ON
B
Cytology of Other Body Sites
CHAPTER
19
Pleural, Peritoneal, and Pericardial Effusions
Bernard Naylor
Contents
In tro d u c tio n
H e p a tic C ir rh o s is
S a m p lin g T e c h n iq u e
P a ra s itic , P r o to z o a l, F u n g a l, a n d V ira l In fe c tio n s
F u n g a l In fe c tio n s
C o lle c t in g S e r o u s E ffu s io n s
F is tu la
G ro s s A p p e a r a n c e o f S e r o u s E ffu s io n s
R e d B lo o d C e ll C h a n g e s
C y to p re p a ra to ry T e c h n iq u e
E n d o m e tr io s is
P r e lim in a r y S te p s
C u r s c h m a n n S p ira ls
W e t - F ilm T e c h n iq u e
C h a r c o t- L e y d e n C t
y
s ta ls
P e r m a n e n t S m e a rs
F e r r u g in o u s (A s b e s to s ) B o d ie s
C e ll B lo c k T e c h n iq u e
R e a c tio n t o Io n iz in g R a d ia tio n a n d C h e m o th e r a p y
U s e fu ln e s s o f S ta in e d W e t F ilm s
N e o p la stic E ffu sio n s
U s e fu ln e s s o f C e ll-B lo c k P re p a r a tio n s
G e n e r a l
T h e S e ro u s C a v itie s
I d e n t if ic a t io n o f N e o p la s tic C e lls
T y p e s o f E ffu sio n s
D if f e r e n t ia l D ia g n o s is o f T y p e s o f N e o p la s m s a n d D e t e r m in a t io n o f
P r im a r y S ite s o f N e o p la s m s
T r a n s u d a te s a n d E x u d a te s
A d e n o c a r c in o m a
N o rm a l C e lls
S q u a m o u s C e ll C a r c in o m a
R a n g e o f N o r m a l C e lls
S m a ll- C e ll A n a p la s tic C a r c in o m a
M e s o t h e lia l C e lls
U r o t h e lia l C a rc in o m a
R e d B lo o d C e lls
M e la n o m a
N e u t r o p h il L e u k o c y te s
M e s o t h e lio m a
E o s in o p h ilic L e u k o c y te s
C a r c in o m a o f t h e L u n g
B a s o p h il L e u k o c y te s a n d M a s t C e lls
C a r c in o m a o f t h e B re a s t
H is tio c y te s (M a c ro p h a g e s )
N e o p la s m s o f t h e O v a r y
L y m p h o id C e lls
P s e u d o m y x o m a P e r ito n e i
M e g a k a ry o c y te s
C a r c in o m a o f t h e G a s t r o in t e s tin a l T r a c t
D e ta c h e d C ilia ry T u fts
M is c e lla n e o u s C a rc in o m a s
N o n -n e o p la s tic E ffu sio n s
L y m p h o m a a n d L e u k e m ia
C h r o n ic I d io p a th ic M y e lo fib r o s is
N o n s p e c ific I n f la m m a t io n
S o m e N e o p la s m s R a re ly S e e n in S e ro u s E ffu s io n s
S p e c ific I n f la m m a t o i
y
P ic tu re s
R e p o rt in g o f R e s u lts a n d S ta tis tic s
C o n g e s t iv e H e a r t F a ilu re
P n e u m o n ia
R e p o r tin g
In fa rc t
R e lia b ility o f P o s itiv e a n d N e g a tiv e R e p o rts
P n e u m o t h o r a x
C o n c lu d in g R e m a rk s
T u b e r c u lo s is
Introduction
Sampling Technique
Cytologic examination of a serous effusion is of paramount
importance because the finding of cancer cells in such a speci-
men denotes that the patient has cancer that is not only advanced
but also almost always incurable. With the exception of cerebro-
spinal fluid, in no other type of cytologic specimen does the
finding of exfoliated cancer cells have such ominous prognos-
tic significance. Apart from the finding of cancer cells, cytologic
examination of pleural, peritoneal, and pericardial effusions
may also reveal information about inflammatory conditions
of the serous membranes, parasitic infestations, and infection
with bacteria, fungi, or viruses. It can also supply evidence of the
presence of a fistulous connection with a serous cavity.
Although a serous effusion may be removed at the time of sur-
gical exploration, it is usually sampled by the relatively simple
procedure of inserting a wide-bore needle (under local anesthe-
sia) through the body wall into the fluid-containing cavity. Peri-
toneal fluid is removed by abdominal paracentesis (colloquially
referred to as paracentesis), pleural fluid by thoracentesis, and
pericardial fluid by pericardiocentesis.
Specimens may be obtained by instilling physiologic saline
solution into the various recesses of the peritoneal cavity,
then withdrawing the fluid, and submitting it for cytologic
examination as a peritoneal "washing." This procedure has
acquired a considerable literature and is now part of orthodox
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