Journal of Pathology and Translational Medicine

Original Article

Can BAP1 expression loss in mesothelial cells be an indicator of malignancy?: Hanife Gulnihal Ozdemir, Sermin Coban Kokten, Nagehan Ozdemir Barisik; J Pathol Transl Med. 2020;54(6):497-503. Published online November 9, 2020; DOI: https://doi.org/10.4132/jptm.2020.09.14

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Background
Malignant mesothelioma is a highly aggressive tumor that can be confused with a benign mesothelial lesion, especially cytomorphologic lesions. BRCA1-associated protein 1 (BAP1) acts as a tumor suppressor. In this study, we aim to investigate the value of BAP1 staining of malignant mesothelioma cases with expression loss and diagnosis in cell block and biopsy tissue.
Methods
Between January 2009 and March 2017, 64 mesotheliomas, 117 reactive mesothelial hyperplasias, and 20 fibrinous pleuritis/pericarditis were diagnosed with morphologic and immunohistochemical findings in our pathology clinic and were included in the study. Formalin-fixed, paraffin-embedded tissues were immunohistochemically examined for BAP1. Inflammatory and stromal cells were used as positive internal controls. BAP1 was assessed for nuclear staining in mesothelial cells.
Results
Examinations of the relationship between patient diagnosis and BAP1 biopsy status showed that the BAP1 loss rate (76.6%) was significantly higher in malignant mesothelioma cases than in other benign diseases (0%) (p<.001). Sensitivity and specificity were 76.56% and 100%, respectively, for biopsy tissue from malignant mesothelioma. Sensitivity and specificity were both 100% for BAP1 test on cell block tissue. Furthermore, the consistency between BAP1 cell block and biopsy results was excellent (ĸ=0.90) and the correlation was significant (p<.001).
Conclusions
This study shows that BAP1 expression loss in both cytology and biopsy tissue in biopsy-confirmed malignant mesothelioma cases is an essential parameter for malignant mesothelioma diagnosis.

Citations

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Thrombocytosis as a paraneoplastic syndrome in metastatic malignant peritoneal mesothelioma of biphasic morphology mimicking ovarian adenocarcinoma: A case report
Moustafa S. Alhamadh, Rakan B. Alanazi, Osama Mohaamad Wadaan, Abdulrahman Yousef Alhabeeb, Mohammad Alkaiyat, Ohoud Zaid Aljarbou, Fouad Sabatin
Clinical Case Reports.2023;[Epub] CrossRef
Primary cardiac mesothelioma presenting with fulminant recurrent pericarditis: a case report
Shmuel Schwartzenberg, Yaron Shapira, Victor Rubachevski, Ram Sharony, Harry Klimis, Domenico Filomena, Edgar Francisco Carrizales Sepulveda, Nikolaos Spinthakis, Jonathan Senior
European Heart Journal - Case Reports.2023;[Epub] CrossRef

Case Studies

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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Abstract PDF

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

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Cytopathological Features of Extensive Bilateral Pleural Effusions in Metastatic Prostate Cancer: Report of a Rare Case
Hehua Huang, Caroline Yap
Cureus.2024;[Epub] 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.2022; 42(1): 46. CrossRef
Bilateral pleural effusion: etiology, diagnostics
N. A. Stogova
PULMONOLOGIYA.2022; 32(6): 885. CrossRef

Erdheim-Chester Disease Involving Lymph Nodes and Liver Clinically Mimicking Lymphoma: A Case Report: Yeoun Eun Sung, Yoon Seo Lee, Jieun Lee, Kyo Young Lee; J Pathol Transl Med. 2018;52(3):183-190. Published online December 27, 2017; DOI: https://doi.org/10.4132/jptm.2017.10.16

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Abstract PDF

Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis and multisystem disease. First described in 1930, there are no more than 750 cases reported. The etiology remains unknown, but a majority of cases of ECD and Langerhans cell histiocytosis were found to have clonal mutations involving genes of the mitogen-activated protein kinase pathway. We recently encountered a 53-year-old male patient with extensive ECD involving the systemic lymph nodes, pleura, liver, and long bones clinically mimicking malignant lymphoma. Biopsies were performed at multiple sites, including a pleural mass, an external iliac lymph node, bone marrow, and the liver. Based on histopathological and immunohistochemical findings of positivity for CD68 and negativity for CD1a and S-100, the patient was diagnosed with ECD. Interferon-α was administered as the first-line treatment, but the patient rapidly progressed to hepatic failure after 2 months of treatment. We report this rare case of ECD clinically mimicking malignant lymphoma and diagnosed by careful pathological review.

