scholarly journals Epithelial Membrane Antigen, Vimentin, Desmin, Calretinin, E-Cadherin on Cell Block Preparations to Distinguish Well Differentiated Adenocarcinoma from Benign, Reactive, Atypical Mesothelial Cells

2021 ◽  
Vol 10 (18) ◽  
pp. 1302-1308
Author(s):  
Neha Jaiswal ◽  
Jayant Makrande ◽  
Sunita Vagha
Keyword(s):  
Epithelial Membrane Antigen ◽  
Mesothelial Cells ◽  
Definitive Diagnosis ◽  
Cytological Diagnosis ◽  
Cell Block ◽  
Malignant Cells ◽  
Immunohistochemical Markers ◽  
Adenocarcinoma Cells ◽  
Well Differentiated ◽  
E Cadherin

BACKGROUND Inconclusive cytomorphology often results due to failure to distinguish between adenocarcinoma cells from benign, reactive, atypical mesothelial cells in effusion specimens. To resolve such dilemmas, auxiliary techniques like immunohistochemistry were utilised to reach a definitive diagnosis for better treatment and management of patients. We wanted to compare cytodiagnosis achieved on cell block preparations with the cytodiagnosis on conventional smear and perform immunohistochemistry for epithelial membrane antigen (EMA), calretinin, desmin, vimentin and E-cadherin on cell block preparation of the fluids in cases of indistinguishable cytomorphology of adenocarcinoma and reactive, atypical, and benign mesothelial hyperplasia. METHODS The immunohistochemical markers namely EMA, calretinin, vimentin, desmin and Ecadherin were applied on cell blocks employing streptavidin-biotin method. Immunohistochemistry was interpreted by giving scores to the percentage of stained cells. RESULTS EMA and E-cadherin had 100 % sensitivity in diagnosing adenocarcinoma whereas calretinin, vimentin and desmin were 100 % sensitive in diagnosing reactive, atypical mesothelial carcinoma on the cell block preparations. CONCLUSIONS Immunocytochemistry of fluid should be carried out on the cell block preparation where cytological diagnosis on conventional smear and cell block fails to detect malignant cells in the preparation. KEY WORDS Cell Block, Adenocarcinoma, Mesothelial Cells, Immunohistochemistry, EMA, Calretinin, Vimentin, Desmin, E-Cadherin

scholarly journals Diagnosis of malignant effusion using cell block and immunohistochemistry

2019 ◽  
Vol 7 (9) ◽  
pp. 3556
Author(s):  
Bhavna Gamit ◽  
Deepshikha Dave ◽  
Neha Shahu
Keyword(s):  
Carcinoembryonic Antigen ◽  
Epithelial Membrane Antigen ◽  
Early Stage ◽  
Abdominal Distension ◽  
Mesothelial Cells ◽  
Cell Block ◽  
Malignant Effusion ◽  
Adenocarcinoma Cells ◽  
Signet Ring ◽  
Atypical Cells

The distinction between reactive mesothelial and adenocarcinoma cells specially signet ring type in serous effusions may be very difficult based only on morphological features particularly in early stage. Reactive mesothelial cells show varying degree of cytological atypia hence posing difficulty in differentiating it from adenocarcinoma cells. We report a case of 45 year old female patient presented with abdominal distension. Patient was an operated case of adenocarcinoma of stomach. Smears prepared from ascitic fluid and cell block shows large number of reactive mesothelial cells and few atypical cells. Atypical cells were immunoreactive for cytokeratin, epithelial membrane antigen and carcinoembryonic antigen. These confirmed the presence of malignant epithelial cells so we reported it as a malignant effusion.

scholarly journals EMA-AND USEFUL IMMUNOCYTOCHEMICAL MARKER AT DIFFERENTIATION OF GLANDULAR MALIGNANT CELLS FROM ATYPICAL MESOTHELIAL CELLS ON CELL BLOCK PREPARATION OF BODY EFFUSIONS

2021 ◽  
Vol 10 (4) ◽  
pp. 3459-3463
Author(s):  
Neha Jaiswal
Keyword(s):  
Sensitivity And Specificity ◽  
Predictive Value ◽  
High Sensitivity ◽  
Mesothelial Cells ◽  
P Value ◽  
Cell Block ◽  
Malignant Cells ◽  
Detection Rates ◽  
Well Differentiated

