates the presence of a bronchogenic carcinoma with a rapidly fatal outcome. Cytologic examination of pericardial fluid is essential in the evaluation of such patients.
PMID: 9626514 [PubMed - indexed for MEDLINE]
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Diagnostic accuracy of pericardial fluid cytology: an analysis of 53 specimens from 44 consecutive patients.
Malamou-Mitsi VD, Zioga AP, Agnantis NJ.
Department of Pathology, Medical School, University of Ioannina, Greece.
Over a 7-yr period, a total of 53 pericardial fluid specimens from 44 patients was examined. A correlation between cytological and histological diagnosis was made in 19 of these cases. In the remaining 25 cases, where a biopsy was not performed, the cytological diagnosis was correlated with the final clinical diagnosis and the patients' clinical outcome. Finally, in 9 out of 14 cases of malignancy where both cytological and a histological diagnosis was made, the cytologic prediction of the histologic type of cancer was evaluated. The overall sensitivity was 100%, the overall specificity was 93.3%, and the overall cytological accuracy was 95.4%. The predictive value of the correct histologic type of cancer by cytology was 77.7%. Our findings show that the careful cytomorphological examination of pericardial fluid aspirates is a valuable, reliable, and diagnostically highly accurate method, which could be performed on a routine basis in a busy cytopathology department. Judiciously chosen ancillary procedures, as well as clinicopathological correlation, are of great value for an accurate diagnosis in problematic cases.
PMID: 8955601 [PubMed - indexed for MEDLINE]
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Cytology of pericardial effusions in AIDS patients.
Zakowski MF, Ianuale-Shanerman A.
Department of Pathology, Bellevue Hospital, New York University Medical Center, NY.
Pericardial effusions in patients with the acquired immunodeficiency syndrome (AIDS) can be due to a variety of causes and are often large enough to be sampled for cytologic examination. Over a period of 46 months, 15 cytologic specimens from 14 patients with AIDS were examined. Thirteen patients were male, one was female; the age range was 26 to 43 years. All male patients were homosexual or intravenous drug abusers, and the female patient was the spouse of an intravenous drug abuser. In general, the cytology specimens were moderately cellular with inflammatory cells seen in all cases. Atypical or reactive mesothelial cells were found in 12 cases (80%), and the atypia in one of these 12 was so marked that carcinoma was suspected; cells suspicious for malignant lymphoma were found in 2 cases (13%); degenerated mesothelial cells were present in one case. No infections were identified in this series. Ten patients (66%) had subsequent pericardial biopsies. Marked cellularity and nuclear pleomorphism in lymphoid cells with an altered nuclear cytoplasmic ratio were the dominant findings in the two suspected lymphoma cases. Both patients had known lymphoma elsewhere; in one, involvement by lymphoma was also found on pericardial biopsy. Mesothelial proliferations showing papillary formations with psammoma bodies were seen in three cases; in one of these, histoplasmosis was later diagnosed by pericardial biopsy. To our knowledge this is the first series to describe cytologically the marked mesothelial atypia seen in pericardial fluid in AIDS patients. We contrast this atypia with that seen in malignant effusions and caution against overinterpretation of pericardial fluids from AIDS patients.
PMID: 8390928 [PubMed - indexed for MEDLINE]
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Items 1-16 of 16 |
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