Nilesh P. Patel, MD, 1 Cullen A. Taylor, MD, 1* Edward A. Levine, MD, 2 Jacqueline K. Trupiano, MD, 1* and Kim R. Geisinger, MD 1.

Size: px
Start display at page:

Download "Nilesh P. Patel, MD, 1 Cullen A. Taylor, MD, 1* Edward A. Levine, MD, 2 Jacqueline K. Trupiano, MD, 1* and Kim R. Geisinger, MD 1."

Transcription

1 Anatomic Pathology / PRIMARY PERITONEAL MESOTHELIOMA Cytomorphologic Features of Primary Peritoneal Mesothelioma in Effusion, Washing, and Fine-Needle Aspiration Biopsy Specimens Examination of 49 Cases at One Institution, Including Post Intraperitoneal Hyperthermic Chemotherapy Findings Nilesh P. Patel, MD, 1 Cullen A. Taylor, MD, 1* Edward A. Levine, MD, 2 Jacqueline K. Trupiano, MD, 1* and Kim R. Geisinger, MD 1 Key Words: Peritoneal; Mesothelioma; Cytology; Chemotherapy; Cytoreductive surgery DOI: /DV1JYBL8LLYYT4J5 Abstract Primary peritoneal mesotheliomas (PPMs) are rare tumors of adults. At our institution, PPMs are treated with a combination of cytoreductive surgery and intraperitoneal hyperthermic chemotherapy (IPHC) in appropriate patients. We present a summary of cytologic features of PPM in 49 positive (malignant) specimens during a 15-year period at 1 institution. Of the corresponding 49 PPM histologic specimens, 46 were epithelial, 2 sarcomatoid, and 1 multicystic mesothelioma. This includes our experience with washing specimens obtained from patients with PPM following treatment with cytoreductive surgery combined with IPHC. The rarity of PPM makes this neoplasm unfamiliar to most pathologists. However, cytologic features can be diagnostic in a majority of cases. We present a summary of cytologic features that, in our experience, we find to be most useful in making or excluding a diagnosis of PPM. To our knowledge, this is the first large series reporting the cytomorphologic features of PPM in peritoneal effusions, pelvic washing specimens, and infradiaphragmatic fine-needle aspiration biopsy specimens. Primary peritoneal mesotheliomas (PPMs) are rare tumors of adults The cytomorphologic features of PPM have not been extensively described, although it is reported to be indistinguishable from mesothelioma occurring within the thorax. We present a summary of the cytologic features of PPM in 49 positive (malignant) cytologic specimens from 43 patients during a 15-year period at 1 institution. We also describe our experience with washing specimens obtained from patients with PPM following treatment with cytoreductive surgery combined with intraperitoneal hyperthermic chemotherapy (IPHC), as our institution serves as a major referral center for this treatment modality. Our aim is to provide a concise, practical reference on the cytomorphologic features of PPM with an emphasis on cytologic features most helpful in distinguishing mesothelial neoplasia from reactive or hyperplastic mesothelial proliferations. Materials and Methods The electronic pathology files at Wake Forest University Baptist Medical Center, Winston-Salem, NC, were searched for all cases of PPM from January 1990 to December Only cases with a definitive diagnosis of PPM were included; any case favoring mesothelioma was excluded unless a definitive diagnosis of mesothelioma was established on a concurrent specimen. A total of 49 PPM specimens from 43 patients were recovered that had smeared glass slides available for review. This included 15 ascitic fluid specimens, 27 washing specimens (including 7 post-iphc specimens), and 7 fine-needle aspiration biopsy specimens (FNABs). We also reviewed 6 post-iphc washings interpreted as negative for 414 Am J Clin Pathol 2007;128: DOI: /DV1JYBL8LLYYT4J5

