19
Pleural, Peritoneal, and Pericardial Effusions
Fig. 19.65 Cell block of pleural effusion containing large spherules
of
Coccidioides immitis
with endospores. The radiate proteinaceous
precipitate adherent to the organism is an example of the Splendore-Hoeppli
effect (H&E x HP).
Fig. 19.66 Smear of pleural effusion containing budding yeast forms
of
Blastomyces dermatitidis.
The purplish cytoplasm is typical of this
organism when stained with the Papanicolaou stain (Papanicolaou x OI).
In addition to the example illustrated by Bedrossian, Mar-
shall and colleagues identified
H. capsulatum
in a pleural effu-
sion of a patient with AIDS.6,150 As would be expected, the
organisms were intracellular, in histiocytes and neutrophilic
leukocytes.
Reyes and co-workers reported a case of pulmonary and pleu-
ral infection with
A. niger
in a patient with pulmonary tuber-
culosis.151 In addition to the fungus (Fig. 19.67), the bronchial
biopsy specimen and pleural fluid contained sheaves of birefrin-
gent calcium oxalate crystals (Fig. 19.68), a metabolic product
of
Aspergillus
spp., especially
A. niger.
These authors suggested
that the presence of such crystals in a background of inflamma-
tory cells should be a clue to infection with
A. niger
.
Examples of extrapulmonary infection with
P carinii
are rare
but have sharply increased in frequency since the onset of the
AIDS epidemic; the organism has been reported in pleural and
peritoneal fluids.6,19,152-155 Figure 19.69 illustrates
P. carinii
in
pleural fluid of a patient with AIDS; it was present both within
histiocytes and extracellular in the background.
Fig. 19.67 Smear of pleural effusion containing hyphae of
Aspergillus
niger
from a patient with pulmonary tuberculosis. The fungus presumably
was a secondary invader of the tuberculous lung (Papanicolaou x MP).
Fig. 19.68 Smear of pleural effusion containing sheaves of birefringent
calcium oxalate crystals. This is from the same specimen as in Fig. 19.67
(polarized light x LP).
Key features of fungal infections
• Seldom seen in North American practices;
• Most of the infections opportunistic; and
• Fungus readily revealed in routine preparations.
Viral Infection
Viral infection, especially of the lung, frequently causes an effu-
sion containing numerous lymphoid cells, the type of cellular
exudate generally associated with such infections. However, to
diagnose with certainty viral infection of a serous cavity, it is
essential to find cells bearing inclusions specific for a particular
type of virus, so-called virocytes. Such changes in serous fluids
are a rarity.
Despite the frequency that infection with the herpes group of
viruses is manifested in cytologic and histopathologic material,
it has rarely been recorded in serous effusions. The first reported
example was by Goodman and associates, who identified her-
petic virocytes in pleural effusion, presumably due to infection
545
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