Journal of Pathology and Translational Medicine

Case Study

Malignant Pleural Effusion from Metastatic Prostate Cancer: A Case Report with Unusual Cytologic Findings: Jinyoung Jeon, Tae-Jung Kim, Hong Sik Park, Kyo-Young Lee; J Pathol Transl Med. 2018;52(4):257-261. Published online June 7, 2018; DOI: https://doi.org/10.4132/jptm.2018.05.08

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We present a case of 55-year-old man who complained of dyspnea and sputum for a month. He was an ex-smoker with a history of prostate cancer and pulmonary tuberculosis. Chest radiographs revealed bilateral pleural effusions of a small to moderate amount. Pigtail catheters were inserted for drainage. The pleural fluid consisted of large clusters and tightly cohesive groups of malignant cells, which however could not be ascribed to prostate cancer with certainty. We performed immunocytochemical panel studies to determine the origin of cancer metastasis. The immunostaining results were positive for prostate-specific antigen, alpha-methylacyl-coenzyme A racemase, and Nkx 3.1, consistent with prostate cancer. Pleural effusion associated with prostate cancer is rare. To our knowledge, this is the first case report in Korea to describe cytologic features of malignant pleural effusion associated with prostate cancer.

Citations

Citations to this article as recorded by

Pleural Metastasis as an Initial Presentation of Prostate Cancer: Case Report and Literature Review
Katarzyna Skrobisz, Kevin Miszewski, Laura Miszewska, Michał Bieńkowski, Marcin Matuszewski, Michał Studniarek
Diagnostics.2025; 15(6): 666. CrossRef
EBUS-TBNA pleural biopsy reveals prostate cancer metastasis: A rare case report and review of the literature
Fotios Sampsonas, Dimitrios Komninos, Vasilina Sotiropoulou, Matthaios Katsaras, Dimitra Gkanetsou, Ourania Papaioannou, Panagiota Tsiri, Vasiliki Tzelepi, Argyrios Tzouvelekis
Pneumon.2024; 37(2): 1. CrossRef
Cytopathological Features of Extensive Bilateral Pleural Effusions in Metastatic Prostate Cancer: Report of a Rare Case
Hehua Huang, Caroline Yap
Cureus.2024;[Epub] CrossRef
Bilateral pleural effusion: etiology, diagnostics
N. A. Stogova
PULMONOLOGIYA.2022; 32(6): 885. CrossRef
Rare Metastatic Prostate Cancer Mimicking Lymphoma with Malignant Pleural Effusion
Tung Liu, En Meng, Yu-Chun Lin, Tai-Kuang Chao, Yi-Ming Chang
Journal of Medical Sciences.2021; 42(1): 46. CrossRef

Case Reports

Cytologic Diagnosis of Malignant Pleural Effusion in Multiple Myeloma: Two Case Reports.: Yoo Duk Choi, Sung Sun Kim, Chang Woo Han, Ji Shin Lee, Jong Hee Nam, Sang Woo Juhng, Chan Choi; Korean J Pathol. 2009;43(4):382-385.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.4.382

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Abstract PDF

Malignant pleural effusion in multiple myeloma (MM) is extremely rare and is associated with poor prognosis. We experienced two cases of MM IgA type with malignant pleural effusion. The diagnoses were based on characteristic cytology and CD138 immunocytochemistry. The patients received several cycles of combination chemotherapy, since symptoms were more aggressive with an uncontrolled pleural effusion. We review the clinical features of these cases and literature concerning myelomatous pleural effusion.

Citations

Citations to this article as recorded by

Características de los pacientes con derrame pleural mielomatoso. Revisión sistemática
V. Riveiro, L. Ferreiro, M.E. Toubes, A. Lama, J.M. Álvarez-Dobaño, L. Valdés
Revista Clínica Española.2018; 218(2): 89. CrossRef
Characteristics of patients with myelomatous pleural effusion. A systematic review
V. Riveiro, L. Ferreiro, M.E. Toubes, A. Lama, J.M. Álvarez-Dobaño, L. Valdés
Revista Clínica Española (English Edition).2018; 218(2): 89. CrossRef
A 76-Year-Old Man With Anemia, Bone Pain, and Progressive Dyspnea
Thitiporn Suwatanapongched, Prapaporn Pornsuriyasak, Wasana Kanoksil, Thotsaporn Morasert, Warapat Virayavanich
Chest.2014; 145(4): 913. CrossRef