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Erdheim Chester Disease Mimicking Lymphoma: A Case Report
Philipp Moritz Wunschel, Wolfgang Voss, Marc Keberle
RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren.2022; 194(03): 310. CrossRef
Erdheim–Chester Disease with Isolated CNS Involvement: A Systematic Review of the Literature
Anam Haque, Carlos A. Pérez, Thejasvi A. Reddy, Rajesh K. Gupta
Neurology International.2022; 14(3): 716. CrossRef
Erdheim‐Chester disease with long‐standing diabetes insipidus and generalized edema
Faezeh Sadat Naji, Minoo Sadat Hajmiri, Zahra Mazari, Faeze Salahshour, Vahid Soleimani, Manouchehr Nakhjavani, Mahboobeh Hemmatabadi
Clinical Case Reports.2021;[Epub] CrossRef
Morbus Erdheim-Chester
J. Knitza, E. Kampylafka, J. Wacker, G. Schett, B. Manger
Zeitschrift für Rheumatologie.2019; 78(1): 66. CrossRef
New causes of hypophysitis
Kevin C.J. Yuen, Vera Popovic, Peter J. Trainer
Best Practice & Research Clinical Endocrinology & Metabolism.2019; 33(2): 101276. CrossRef
Primary Necrobiotic Xanthogranulomatous Sialadenitis with Submandibular Gland Localization without Skin Involvement
Myunghee Kang, Na Rae Kim, Dong Hae Chung, Jae Yeon Seok, Dong Young Kim
Journal of Pathology and Translational Medicine.2019; 53(4): 261. CrossRef
Interferon-α

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Merkel Cell Carcinoma Metastatic to Pleural Fluid: A Case Report: Ye-Young Rhee, Soo Hee Kim, Eun Kyung Kim, Se Hoon Kim; J Pathol Transl Med. 2018;52(3):206-209. Published online November 23, 2017; DOI: https://doi.org/10.4132/jptm.2017.11.10

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Abstract PDF

Merkel cell carcinoma (MCC) is a rare aggressive neuroendocrine carcinoma of the skin that shows locoregional or distant metastasis. Metastasis of MCC to body cavity effusion is extremely rare; only three cases have been reported so far. Metastatic MCC in effusion cytology shows small blue round cells with fine stippled chromatin like other small blue round cell tumors such as small cell lung carcinoma or lymphoma. The diagnosis of metastatic MCC can grant patients good chances at recently advanced therapeutic options. Here, we present a case of metastatic MCC to pleural effusion with characteristic single file-like pattern.

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Merkel cell carcinoma presenting as a malignant pleural effusion post‐COVID‐19 hospitalization: A case report and literature review
Joel Lanceta, Mesut Toprak, Oana C. Rosca
Diagnostic Cytopathology.2022;[Epub] CrossRef
Cytology coupled with immunocytochemistry identifies Merkel cell carcinoma: A rare intruder in the cerebrospinal fluid
Reetu Kundu, Brijdeep Singh, Pranab Dey
Cytopathology.2022; 33(4): 530. CrossRef
Derrame pleural por carcinoma de células de Merkel
María J. Soler-Sempere, María O. Alvárez-Fernández, Isabel Padilla-Navas, María Cabezas-Macián, Jose F. Sánchez-Hernández, Eduardo García-Pachón
Archivos de Bronconeumología.2021; 57(11): 715. CrossRef
A rare case of pleural localisation of both metastatic Merkel cell carcinoma and chronic lymphocytic leukaemia
Elise Kaspi, Shirley Fritz, Julien Colle, Florent Amatore, Diane Frankel, Patrice Roll
Cytopathology.2021; 32(3): 367. CrossRef
Merkel cell carcinoma with pleural effusion
María J. Soler-Sempere, María O. Alvárez-Fernández, Isabel Padilla-Navas, María Cabezas-Macián, Jose F. Sánchez-Hernández, Eduardo García-Pachón
Archivos de Bronconeumología (English Edition).2021; 57(11): 715. CrossRef

Brief Case Report

Primary Leiomyosarcoma of Adrenal Gland with Tissue Eosinophilic Infiltration: Seungkoo Lee, Gail Domecq C. Tanawit, Rolando A. Lopez, Jaime T. Zamuco, Betsy Grace G. Cheng, Menandro V. Siozon; Korean J Pathol. 2014;48(6):423-425. Published online December 31, 2014; DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.6.423

