Cytologic diagnosis of metastatic malignant phyllodes tumor of the breast in pleural effusion

Li, Joshua J.X.; Chan, Wing C.; Chau, Helen H L; Wu, Cherry; Tse, Gary M.

doi:10.1002/dc.24151

Cited by 8 publications

(6 citation statements)

References 11 publications

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“…A search of PubMed for publications focused on the distribution of malignant effusions published in the past two decades in the English language resulted in individual case reports, original studies consisting of relatively low number of malignant specimens, and limited reviews 2‐12 . To investigate how the incidence of different types of malignancy involving malignant effusions has changed, Dermawan et al conducted a study consisting of malignant pleural, peritoneal and pericardial effusions diagnosed during a 17‐year (2000‐2016) period.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and categorization of malignant effusions: A 6‐year review from a single academic institution

Lew

Cantley

Heider

et al. 2020

Diagnostic Cytopathology

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Background Cytologic detection of malignant cells in pleural, peritoneal, or pericardial effusion most likely indicates advanced stage of malignant disease. There are a few studies updating the categorization of malignant effusions. Methods The electronic pathology database was searched to identify consecutive cases of malignant effusion during a 6‐year period. Patient age and gender, origins of known malignancy, and cytologic diagnoses were recorded and summarized. Results A total of 1059 specimens included 561 (53%) pleural, 441 (41.6%) peritoneal, and 57 (5.4%) pericardial fluids. Most of the pleural (516, 92.0%), peritoneal (418, 94.8%), and pericardial (53, 93.0%) specimens were derived from patients with a single known malignancy. More common origins involving pleural fluid were lung (152, 27.1%) followed by breast (103, 18.4%) and gastrointestinal tract (76, 13.5%). The most common etiology for women and men was breast (102, 30.8%) and lung (67, 36.2%), respectively. More common origins involving peritoneal fluid were gastrointestinal (158, 35.8%) and gynecologic (156, 35.4%) tracts, and breast (46, 10.4%). The most common etiology for women and men was Mullerian (156, 55.5%) and gastrointestinal tract (94, 68.6%), respectively. Most common origins involving the pericardial fluid were breast (20, 37.7%) and lung (17, 29.8%). Breast and lung were the most common etiology for women (20, 57.1%) and men (8, 44.4%), respectively. Conclusions Breast and lung remain to be the most common origin of both malignant pleural and pericardial effusion for women and men, respectively. The most common origin involving peritoneal effusion is Mullerian for women and gastrointestinal tract for men.

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Section: Discussionmentioning

confidence: 99%

Diagnosis and categorization of malignant effusions: A 6‐year review from a single academic institution

Lew

Cantley

Heider

et al. 2020

Diagnostic Cytopathology

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“…However, in the context of pleural effusion, fluid cytology has the potential advantage of sampling exfoliated cells from the entire pleural cavity 5 . The diagnostic accuracy and yield of these two methods may vary according to the nature of pleural effusion, as small or mediastinal pleural lesions can be difficult to biopsy, 6 whereas tumor cells shed to pleural fluid may be scanty in sarcomas 7 . A direct comparison of the diagnostic accuracy and yield of these two methods, with respect to the underlying condition, is necessary for selecting the optimal mode of tissue acquisition.…”

Section: Introductionmentioning

confidence: 99%

“…5 The diagnostic accuracy and yield of these two methods may vary according to the nature of pleural effusion, as small or mediastinal pleural lesions can be difficult to biopsy, 6 whereas tumor cells shed to pleural fluid may be scanty in sarcomas. 7 A direct comparison of the diagnostic accuracy and yield of these two methods, with respect to the underlying condition, is necessary for selecting the optimal mode of tissue acquisition. In this study, we reviewed a large cohort of matched pleural effusion cytology and biopsy, compared the diagnostic concordance of these two methods, and further analyzed their accuracy by reviewing hospital disease coding confirmed with clinical, radiological, microbiological, serological, and /or pathological data.…”