2 Anatomic Pathology / ORIGINAL ARTICLE residual PPM. Cytoreductive surgery and IPHC have been used at our institution for PPM for more than a decade. Our technique and results have been described elsewhere. 12,13 Briefly, after aggressive resection of gross disease, the peritoneum is perfused with chemotherapy (mitomycin C, mitoxantrone and/or cisplatin) for 2 hours with mild hyperthermia (40 C). When this is completed, peritoneal washing specimens are obtained in selected cases before definitive surgical closure. Results The mean patient age was 53 years (range, years) with a male/female ratio of 2.5:1. All specimens had alcoholfixed Papanicolaou (Pap)-stained smeared slides available for review; in addition, paired air-dried smears stained by a rapid Romanowsky (Diff-Quik) method were available for most effusion specimens (9/15) and all FNABs. Histologically, the majority of mesotheliomas were epithelial (tubulopapillary) (46/49). Mesothelioma variants included 2 sarcomatoid cases and 1 multicystic case. Cytologic Features of Effusion Specimens We reviewed 15 cases of PPM diagnosed by effusion cytologic examination, including cases that were initially diagnosed as PPM and others that were initially thought to be suspicious for PPM; all cases were confirmed to be mesothelioma by histologic evaluation. The volume of ascitic fluid varied greatly from 15 ml to substantially more than 1,000 ml. The majority of cases demonstrated a moderate to high number of tumor cells, regardless of specimen volume. The smears typically displayed a background of blood or proteinaceous fluid with a small number of scattered chronic inflammatory cells, including lymphocytes and histiocytes; acute inflammation was not observed. In 3 cases, necrotic debris was conspicuous. One case had rare foci of psammomatous calcification. A few smears contained scattered, single, cytologically bland mesothelial cells within the background, likely representing a separate benign population. The neoplastic mesothelial cells generally were present in high numbers, forming small to medium-sized 3-dimensional groups (typically 5-30 cells per group) Image 1. The groups were tightly cohesive and formed borders that were rounded ( cannonballs ) or knobby (scalloped). The cells at the edges of the scalloped groups often had nuclei directed toward the center with homogeneous cytoplasm directed to the perimeter. Malignant mesothelial cells were also present as dispersed single cells and in couplets, as 1 case consisted exclusively of dispersed single malignant cells. This has previously been described as an epithelial noncohesive cell type of malignant mesothelioma. 4 In our experience, it is uncommon for PPM to manifest exclusively as dispersed single cells in effusions. Image 1 Peritoneal effusion specimen. Three-dimensional group of cohesive neoplastic mesothelial cells with distinct nucleoli, nuclear grooves, and a rare nuclear pseudoinclusion (Papanicolaou, original magnification 600). Cellular groups generally displayed loss of organization and polarity. There was considerable variation in cellular and nuclear size. Cell crowding was prominent, often with compression of adjacent nuclei, but cell overlapping was minimal. Cell-in-cell engulfment was readily noted in the majority of cases (9/15). Mitotic activity was observed in one third of cases (5/15); atypical mitotic figures were not recognized. For the most part, inflammatory cells did not permeate the cell groups. Individually, malignant mesothelial cells displayed central or eccentrically placed nuclei with increased nuclear/cytoplasmic (N/C) ratios, although varying greatly among cells. Many tumor cells had N/C ratios appearing to be within the normal range. Binucleation was seen in scattered tumor cells in all 15 cases. In addition, many cases contained individual tumor cells with 3 to 8 nuclei; in such cases, the nuclei showed obvious pleomorphism but had a tendency to maintain an overall central location. Prominent nucleolation was present in a large percentage of cells in almost all cases (14/15), with nucleoli ranging from 5 to 15 µm in diameter. Nuclear irregularities were present, although sometimes minimal, and were best evaluated on the Pap smears, often revealing small nuclear nicks, notches, and thickening of the nuclear envelopes, in addition to nuclear pseudoinclusions Image 2. Such nuclear irregularities were far more common than overt nuclear abnormalities, eg, nuclear convolutions and grooves (Image 1). In the majority of cases, the tumor cell nuclei were slightly hyperchromatic, although several cases contained cells with vesicular chromatin without obvious chromatin irregularities. In our experience, chromatin detail may be more Am J Clin Pathol 2007;128: DOI: /DV1JYBL8LLYYT4J5 415