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Challenges in the diagnosis of the enigmatic primary adrenal leiomyosarcoma: two case reports and review of the literature
Sawako Suzuki, Naoya Takahashi, Masafumi Sugo, Kazuki Ishiwata, Akiko Ishida, Suzuka Watanabe, Katsushi Igarashi, Yutaro Ruike, Kumiko Naito, Masanori Fujimoto, Hisashi Koide, Yusuke Imamura, Shinichi Sakamoto, Tomohiko Ichikawa, Yoshihiro Kubota, Takeshi
BMC Endocrine Disorders.2023;[Epub] CrossRef
Primary adrenal leiomyosarcoma: clinical case and literature review
S. V. Lukyanov, K. M. Blikyan, S. S. Todorov, V. Y. Deribas, N. S. Lukyanov
Endocrine Surgery.2021; 15(1): 36. CrossRef
Pleomorphic Leiomyosarcoma of the Adrenal Gland in a Young Woman: A Case Report and Review of the Literature

Yuanyuan Wang, Yongliang Teng, Shibo Na, Ye Yuan
OncoTargets and Therapy.2020; Volume 13: 4705. CrossRef
Primary Adrenal Leiomyosarcoma: Clinical, Radiological, and Histopathological Characteristics
Fatema Jabarkhel, Henri Puttonen, Lina Hansson, Andreas Muth, Oskar Ragnarsson
Journal of the Endocrine Society.2020;[Epub] CrossRef
Primary adrenal leiomyosarcoma with inferior vena cava extension in a 70-year-old man
Sai K Doppalapudi, Tejash Shah, Valerie A Fitzhugh, Vladislav Bargman
BMJ Case Reports.2019; 12(3): e227670. CrossRef
Primary Adrenal Leiomyosarcoma: An Extremely Rare Mesenchymal Tumor
D Lokanatha, Linu Abraham Jacob, MC Suresh Babu, KN Lokesh, Ram Krishna Sai, AH Rudresha, LK Rajeev, Smitha Saldanha, MN Suma, A Usha
Indian Journal of Medical and Paediatric Oncology.2019; 40(04): 559. CrossRef

Original Article

Pleural Mesothelioma: An Institutional Experience of 66 Cases: Soomin Ahn, In Ho Choi, Joungho Han, Jhingook Kim, Myung-Ju Ahn; Korean J Pathol. 2014;48(2):91-99. Published online April 28, 2014; DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.2.91

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Abstract PDF

Background

Malignant mesothelioma of the pleura is an aggressive tumor known to be associated with asbestos. Histological diagnosis of mesothelioma is challenging and is usually aided by immunohistochemical markers.

Methods

During an 18-year period (1995-2012), 66 patients with pleural mesothelioma were diagnosed at the Samsung Medical Center in Seoul. We reviewed hematoxylin and eosin and immunohistochemical slides of pleural mesothelioma and evaluated their pathological and clinical features.

Results

The male-to-female ratio was 1.75:1, and age of patients ranged from 28 to 80 years with an average age of 56.84 years. Twenty-two out of 66 patients underwent curative pneumonectomy. Follow-up data was available in 60 patients (90.9%), and 50 of them (83.3%) died from the disease. The average overall survival was 15.39 months. Histologically, the epithelioid type was the most common, followed by the sarcomatoid and the biphasic types. Epidemiologic information was not available in most cases, and only one patient was confirmed to have a history of asbestos exposure.

Conclusions

Malignant mesothelioma of the pleura is a fatal tumor, and the therapeutic benefit of pneumonectomy remains unproven. The combination of calretinin, Wilms tumor 1, HMBE-1, and thyroid transcription factor-1 may provide high diagnostic accuracy in diagnosing mesothelioma.