The Cytology of Metastatic Angiosarcoma in Pleural Fluid : A Case Report.: Na Rae Kim, Dong Hae Chung, Hyun Yee Cho; Korean J Pathol. 2009;43(3):285-259.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.3.285

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Abstract PDF

A 74-year-old woman presented with an abrupt onset of dyspnea that she had experienced for a week. She had been suffering from cutaneous nodules in the scalp for a year. Thoracentesis of the pleural fluid was performed. The Papanicolaou-stained smears, Thin prep and cell block preparations revealed clusters of oval-shaped cells concentrically layered about amorphous acellular cores, i.e., there was microacinar lumen formation as well as singly scattered atypical cells. The cells occasionally demonstrated intracytoplasmic vacuoles and hemosiderin deposits. Those cells stained for CD31 and they were negative for pancytokeratin. Punch biopsy from the scalp nodules revealed angiosarcoma. There are currently few reported cases of angiosarcoma in an exfoliative pleural effusion. Angiosarcoma has diverse, heterogeneous cytologic features. Making the cytologic diagnosis of metastatic angiosarcoma in pleural fluid is a challenge for pathologists. Knowledge of the clinical history is of great help for diagnosing this tumor when it appears in rare sites. Immunopanels with CD31, pancytokeratin and TTF-1 are helpful for making the differential diagnosis. The pathologists should look for clues suggesting the presence of vascular differentiation in the exfoliative cytologic materials when a diagnosis of angiosarcoma is suspected.

Citations

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Metastatic pleural angiosarcoma: A diagnostic pitfall might be overcome by morphologic clues and clinical correlation
Ok Ran Shin, Uiju Cho, Eundeok Chang, Kyung Jin Seo
Diagnostic Cytopathology.2015; 43(8): 669. CrossRef
Pleural fluid cytology in metastatic uterine angiosarcoma—A case report—
Shiho KURODA, Shioto SUZUKI, Akira KURITA, Mari MURAKI, Fumihiko TANIOKA
The Journal of the Japanese Society of Clinical Cytology.2014; 53(6): 498. CrossRef
Intranasal delivery of biologics to the central nervous system
Jeffrey J. Lochhead, Robert G. Thorne
Advanced Drug Delivery Reviews.2012; 64(7): 614. CrossRef
Fine Needle Aspiration Cytologic Findings of Angiosarcoma - Report of Two Cases -
Jin Xian Ji, Young Chae Chu, Lucia Kim, Suk Jin Choi, In Suh Park, Jee Young Han, Joon Mee Kim, Kyu Ho Kim, Ju Young Song
The Korean Journal of Pathology.2011; 45(2): 217. CrossRef

Effusion Cytology of Ki - 1 Positive Anaplastic Large Cell Lymphoma: A Case Report.: Mi Sook Lee, Mi Ja Lee, Yu Kyung Jeong, Sung Chul Lim, Keun Hong Kee, Ho Jong Jeon; Korean J Cytopathol. 1995;6(2):163-168.

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Abstract PDF: Ki-1 positive anaplastic large cell lymphoma is a newly described high-grade lymphoma and is defined by histopathological and immunologic criteria. We experienced a case of systemically involving Ki-1 positive anaplastic large cell lymphoma in a 44 year-old female which initially manifested as pleural effusion. Abdominopelvic CT scan showed the evidence of marked lymphadenopathy in retroperitoneal and both external and inguinal lymph nodes. On cytologic examination of pleural fluid tumor cells revealed pleomorphic large isolated cells with prominent nucleoli and abundant cytoplasms. The nuclei were large with irregular profiles including some deep invaginations. Also. occasional multilobed/multinucleated and binucleated nuclei were seen. Immunohistochemical examination was performed to differentiate from the undifferentiated adenocarcinoma. Hodgkin's disease, non-Hodgkin's lymphoma and malignant histiocytosis. The neoplastic cells were positive for leukocyte common antigen. CD3 CD30(ki-1) but negative for cytokeratin. epithelial membrane antigen. and CD15. A histologic diagnosis of Ki-1 positive anaplastic lymphoma was made by biopsies of the inguinal lymph node, polypoid lesion of the stomach and cecum.