The detection of the malignant cells by cytologic method has long been practised. The detected malignant cells are difficult to be typed specially in the situations of overlapping cytomorphology. The conventional cytologic preparation may harbour lower number of malignant cells but the method of cell block offers high detection rates of such malignant cells. Still the problem remains when the evaluation is short by morphological features and requires immunoexpression studies. The commonest situation encountered of overlap cytomorphology is the distinction between well differentiated adenocarcinoma from reactive mesothelial cells with atypia in effusion. Such a distinction is not only important for the purposes of diagnosis but also for prognostification by stage and management of the patient .The review presents the experiences of the past studies over utility of EMA in detection and segregation of the cells of well differentiated adenocarcinoma infiltrating the effusions from reactive atypical mesothelial cells. The present review is compiled from the publications from various institute across the globe and shares the authors experience for the utility of epithelial membrane antigen over the cell block of effusions at distinction of overlap cytomorphology. Compilation of the study by inclusion of articles by 1,2,3,3,4,5,6,7,8,9,10.The articles were searched through google engine and Pubmed search. The 10 articles dealing onto the role of EMA as a immunocytochemical marker have affirmed the high sensitivity and specificity of EMA at seggregating glandular malignant cells from atypical mesothelial cells on cell block preparation of body effusions.The range of sensitivity and specificity for EMA was found to be 81% -100% and 98.86 -100% respectively.The positive predictive value range from 92-97% and negative predictive value ranging from 88.64 – 100%. All the studies reviewed confirmed the high value of significance (P value for EMA). The systematic review carried out re-affirms the role of EMA in the situations of of indistinguishable cytomorphology of adenocarcinoma from that of benign , reactive , atypical mesothelial cells. The overall diagnostic utility of EMA was conducted to br over 90% in such situations.

scholarly journals Cytological diagnosis of metastatic alveolar rhabdomyosarcoma in the ascitic fluid: Report of a case highlighting the diagnostic difficulties

CytoJournal ◽  
2012 ◽  
Vol 9 ◽  
pp. 9 ◽  
Author(s):  
Andrew C. Nelson ◽  
Charanjeet Singh ◽  
Stefan E. Pambuccian
Keyword(s):  
Ascitic Fluid ◽  
Body Fluid ◽  
Mesothelial Cells ◽  
The Body ◽  
Alveolar Rhabdomyosarcoma ◽  
Cytological Diagnosis ◽  
Malignant Cells ◽  
Diagnostic Difficulties ◽  
Cytological Features ◽  
Fluid Cytology

Alveolar rhabdomyosarcoma is an uncommon tumor affecting adolescents and young adults that is only rarely encountered in body fluid cytology. We report the cytological features of metastatic alveolar rhabdomyosarcoma in the ascitic fluid of a 17-year-old female patient, who had presented with abdominal distention, 21 months after being diagnosed with perirectal alveolar rhabdomyosarcoma. The rare single neoplastic cells that were admixed with abundant reactive mesothelial cells were initially misinterpreted as reactive mesothelial cells. However, their neoplastic nature was established after a careful review of their cytological features and the performance of immunoperoxidase stains. Compared to the reactive mesothelial cells that were present in the sample, the malignant cells were smaller, with less ample and more homogenous cytoplasm. They had slightly larger, more hyperchromatic, and more frequently eccentric nuclei, with larger nucleoli. This case highlights the potential pitfall of the misinterpretation of metastatic alveolar rhabdomyosarcoma cells for reactive mesothelial cells. Awareness of this potential diagnostic problem and recognition of the cytomorphological features of this neoplasm in the body fluids allows the identification of malignant cells, even when they are rare and intimately associated with mesothelial cells.

Cytologic Malignancy Versus Benignancy: How Useful Are the “Newer” Markers in Body Fluid Cytology?

2008 ◽  
Vol 132 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Virganeyce Lyons-Boudreaux ◽  
Dina R. Mody ◽  
Jim Zhai ◽  
Donna Coffey
Keyword(s):  
Malignant Mesothelioma ◽  
Body Cavity ◽  
Mesothelial Cells ◽  
Cell Block ◽  
Metastatic Adenocarcinoma ◽  
Immunohistochemical Markers ◽  
Formalin Fixed Paraffin ◽  
Formalin Fixed Paraffin Embedded ◽  
Membranous Staining ◽  
Sensitive Marker