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Expression of V-set immunoregulatory receptor in malignant mesothelioma
Yeon Seung Chung, Moonsik Kim, Yoon Jin Cha, Kyung A Kim, Hyo Sup Shim
Modern Pathology.2020; 33(2): 263. CrossRef
Is the pathology related to the amount of pleural thickening measured by thorax CT?
özgür katrancıoğlu, Tuba Sahinoglu, Kayhan Karakus, Ozan Kandemir, Semiha Urvay, Esra Aydın Karakaya, Nurkay Katrancioglu
Cumhuriyet Medical Journal.2018; 40(2): 157. CrossRef

Case Reports

Fine Needle Aspiration Cytologic Features of Well-Differentiated Papillary Mesothelioma in the Pleura: A Case Report.: Han Suk Ryu, Min Sun Jin, Hee Seung Choi, HeeJong Baek, Jae Soo Koh; Korean J Pathol. 2009;43(6):583-588.; DOI: https://doi.org/10.4132/KoreanJPathol.2009.43.6.583

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Abstract PDF

Well-differentiated papillary mesothelioma (WDPM) is a rare subtype of malignant mesothelioma, which is considered to have low malignant potential. Because of its rare occurrence in the pleura, cytopathologists are not familiar with the cytologic features of WDPM, and to date only one report regarding the cytomorphology of aspiration biopsies of WDPM in pleura has been released. The authors present the findings of fine needle aspiration cytology of WDPM in the pleura in a 53-year-old woman. Aspiration smears showed papillary clusters composed of one to three layers of surface tumor cells and a central hyalinized stromal core. Tumor cells were round, ovoid, and spindle like with minimally atypical nuclei and small conspicuous nucleoli. Mitotic activity was virtually absent. Excisional biopsy histologic and immunohistochemical findings were wholly compatible with WDPM findings. Knowledge of the specific cytologic findings of WDPM is crucial for accurate diagnosis and appropriate treatment.

Citations

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Well-Differentiated Papillary Mesothelioma of the Peritoneum
Jitendra G. Nasit, Gauravi Dhruva
American Journal of Clinical Pathology.2014; 142(2): 233. CrossRef

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

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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.

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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
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Shiho KURODA, Shioto SUZUKI, Akira KURITA, Mari MURAKI, Fumihiko TANIOKA
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The Korean Journal of Pathology.2011; 45(2): 217. CrossRef

Original Article

Squamous Metaplasia of the Pleura.: Hyun Ju Kim, Jeong Hee Lee, Gyung Hyuck Ko; Korean J Pathol. 1995;29(6):792-793.

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Abstract PDF: We report a case of squamous metaplasia of the pleura observed in a 51 year old man. Squamous metaplasia of serosal surface, and in particular of the pleura, is uncommon. The pathogenesis of squamous metaplasia is obscure, but it may be associated with chronic irritation.

Case Report

Malignant Solitary Fibrous Tumor of the Pleura in Mediastinum.: Yun Kyung Kang, Hyun Joo Yoo, Ho Kee Yum, Hong Sup Lee; Korean J Pathol. 1997;31(4):351-356.

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Abstract PDF: Solitary fibrous tumors (SFTs) most often involve the pleura and also may encompass the peritoneum and nonserosal sites. They occur as solitary encapsulated tumors and pursue a relatively benign clinical course. The usual criteria for malignancy are high cellularity, mitotic activity (more than 4 per 10 high-power fields), cellular pleomorphism, hemorrhage and necrosis as well as infiltrative growth. We report a case of malignant SFT of pleura who presented with an anterior mediastinal mass. Grossly, it was a 10x8x6.5 cm sized, encapsulated and well-demarcated, solid neoplasm with areas of extensive necrosis. Microscopically, parallel or haphazard arrangement of spindle cells with variable degrees of collagenous background were noted. Storiform fascicle formation, hemangiopericytoma-like pattern, and epithelioid cell clusters were often intermingled. Nodular areas with high cellularity and mitotic activity (> or =10/10 HPFs) were scattered throughout the neoplasm, however no definite cellular pleomorphism was encountered. Tumor cells were immunoreactive for vimentin and CD-34, which distinguished them from the mesothelial cells. Electron microscopically, they revealed fibroblastic and myofibroblastic differentiation.

Original Articles

Extrapleural Solitary Fibrous Tumor A clinical & pathological study of 8 cases.: Mi Kyung Lee, Dong Hwan Shin, Min Sun Cho, Yuon Mee Kim, Jin Kim; Korean J Pathol. 1999;33(2):108-114.

