KCP673 C 09 8817 Ascites liquid based prepartion

KCP-673 제출기관 : 연세원주기독병원 ; C 09 -8817 Ascites, liquid based prepartion 2009. 04. 전북대학교병원 노상재

Microscopic findings • Moderate cellularity • Atypical cell clusters – Size : medium size – Shape: Polygonal or round to oval – Structure – – • Diffuse sheet or trabecular clusters Distinct cell border Delicate chromatin Irregular nuclear contour One or more small, red nucleoli • Single cells with nuclear indentation – Monocytes? Atypical lymphoid cells? • Background – Lymphocytes, histiocytes, and eosinophils – Few mitoses

Differential diagnosis • Benign condition – Reactive, peritoneal dialysis effect? • Malignancy – Carcinoma • Hepatocellular carcinoma • Adenocarcinoma – Lymphoma – Mesothelioma

• Mesothelioma – Many and large cluster, Variable N/C ratio – Large nucleoli, Thick nuclear membrane, hyperchromatic • Adenocarcinoma – High N/C ratio, large nucleoli, coarse chromatin – Eccentric nucleus, vacuolization, 3 -D aggregates – Glandular, acinar, or papillae • Hepatocellular carcinoma – – – Singly or small clusters, trabecular architecture Prominent nucleoli Abundant, granular cytoplasm Well defined cytoplasmic border Pleomorphism, clumped chromatin Intracytoplasmic vacuole, Bile pigment • Lymphoma – Usually present in large numbers. – Almost never form cohesive, organized aggregates of cells – The nuclear features vary widely depending on the type of lymphoid cells or malignancy.

Benign condition • Peritoneal dialysis: cytologic features – – – N/C ratio ↑ Nuclear hyperchromasia and clumped chromatin Mitosis ↑, atypical mitosis. Spectrum of changes from atypical to normal. Variable inflammatory cells • Neutrophils, lymphocytes, eosinophils • Daisy cells – Unusual variant of mesothelial cells in peritoneal washing chracterized by lobulated nucleus.

Diagnosis • Ascites, liquid based preparation: – Atypical cell clusters, favor reactive mesothelial cells. – Atypical cells with nuclear indentation. – (Lymphoma? ) – Recommend systemic evaluation.