VOLUM OMAGIAL - Facultatea de Ştiinţe ale Naturii şi Ştiinţe Agricole

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Ovidius University Annals of Natural Sciences, Biology – Ecology Series Volume 14, 2010 THE CLINICAL UTILITY OF ADITIONAL METHODS IN EFFUSIONS EVALUATION Ana Maria CRETU * , Mariana ASCHIE ** , Diana BADIU ** , Natalia ROSOIU *** *Ovidius University of Constanţa, Natural Sciences Faculty, Department of Biology, Mamaia Avenue, No. 124, Constanţa, 900552, Romania, e-mail: cretu_anamaria@yahoo.com ** Clinical Emergency Hospital of Constanta, Department of Pathology, Tomis Avenue, No. 145, 900591, Constanta ***Ovidius University of Constanţa, Medicine Faculty,Mamaia Avenue, No. 124, Constanţa, 900527, Romania ________________________________________________________________________________________ Abstract: Cells from reactive or hyperplasic mesothelium shed from body cavity surface, in various biological conditions, may present a wide range of deviation from normal cellular morphology, making it difficult, or even impossible, to distinguish them from malignant cells by mean of purely cytological criteria. This study was carried out with the aim to evaluate if macroscopic features and cytologic formula can be used as potential diagnostic tool for distinguishing between malignant cells from reactive mesothelial cells in peritoneal effusions. We have examined the peritoneal effusions collected from 81 available cases, with a histological diagnosis known, from routine morphologic features. The various macroscopic parameters that were registered by macroscopic analysis included the registration of color, transparency and fluidity of peritoneal effusions. Comparing the results, there wasn`t found any relationship between peritoneal fluid containing cancer cells and liquid color. Cell smear appearance had a various cells populations and the quantitative analysis of effusions was not enough useful in establishing the final diagnosis. Keywords: peritoneal effusions, macroscopy, cytology, malign, benign __________________________________________________________________________________________ 1. Introduction The cytological diagnoses of serous effusions are usually made by routine cytomorphology with certainty, allowing treatment decisions. Various studies have shown a sensitivity of 57.3% and specificity of 89% by conventional cytology for the detection of malignant cells in effusion samples [1]. The conventional cytology rate for identification of neoplastic cells in effusions is about 60%. The rate of diagnostically equivocal effusions in routine cytology is dependent on the volume of effusion examined, type of preparation and staining, experience of the examiner, and application of ancillary methods [2]. Peritoneal effusions are a frequently encountered clinical manifestation of metastatic disease, with breast, ovarian, and lung carcinomas and malignant mesothelioma leading the list [3, 4]. Neoplastic cells that disseminate into cavities containing effusions are highly metastatic and possess a strong autonomous proliferative drive while concurrently being stimulatory of exudative effusions. The diagnosis of a malignant effusion signifies disease progression and is associated with a worse prognosis regardless of the tumor site of origin. Furthermore, cancer cells of different origins differ considerably in their biology and have unique phenotypic and genotypic characteristics [5]. Primary cytomorphologic criteria of malignancy include cellular aggregates, pleomorphism (variable cellular appearance), anisocytosis (variation in cell size), anisokaryosis (variation in nuclear size), multinucleation, prominent to irregular nucleoli, increased nuclear to cytoplasmic ratio, monomorphic cellular appearance, and increased mitotic figures. Hyperplastic mesothelial cells also may exhibit anisocytosis, anisokaryosis, increased nuclear to cytoplasmic ratio, binucleate and multinucleate, and scattered mitoses. Any situation that results in fluid accumulation within the body cavities can induce mesothelial cell hyperplasia and exfoliation with an ISSN-1453-1267 © 2010 Ovidius University Press
The clinical utility of aditional methodes... / Ovidius University Annals, Biology-Ecology Series 14: 157-162 (2010) abnormal cellular morphology [2]. Therefore, the differentiation between mesothelial cell hyperplasia and mesothelioma may be difficult or impossible. The first report of an intraoperative examination of peritoneal cytology to detect subclinical metastases was presented in 1971. Patients with normal peritoneal cytological specimens had better survival rates than patients with abnormal findings, but only one abnormal cytologic specimen was found in early stage disease. [6]. Factors such as in patient versus outpatient management and associated procedural discomfort are important in the decision making process, and the patient should participate in these subjective considerations [7]. In addition, the etiology of the primary complaint is frequently multifactorial. However, malignant effusions recur, and therefore repeated paracentesis, especially if the fluid rapidly reaccumulates, is usually not a good long-term solution unless the patient’s overall prognosis and current condition prohibits a more invasive option. It is difficult to compare results and determine the true efficacy of different techniques and agents because endpoints and response criteria as well as the extent and method of follow-up vary. Therefore various techniques should be used to increase the diagnostic accuracy of malignancy in serous effusions. 2. Material and Methods This study was based on evaluation of 81 available cases, with a histological diagnosis known, carried out in Emergency Clinical Hospital of Constanta – Pathological Anatomy Department (SCJUC ) from octobre 2007 to January 2010. Follow-up data were obtained from the Tumor Registry at SCJUC. Clinical charts of all the patients whose peritoneal fluid samples were sent for cytological examination during the study period were retrieved for relevant information. The fluid for cytological analysis was collected during laparotomy from the abdominal cavity. If no fluid was present, the peritoneal cavity was lavaged with saline solution, and the fluid was then collected for analysis. Giemsa stained and Papanicolaou stained slides were prepared from sediment obtained by 158 centrifuging the peritoneal liquid samples at 1500 rpm for 5 minutes, using Shandon Cytospin preparations. After the centrifugation, the stained is fixed using alcohol (95% ethyl alcohol) as the fixative. Effusion cytology was studied from 40 peritoneal effusions associated with at least one malignancy and 41 effusions collected from pacients with hepatic cirrhosis. We have examined the peritoneal effusions from routine macroscopic and cytologic features. Determination (the qualitative method) of cellular density, specific weight and protein content from peritoneal fluid was performed by the Riwalta reactions [61]. Riwalta reaction is the reaction performed for differential diagnosis of exudates from transudates, based on precipitation of fibrin (insoluble protein, the main component of blood clot, a result of thrombin action on fibrinogen in plasma soluble, synthesized by the liver) meeting usual in inflammatory exudates (transudates usual, do not contain this fibrin) [10]. The reaction is positive when dripping the liquid examined in the mixture is obtaining an opalescent, as a cloud. For obtaining the liquid peritoneal cytology formula, 100 cellular elements were measured from each smear cellular, thus directly establishing a percentage value. 3. Results and Discussions From all 81 cases who developed peritoneal fluid, 41 were benign cases (associated with liver cirrhosis), 4 cases were associated with hepatic carcinoma, 4 cases with lung carcinoma, 18 cases with ovarian carcinoma, 4 cases with breast carcinoma, 9 cases with gastrointestinal carcinoma tract and 2 cases with peritoneal mesothelioma (Table 1). The studied cases were divided into two groups: the 41 benign cases were included in lot I and 40 cases of peritoneal fluid associated with cancer were included in lot II. Table 1. Peritoneal fluid distribution according to primary disease and the number of cases Lots Primary disease No of cases Lot I Hepatic cirrhosis 41 (no=41)
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VOLUM OMAGIAL - Facultatea de Ştiinţe ale Naturii şi Ştiinţe Agricole

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