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Abstract: We reviewed eight solitary fibrous tumors occurring at sites other than pleura (three orbit, two retroperitoneum, one each hard palate, thyroid, and tongue) which shared the histologic and immunohistochemical features of solitary fibrous tumors of pleura. Six patients were women, and two were men, aged from 26 to 74 years. The tumors ranging from 1.5 to 19 cm in diameter presented as well-circumscribed, unencapsulated, soft to rubbery tissue masses. Histologically they were characterized by a proliferation of spindle or ovoid cells intervened by a dense bundles of collagen. A variety of growth patterns was identified but the so-called patternless pattern was the predominant one. One tumor exhibited highly cellular sarcomatous areas with extensive necrosis, which was diagnosed as malignant solitary fibrous tumor. Immunohistochemical studies showed that all of the tumors were strongly positive for both CD34 and vimentin, but negative for cytokeratin, S-100 protein, EMA, and desmin. One case examined ultrastructurally showed features of fibroblast. All but one showed no evidence of recurrence or metastasis over follow-up period of 14 to 32 months. We conclude that extrapleural solitary fibrous tumors represent a distinct mesenchymal tumor with variable histologic features and should be differentiated from other spindle cell mesenchymal tumors.

Fine Needle Aspiration Cytology of Myxodi Chondrsarcoma of Pleura: A Case Report.: Na Hye Myong, Kyung Ja Cho, Ja June Jang, Jae Il Zo, Young Mog Shim; Korean J Cytopathol. 1990;1(2):152-157.

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Abstract PDF: A 70-year-old female who was diagnosed as myxoid chondrosarcoma by fine needle aspiration of a pleural mass is described. She presented with left chest discomfort of 4 months' duration and aggravating dyspnea and chest pain for 2 months. Chest X-ray and CT scan revealed a large lobulated low density mass invading chest wall at the left pleural cavity and massive pleural fluid. Fine needle aspiration was done under the impression of mesothelioma or metastatic cancer. The aspirates from the mass were very cellular and composed of isolated or clustered forms of large plump cells. Abundant cytoplasm was bluish opaque and the margin was rounded in the isolated cells, whereas clustered cells show ill-defined cell borders and aggregating tendency. The nuclei were eccentric, round to ovoid, and had fine chromatin pattern and multiple small nucleoli. Cellular pleomorphism or mitotic figure was not definite. These findings were consistent with cytologic features of chondrosarcoma. Final diagnosis was confirmed as myxoid chondrosarcoma by mediastinoscopic biopsy and the tumor showed strong positivity for S-100 protein.

Case Report

Cytologic Diagnosis of Malignant Fibrous Histiocytoma in Pleural Fluid: A Case Report.: Hwa Eun Oh, Yoo Hoon Kim, Seong Jin Cho, Young Sik Kim, In Sun Kim; Korean J Cytopathol. 1995;6(1):80-83.

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Abstract PDF: Malignant fibrous histiocytoma is the most common soft tissue sarcoma of late adult life, but it is rare in the pleura. We recently experienced a case of cytology of malignant fibrous histiocytoma in pleural fluid. The smear revealed histiocytic malignant cells, spindle malignant cells and inflammatory cells. The histiocytic cells showed abundant, pale cytoplasm and ovoid, irregular, eccentrically placed nuclei. The spindle cells showed elongated nuclei. Intercellular collagen was also present.

Original Article

Cytologic Analysis of Metastatic Malignant Tumor in Pleural and Ascitic Fluid.: Mee Joo, Hye Je Cho; Korean J Cytopathol. 1995;6(2):125-132.

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Abstract PDF: Cytodiagnosis of pleural and ascitic fluid is a commonly performed laboratory examination. Especially, positivity for malignant cells in effusion cytology is very effective and also presents the first sign of malignancy in unknown primary site of the tumor. We examined each 34 cases of pleural and ascitic fluid cytologic specimen diagnosed as metastatic tumor, which was selected among 964 pleural fluid cytology cases and 662 ascitic fluid cytology cases from September 1989 to June 1995. Among the ascitic fluid cytology specimens examined, 34 specimens were positive in 29 patients. The most common primary neoplasms were carcinomas of ovary (32%), stomach (32%), colon (6%), breast (3%), pancreas (3%), and lung (3%) and lymphoreticular neoplasms (3%). The metastatic tumor was predominantly adenocarcinoma type in both pleural (82%) and ascitic (91%) fluid. The study of metastatic adenocarcinoma in effusion from lung, ovary, and stomach was undertaken to find distinctive features for the identification of the primary site. The smears of metastatic pulmonary adenocarcinoma had a tendency to show high grade pleomorphism and many large tight cell clusters, whereas that of the ovarian adenocarcinoma showed low grade pleomorphism with abundant intracytoplasmic vacuoles in relatively clear background. That of the stomach revealed the intermediate features.

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