Abstract

Aim: To study cytological patterns, both benign and malignant in pleural and peritoneal fluids and to correlate cellular findings with clinical diagnosis

Materials and Methods: The study was conducted in the Department of Pathology, Acharya Shri Chander College of Medical Sciences and Hospital, Sidhra, Jammu (J&K), over a period of one year (Nov.1, 2014 to Oct. 31, 2015). All clinical information regarding age, sex, symptoms and accompany signs, various pathological, biochemical and radiological findings was recorded in a pre structured proforma. Fluids were examined grossly followed by smear preparation. Staining of the slides by Papanicolaou stain and Hematoxylin and Eosin stain (H&E) was done and whenever required special staining like Periodic acid Schiff (PAS) and Alcian blue-PAS was performed.

Results: A total of 140 serous fluids were studied. The youngest patient was 7 years old and the oldest was 80 years old. Male to female ratio was 1.3:1. Of the serous fluids studied, 73 (52.15%) were pleural fluids, 67 (47.85%) were peritoneal fluids. 20% of the serous fluids studied were cytologically malignant and 80% were cytologically benign. 62.14% of the serous fluids were exudative and 37.86% were transudative in nature. Of all the cytologically malignant cases, 85.71% were exudative and 14.29% were transudative in nature. Among the cytologically non-malignant cases, 56.25% were exudative and 43.75% were transudataive in nature. The non-malignant effusions were chiefly caused by Congestive cardiac failure (18.75%), Cirrhosis of liver (13.40%) and tuberculosis (12.50%). Most common causes of transudative non-malignant effusion were CCF, Cirrhosis of liver, nephritic syndrome and pneumothorax. Tuberculosis, renal failure, pneumonia, peritonitis, COPD, acute cholecystites, appendicitis, hepatic abscess, pancreatitis, empyema and pelvic abscess constituted the common causes of exudative non-malignant effusions in decreasing order of frequency .Among the 28 malignant cases 82.14% were adenocarcarnoma, 7.14% as squamous cell carcinoma and lymphoma each and 3.57% as HCC. Lung was the most common primary site for malignant pleural effusion in case of males. In females, lung and breast both shared being the most frequent primary site. In case of peritoneal effusions, GIT formed the most frequent primary site in case of males and ovary in females.

Conclusions: The cytological study of body effusions is a complete diagnostic modality which aims at pointing out the etiology of effusions as well as in certain cases a means of prognostication of the disease process. Further studies need to be carried out including large number of cases along with application of newer technologies in the evaluation of effusions regarding etiology and in case of malignant effusions to determine the primary site. In the recent years with the availability of several antibodies, use of immunohistochemistry (IHC) and even molecular genetics on these fluid specimens, accurate diagnosis can be achieved and the typing of malignant cells has become more reliable.