Abstract Context.—Differentiating reactive effusion, malignant mesothelioma, and metastatic adenocarcinoma in body cavity fluids can be challenging. Interpreting immunohistochemical markers in cell block preparations can be difficult because of nonspecific staining, focal staining, or poor staining quality. We selected a panel of conventional and newer markers to assess their utility in evaluating effusions. Objective.—To evaluate the efficacy of 5 immunohistochemical markers in the differential diagnosis of reactive mesothelial proliferation, malignant mesothelioma, and metastatic adenocarcinoma in body cavity fluids. Design.—A total of 72 formalin-fixed, paraffin-embedded cell block specimens from pleural and peritoneal effusions, including 5 mesotheliomas, 48 adenocarcinomas, and 19 benign effusions were stained with antibodies against calretinin, D2-40, XIAP, MOC-31, and WT1. Results.—All benign effusions and mesotheliomas demonstrated diffuse membranous staining with D2-40. All mesotheliomas displayed calretinin positivity, whereas only 58% of benign effusions stained focally with calretinin. MOC-31 was positive in all cases of adenocarcinoma, whereas all benign effusions and mesotheliomas were negative. All cases of the metastatic adenocarcinoma were negative for calretinin and D2-40. However, background reactive mesothelial cells were positive for calretinin and D2-40. Overall, D2-40 highlighted more mesothelial cells than calretinin. WT1 was positive in 50% of benign effusions, 60% of mesotheliomas, and 27% of adenocarcinomas. XIAP stained most mesotheliomas (80%), some adenocarcinomas (51%), and rare benign effusions (11%). Conclusions.—MOC-31 and D2-40 were very sensitive and specific markers of epithelial and mesothelial cells, respectively. Compared with calretinin, D2-40 was a more sensitive marker of mesothelial cells. WT1 proved to be nonspecific. XIAP was not a sensitive marker for malignancy and had a limited value in cytology. We recommend using a panel to include MOC-31 and D2-40 to improve diagnostic accuracy in body cavity effusions.

scholarly journals A COMPARATVE STUDY ON DIAGNOSTIC YIELD BETWEEN CENTRIFUGED METHOD OF CYTOLOGY AND CELL BLOCK TECHNIQUE

2019 ◽  
Vol 3 (6) ◽  
Author(s):  
Dr. C.Venkata Harish ◽  
Dr. B. Spandana ◽  
Dr. B. Bhanumathi
Keyword(s):  
Diagnostic Yield ◽  
Correct Diagnosis ◽  
Malignant Lesion ◽  
Disease Diagnosis ◽  
Cell Block ◽  
Malignant Cells ◽  
Medical College ◽  
Architectural Patterns ◽  
Well Differentiated ◽  
Adeno Carcinoma

Cytological examination of serous fluids is of paramount importance in disease diagnosis. Cell blocks are particularly useful when the cytological abnormalities are misleading, such as in reactive mesothelial cells or obscure as in occasional well differentiated adenocarcinoma. In the present study, these methods are applied to pleural and peritoneal fluids to conclude the diagnosis as inflammatory, benign or malignant lesion. A sample of 110 fluids obtained during August 2011 to August 2012 in the Department of Pathology, Narayana Medical College, Nellore. Out of 110, 76 (69%) are pleural and 34 (31%) were peritoneal samples. Men were 56.4% and women were 43.6% and the mean age of the study was 50.19 with a standard deviation of 14.81. Among 110 fluids 15 were clinically diagnosed as malignant effusions. Out of which 11 were reported as positive for malignant cells and 4 cases were negative. 3 cases were reported as positive for malignant cells in which they were clinically not diagnosed. Out of 110 cases, 12 were reported as positive for malignant cells by smear whereas 14 cases were reported as positive for malignant cells by cell block. The diagnostic yield is increased by cell block technique. The cell block technique not only increased the positive results, but also helped to demonstrate better architectural patterns which could be of great help in approaching the correct diagnosis of the primary site. Keywords: Cell Block Technique, Cytospin smear, Diagnostic Yield, Adeno carcinoma

scholarly journals Peritoneal well-differentiated papillary mesothelioma associated with infertility in a 37-year-old woman

2021 ◽  
Vol 49 (1) ◽  
pp. 030006052098668
Author(s):  
Bo Pang ◽  
Cong Hu ◽  
Qian Liu ◽  
Jinyu Yu ◽  
Zhentong Wei ◽  
...  
Keyword(s):  
Benign Tumors ◽  
Free Fluid ◽  
Adenomatoid Tumor ◽  
Cancer Antigen 125 ◽  
Immunohistochemical Markers ◽  
Serum Ca125 ◽  
Life Threatening ◽  
Well Differentiated ◽  
The Right

