A review of uncommon cytopathologic diagnoses of pleural effusions from a chest diseases center in Turkey

Our plain-English summary of A review of uncommon cytopathologic diagnoses of pleural effusions from a chest diseases center in Turkey, by E. Cakir, F. Demirag, M. Aydin, et al (CytoJournal, 2011).

The study

• Authors: E. Cakir, F. Demirag, M. Aydin, Y. Erdogan
• Journal: CytoJournal
• Published: 2011;8:13
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: After pneumonia, cancer involving the pleura is the leading cause of exudative pleural effusion. Cytologic examination of pleural effusions is an important initial step in management of malignant effusions. The aim of this study is to evaluate the spectrum of uncommon malignant pleural effusions in a chest disease center in Turkey.

Materials And Methods: A retrospective study of samples of pleural effusions submitted to Ataturk Chest Diseases and Chest Surgery Education and Research Hospital Department of Pathology between March 2005 and November 2008 was performed.

Results: Out of a total of 4684 samples reviewed 364 (7.8%) were positive for cancer cells. Of the malignant pleural effusions 295 (81%) were classified as adenocarcinoma or carcinoma not otherwise specified (NOS). Pleural effusion specimens revealing a diagnosis other than adenocarcinoma/carcinoma NOS were: 32 (8.8%) malignant mesotheliomas, 14 (3.8%) small cell carcinomas, 13 (3.5%) hematolymphoid malignancies and 10 (2.7%) squamous cell carcinoma. Hematolymphoid malignancies included non- Hodgkin lymphoma (diffuse B large cell lymphoma, mantle cell lymphoma), multiple myeloma, chronic myeloid leukemia, and acute myeloid leukemia.

Conclusions: Despite that adenocarcinoma is the most common cause of malignant pleural effusions, there is a significant number of hematological and non-hematological uncommon causes of such effusions. Cytopathologists and clinicians must keep in mind these uncommon entities in routine practice for an accurate diagnosis.

In plain English

This was a retrospective review of pleural fluid samples (fluid from around the lungs) sent to the pathology department of a chest diseases hospital in Ankara, Turkey, from March 2005 to late 2008. Of 4684 specimens from 4516 patients, 364 (7.8%) contained cancer cells, 149 (3.2%) were suspicious for cancer and 4171 (89%) were negative. Most cancer-positive samples, 295 (81%), were adenocarcinoma or carcinoma not otherwise specified. Among the other 69, malignant mesothelioma was most common: 32 samples (8.8% of malignant samples), all confirmed by tissue biopsy. The others were 14 small cell carcinomas, 13 blood or lymph system cancers and 10 squamous cell carcinomas. Of 14 samples reported as suspicious of mesothelioma, clinical follow-up revealed pulmonary embolism in three, and surgical (VATS) biopsy material showed atypical mesothelial proliferation in two. Nine had no follow-up. The authors attributed the high share of mesothelioma to its high incidence in Turkey. The article did not report patients' fiber exposures. The authors concluded that uncommon cancers cause a significant number of malignant pleural effusions.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Retrospective review of pleural effusion cytology specimens at one hospital pathology department
• Who was studied: 4684 pleural fluid specimens from 4516 patients (56 with multiple taps), Ataturk Chest Diseases and Chest Surgery Education and Research Hospital, Ankara, Turkey. The Methods give March 2005 to December 2008; the abstract gives March 2005 to November 2008.
• Exposure: Not studied. No asbestos or other fiber exposure data were reported for the patients. The authors list a history of asbestos exposure among the factors used to tell mesothelioma from reactive mesothelial proliferation.
• Main results:
  • Of all 4684 specimens, 4171 (89%) were negative for cancer, 149 (3.2%) were suspicious for cancer, and 364 (7.8%) were positive for cancer
  • Of the 364 malignant specimens, 295 (81%) were adenocarcinoma or carcinoma not otherwise specified
  • Of the 69 (19%) malignant specimens with other diagnoses, malignant mesothelioma was most common at 32 specimens (8.8% of malignant specimens)
  • Other uncommon cancers among the malignant specimens were small cell carcinoma 14 (3.8%), hematologic malignancies 13 (3.5%) and squamous cell carcinoma 10 (2.7%)
  • All 32 mesothelioma cases had tissue confirmation by pleural or VATS biopsy. The fluid gave the initial diagnosis of malignancy in 7 of the 32.
  • Hematolymphoid malignancies were 9 non-Hodgkin lymphoma, 1 chronic myeloid leukemia, 1 acute myeloid leukemia and 2 multiple myeloma
  • Of 14 specimens reported as suspicious of malignant mesothelioma, 3 revealed pulmonary embolism in clinical follow-up, 2 revealed atypical mesothelial proliferation in VATS material, and 9 had no follow-up
  • In 8 of the 14 small cell carcinoma patients, the initial diagnosis came from pleural fluid cytology
• The authors' conclusion: The authors concluded that malignant mesothelioma was second to adenocarcinoma as a cause of malignant pleural effusion in their study. They also concluded that a significant number of such effusions have uncommon hematological and non-hematological causes, which cytopathologists and clinicians should keep in mind. They attributed the high mesothelioma rate to the high incidence of mesothelioma in Turkey.
• Limitations the authors state:
  • The authors did not use a specific immunostain panel to distinguish reactive mesothelial cells from mesothelioma
  • Nine of the 14 cases reported as suspicious of malignant mesothelioma had no follow-up

Topics

Medical terms in this study, explained in our Lexicon: Pleural Effusion, Pleura, Pathology, Adenocarcinoma, Carcinoma, Mesothelioma, Squamous Cell Carcinoma, Myeloma.

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