BackgroundSerous effusions (SE) in leukemic patients can be due to infections, therapy, volume overload, lymphatic obstruction or malignancy having implications on treatment and mortality. The objective of the present study is to highlight the spectrum of cytomorphology, immunophenotype, and cytogenetics in leukemic serous effusions (LSE).MaterialsPresent study is retrospective and descriptive. We reviewed all the SE, which were reported as suspicious or positive of leukemic infiltration from 2016 to 2019 for cytomorphological features. CSF and effusions involved by lymphomas were excluded. Cyto‐diagnosis was compared with primary proven diagnosis (by ancillary techniques) and disconcordant cases were analyzed.ResultsOut of total 9723 effusions, only 0.4% (n = 40) showed leukemic involvement and included nine cases of AML, three of B‐ALL, 13 T‐ALL, 2 MPAL, 6 CML, 5CLL, one each of chronic myelomonocytic leukemia and AML with myelodysplasia. The most common site of involvement was the pleural cavity (n = 30), followed by the peritoneal cavity (n = 7) and the pericardial cavity (n = 3). T ‐ALL (41.9%) was the most common leukemia involving pleural fluid followed by AML (23.3%). CML (42.8%) was the most common leukemia involving the ascitic fluid followed by B‐ALL (28.6%). Accurate diagnosis was given on cytomorphology in 72.5% (29/40) cases and 15.0% (6/40) were reported as non‐Hodgkin lymphoma.ConclusionCytology is an effective tool available to make a diagnosis of LSE. Nuclear indentations in large atypical cells and cells with eosinophilic granular cytoplasm with sparse or abundant eosinophils in the background are an important clue in favor of leukemia over lymphoma.
<b><i>Introduction:</i></b> Cytology provides crucial window for early diagnosis of malignant mesothelioma (MM) since it is often the first and easily available material for evaluation, resulting in early treatment. Still, its role is overlooked in the current treatment guidelines. The aim of this study is to determine the sensitivity of cytomorphology and role of subsequent ancillary techniques in diagnosing MM. <b><i>Methods:</i></b> This is a 5-year retrospective analysis of MM in the tertiary oncology center to determine sensitivity of cytomorphology and subsequent role of immunohistochemistry (IHC) in final diagnosis of MM according to the guidelines for cytopathologic diagnosis of epithelioid and mixed-type malignant mesothelioma (GCDMM) laid by International Mesothelioma Interest Group. Cytomorphology and immunocytochemistry from effusions and fine needle aspirations were analyzed. <b><i>Results:</i></b> Sixty-two of 128 cases of MM had cytology and cytomorphological criteria described in GCDMM were fulfilled in 61.3% cases. Architectural atypia was useful in identifying cases with low cytological atypia. Overall sensitivity of cytomorphology was 73.01%. Sensitivity of effusion cytology was 77.8%. Subsequent IHC on cell blocks revealed the sensitivity as 100% for mesothelin, calretinin, and cytokeratin 5/6; 87.5% for thrombomodulin; and 50% for WT1, while CEA and TTF1 showed 100% specificity. Treatment was given based on final diagnosis of MM given after IHC on cytology material in only 25.8% cases. However, it was possible in additional 35.5% cases. Mean survival was 10 months when diagnosed by cytology, compared to 7 months by histology. <b><i>Conclusions:</i></b> Rather than ignoring the role of cytology in the diagnosis and treatment guidelines for MM, it is important to understand its strengths and limitations. Standardized guidelines in future can play an important role in more streamlined communication between cytopathologist and clinician.
Disorders of the gastric epithelium are frequent cause of clinical disease with inflammatory and neoplastic lesions being particularly common. Adenocarcinoma is the commonest gastric malignancy, commonly arising from the antrum or lesser curvature. Morphometry and immuno staining help in classifying different lesions of stomach, specially when there is dilemma in concluding a lesion either benign, premalignant or malignant particularly in small biopsy specimens. The aim is to assess the role of morphometry and proliferative markers in diagnosis of gastric epithelial lesions. In this study, total 100 gastric biopsy specimens from 100 patients were included and analysed by H&E stained sections using morphometric parameters as well as proliferative markers like Ki-67 and proliferating cell nuclear antigen (PCNA). Statistically significant differences found in between the gastric premalignant and malignant epithelial lesions in terms of morphometric parameters and in expression of proliferative markers. Morphometry and immunohistochemistry help in the proper diagnosis of different gastric epithelial lesions particularly those lying in the grey zone on routine histopathological sections.
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