Cytologic Findings of Rheumatoid Pleuritis in Pleural Effusion: A Case Report .: Hee Jeung Cha, Soo Kee Min, Joon Mee Kim, Young Chae Chu; Korean J Cytopathol. 1997;8(1):47-51.

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Abstract PDF: Patients with rheumatoid arthritis of any degree of severity or duration may develop necrotizing granulomatous pleuritis, a morphologic replica of the inflammatory reaction characteristic of rheumatoid synovitis and rheumatoid nodules. The principal feature is the background composed of granular, amorphous, particulate material or debris of various hues. The material is sometimes eosinophilic, sometimes more cyanophilic, or even green in the Papanicolaou stain. Within this background are elongated, fibroblast-like epithelioid cells, numerous multinucleated giant cells and degenerating leukocytes. The combination of the debris, spindle epithelioid cells, and multinucleated giant cells in fluid is pathognomonic for rheumatoid pleuritis. We experienced a hcase of rheumatoid pleuritis showing these characteristic cytologic findings. The patient was a 63 year-old man with positive rheumatoid factor. The pleual fluid specimen revealed elongated epithelioid cells and multinucleated giant cells in a background of amorphous granular material.

Composite Epithelioid Hemangioendothelioma in Pleural Effusion Mimicking Metastatic Adenocarcinoma: Cytologic and Immunocytochemical Findings.: Ki Seok Jang, Hong Xiu Han, Moon Hyang Park; Korean J Cytopathol. 2003;14(1):36-41.

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Abstract PDF: Epithelioid hemangioendothelioma is a rare vascular tumor of borderline malignancy which is characterized by the presence of "epithelioid" or "histiocytoid" endothelial cells. Superficial and deep tumors have been recognized in the extremities, head, neck, chest, and mediastinum of adult patients. It may also occur as a primary tumor of liver, bone, and other visceral organs. Few effusion cytologic findings of epithelioid hemangioendothelioma have been reported. We report a case of composite epithelioid hemangioendothelioma with focal epithelioid angiosarcomatous areas of the iliac bone and adjacent soft tissue in a 38-year-old female, which, during its metastatic course, was presented as a pleural effusion. The effusion was cellular with epithelioid cells presenting both singly and in clusters. The tumor cells were round to ovoid showing cytoplasmic vacuolization, variability in cell size, and prominent nucleoli. The effusion smears and cell block sections revealed strong positive staining for CD31 and vimentin, weak positive for CD34 and Factor VIII-related antigen, and negative for cytokeratin, CEA, and calretinin. The cytologic findings in this case were similar to that of metastatic adenocarcinoma or malignant mesothelioma. Therefore, immunocytochemical staining in smear and cell block is a helpful tool to differentiate malignant "epithelioid" cells in effusion.

Original Article

A Pathological Review of Pleural Effusion by Immunocytochemical Methods.: Dong Hwan Shin, Hee Jeong Ahn, Woo Ick Yang, In Joon Choi; Korean J Pathol. 1990;24(4):476-481.

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Abstract PDF: An unequivocal diagnosis of mesothelioma during life, on the basis of limited biopsy tissue or cytological specimens, is frequently difficult and requires distinction from inflammatory mesothelial hyperplasia on the one hand and secondary neoplasms, especially adenocarcinoma on the other. Although some studies have produced conflicting results, it is generally believed that immunohistochemical methods can aid in this distinction. To obtain comparable and reproducible results, 23 metastatic carcinoma of the pleura and 2 unequivocal malignant epiehtlial mesotheliomas were studied by the peroxidase-antiperoxedase method on paraffin-embedded cell blocks, and commercially available antibodies to carcinoembryonic antigen (CEA), keratin and epithelial membrane antigen (EMA) were used. Nineteen metastaic adenocarcinoma (73%) and two mesotheliomas (100%) reacted with keratin and EMA antibodies. Nineteen matastatic adenocarcinomas (73%) reacted with EMA antibodies. Nineteen metastatic adenocarcinoma (73%) reacted with CEA antibody; no mesotheliomas stained for CEA. Two cases of reactive mesothlial hyperplasia showed positive for keratin, but negative reaction for EMA and CEA. Noen of the antibodies used in this study was specific for mesothelioma, but CEA was found to be the most useful marker for differentiating between mesothelioma and metastatic carcinoma.

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