Well-differentiated papillary mesothelioma (WDPM) is an uncommon mesothelial tumor. The lesions may be single or multiple and usually behave in a benign or indolent fashion, sometimes persisting for many years. In the present case, a 37-year-old woman had experienced primary infertility for 12 years, and a diagnostic laparoscopy was performed. Approximately 200 mL of dark red, free fluid in the pelvis and more than 10 yellow-white nodules on the surface of the right round ligament, sacrum ligament, right fallopian tube, and both sides of the uterus were found. A lesionectomy was performed and immunohistochemical markers indicated WDPM with adenomatoid tumor. The patient was monitored by computed tomography and serum CA125 (cancer antigen 125) levels for 49 months with no recurrence. WDPM and adenomatoid tumor are both benign tumors of mesothelial origin. Because of the lack of effective radical treatment, regular follow-up is sufficient. However, the effects of estrogen and progesterone on WDPM and adenomatoid tumors during ovulation or pregnancy remains unclear. Although WDPM is not life threatening, a strategy to fulfill the fertility requirements of women with this condition is a new challenge for infertility doctors.

DNA Content of Normal and Neoplastic Urothelial Cells

1980 ◽  
Vol 66 (4) ◽  
pp. 445-458 ◽  
Author(s):  
Mathilde E. Boon
Keyword(s):  
Dna Content ◽  
Cell Populations ◽  
Malignant Cells ◽  
Urothelial Cells ◽  
Chromatin Pattern ◽  
Normal Bladder ◽  
Well Differentiated ◽  
Dna Measurements ◽  
Combined Parameters ◽  
Umbrella Cells

In search for suitable parameters to detect neoplastic urothelial cells in Acriflavine-Feulgen-SITS stained specimen we compared the cytofluorometric DNA content with the morphology of normal urothelial cells (bladder scrapings) and neoplastic urothelial cells from grade 1, 2, 3 and 4 tumors. An individual normal urothelial cell could not be distinguished from a grade 1 tumor cell, neither morphologically nor fluorometrically. However, the shape of the histograms of DNA measurements of the cell populations of respectively normal bladder scrapings and grade 1 tumors differs. It is postulated that also morphometry of these cell populations may be of some aid to distinguish well-differentiated neoplastic cells from normal urothelial cells. Seventy-one percent of the morphologically malignant cells in the grade 2, 3 and 4 tumor samples could be identified by applying the combined parameters: high DNA content (> 5 C) and nuclear-cytoplasmic ratio (> 0.5) and all grade 2, 3 and 4 tumor samples contained cells which were objectively classified as malignant. Using the same parameters morphologically malignant cells could be distinguished from normal, polyploid umbrella cells, thus these malignant cells are detectable objectively without using chromatin pattern as parameter.

SECRETORY CARCINOMA OF ENDOMETRIUM: A MORPHOLOGICAL MIMICKER POSING DIAGNOSTIC DILEMMA - A RARE CASE

2021 ◽  
pp. 32-33
Author(s):  
Dharani V C ◽  
Manjunath H K ◽  
Bhargavi Mohan ◽  
Varaprasad B M ◽  
Thej M J
Keyword(s):  
Endometrial Thickness ◽  
Good Prognosis ◽  
Endometrial Biopsy ◽  
Pathological Examination ◽  
Secretory Carcinoma ◽  
Diagnostic Dilemma ◽  
Immunohistochemical Markers ◽  
Obese Female ◽  
Well Differentiated ◽  
Post Menopausal

BACKGROUND: Secretory carcinoma of the endometrium, a rare subtype of endometrioid carcinoma morphologically resembles the early secretory phase of endometrium and is almost always well differentiated and carries excellent prognosis. Very few cases of secretory carcinoma have been reported in the literature till date. Case presentation:A 58 yr old obese female presented with post-menopausal bleeding. Ultrasound revealed increased endometrial thickness and endometrial biopsy showed hyperplasia without atypia in secretory transformation. Pathological examination of the hysterectomy specimen revealed features of secretory carcinoma of the endometrium as an incidental nding. CONCLUSION: Secretory carcinoma, a rare subtype of well differentiated endometrial carcinoma carries very good prognosis and morphologically mimics various pathological conditions of endometrium. Hence, this needs to be carefully evaluated morphologically in addition with immunohistochemical markers to arrive at an accurate diagnosis.

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