Section: Introductionmentioning

confidence: 99%

A comparative study of diagnostic accuracy in 3026 pleural biopsies and matched pleural effusion cytology with clinical correlation

et al. 2022

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Background: Pleural effusion can be caused by a wide range of benign and malignant conditions. Pleural biopsy and effusion cytology represent two key methods of pathological diagnosis. To compare the performance these two methods, a large cohort of matched pleural biopsy and effusion cytology with clinical followup was reviewed.Methods: Pleural biopsies and effusion cytology specimens over a period of 18 years were retrieved. Cytology specimens collected within 7 days of pleural biopsy were matched. Reports were reviewed, and the cause for pleural effusion was determined by hospital disease coding and clinical data.Results: Totally, 3026 cases were included. The leading cause of benign effusion was tuberculosis (n = 650). Malignant pleural effusion (MPE) was more common in older females (p < 0.001) and mostly due to lung cancer (n = 959), breast cancer (n = 64), and mesothelioma (n = 48). The inadequate/insufficient (B1/C1) rate of biopsy was higher than cytology (15.6% vs. 0.3%) but the rates for other diagnostic categories were similar. Biopsy and cytology showed a correlation coefficient of 0.315, improving to 0.449 when inadequate/insufficient (B1/C1) cases were excluded. The ROM for benign cytology (C2) was lower than biopsy (B2) (p < 0.001). Compared with biopsy, the diagnostic accuracy was higher in cytology overall and for metastatic carcinomas (p < 0.001) but lower for hematolymphoid malignancies (p = 0.014) and mesotheliomas (p = 0.002).Conclusions: These results suggest that effusion cytology may be better for confirming benignity and diagnosing carcinomatous MPE. In these cases, pleural biopsy may be withheld to reduce procedural risks. However, for suspected hematolymphoid malignancies and mesothelioma, biopsy should be considered.

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“…Similar to carcinomas, tumor cells in sarcomas exfoliate into fluid filled body cavities and can be detected on cytology. 2 However, the incidence of sarcomas are relatively low compared to carcinomas, 4 and malignant sarcomatous effusions are far less often encountered than carcinomatous effusions in routine cytology practice. 3 Retroperitoneal liposarcomas not uncommonly extends to the peritoneal cavity, and are associated with a higher risk of peritoneal sarcomatosis than sarcomas of the extremities.…”

Section: Discussionmentioning

confidence: 99%

Liposarcoma Involving Serous Fluid Cavities—A Case Series Illustrating Clinical Implications and the Diagnostic Role of Exfoliative Cytology

Ng,

2023

Int J Surg Pathol

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Introduction: Cytological diagnosis of sarcomas requires detailed cytomorphological assessment and integration of immunocytochemistry and/or molecular testing. The role of exfoliative cytology, as compared to aspiration cytology, is less understood. This case series describes well-differentiated/dedifferentiated liposarcomas in effusions, with cytomorphological features, ancillary test results and clinical outcomes detailed. Methods: A computerized search of the department pathology archives was performed for sarcomatous effusions with histological diagnosis or clinical history of well-differentiated/dedifferentiated liposarcoma. Clinical progress, cytology slides, immunocytochemistry and molecular test results were reviewed. Results: Six patients were identified. In 5 patients with clinical follow up, 4 (80%) were deceased within 5 months of malignant effusion. One patient was alive with 12 years disease-free survival after radical resection with adjuvant radiotherapy. Three patients showed dedifferentiation on histology, and high-grade (dedifferentiated) tumor cells were present in effusion cytology of 2 patients. Two showed well-differentiated components only on biopsy, but high-grade (dedifferentiated) tumor cells were identified in cytology. The high-grade tumor cells displayed marked nuclear irregularity, enlargement, size variation, with macronucleoli and multinucleation. Well-differentiated lipomatous components were demonstrated in 4 patients (66.7%), comprising of multivacuolated lipoblasts and atypical lipocytes. CDK4 and MDM2 immunoreactivity in all 3 cases with cell blocks, and CDK4 and MDM2 amplification in one were successfully demonstrated. Conclusion: Lipomatous and dedifferentiated components can be sampled and cytomorphologically identified on effusion fluids of liposarcomas, with sufficient cellularity for immunocytochemistry and molecular testing. Although generally associated with poor prognosis, long disease-free survival with sarcomatous effusion is possible with radical surgery and adjuvant treatment.

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Cytologic diagnosis of metastatic malignant phyllodes tumor of the breast in pleural effusion

Cited by 8 publications

References 11 publications

Diagnosis and categorization of malignant effusions: A 6‐year review from a single academic institution

Diagnosis and categorization of malignant effusions: A 6‐year review from a single academic institution

A comparative study of diagnostic accuracy in 3026 pleural biopsies and matched pleural effusion cytology with clinical correlation

Liposarcoma Involving Serous Fluid Cavities—A Case Series Illustrating Clinical Implications and the Diagnostic Role of Exfoliative Cytology

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