3 Patel et al / PRIMARY PERITONEAL MESOTHELIOMA difficult to detect in effusion specimens in comparison with specimens obtained by direct sampling methods, particularly if the smears are thick or have a bloody background. On rapid Romanowsky stained smears, most mesothelioma cells contained a modest volume of homogeneous, dense, blue-green cytoplasm and had well-defined endoplasmic-ectoplasmic demarcations and ruffled cytoplasmic edges or blebs, typical of mesothelial differentiation. There were also scattered cells with large ballooning degenerative vacuoles (empty), occasionally indenting the nucleus into a pseudo signet-ring form. Some cells at the edges of balled-up groups had abundant apical cytoplasm imparting a low-columnar appearance. Rapid Romanowsky staining revealed that a minority of cases (3/15) contained scattered cells with intracytoplasmic magenta material consistent with hyaluronic acid; it is important to not mistake this finding as evidence of epithelial mucin production.9 On many of the effusion specimens (12/15), scanning low-power magnification raised the suspicion of neoplasm owing to the overall hypercellularity and 3-dimensional aggregates of cells. Closer examination of the cytologic features of individual cells enabled the examiner to conclude that the cells were, in fact, neoplastic. Table 1 summarizes the important cytologic features of PPM in effusion specimens. Cytologic Features of Washing Specimens We reviewed 27 available peritoneal washing specimens; all specimens were alcohol-fixed and prepared by a modified Pap method. The specimen volumes ranged from 40 to 350 ml. Seven samples positive for residual PPM were obtained Image 2 Peritoneal effusion specimen. Small cluster of cohesive neoplastic mesothelial cells with a distinct nuclear pseudoinclusion. Note the variability of nuclear sizes (Papanicolaou, original magnification 600) Am J Clin Pathol 2007;128: DOI: /DV1JYBL8LLYYT4J5 Table 1 Cytomorphologic Features of 35 Cases of Primary Peritoneal Mesothelioma in Effusion and Washing Specimens* No. (%) of Cases Feature Nuclear membrane irregularities Macronucleoli Three-dimensional cohesive groups, often scalloped Background blood and chronic inflammatory cells Hypercellular smear Variation in cell size and high nuclear/cytoplasmic ratios Tubulopapillary-like arrangements without fibrovascular cores Cell-in-cell engulfment * 35 (100) 33 (94) 31 (89) 30 (86) 29 (83) 28 (80) 27 (77) 21 (60) In addition, washing specimens had large, irregular sheets of neoplastic mesothelial cells (15/20 [75%]). following IPHC and are discussed in the next section. In addition, the findings on 6 post-iphc washing specimens negative for residual PPM were reviewed. Peritoneal washing specimens in cases of PPM were generally hypercellular with a background of blood, lymphocytes, and macrophages. Cohesive cell groupings similar to those described for effusion specimens were present in most cases. Many dispersed neoplastic cells also populated the background as single cells or in small clusters. In comparison with effusion specimens, washing specimens were more likely to contain broad, irregular, branching sheets, often containing more than several hundred cells per sheet (20/27 [15/20 non-iphc cases]) Image 3. These sheets were several cell layers thick and formed sharp edges, often with loosely cohesive cells Image 3 Peritoneal washing specimen. Two-dimensional sheet of cohesive neoplastic mesothelial cells in a bloody background. Note the conspicuous intercellular windows and rather bland-appearing nuclei (Papanicolaou, original magnification 600).

4 Anatomic Pathology / ORIGINAL ARTICLE exfoliating at the perimeter. Narrow intercellular spaces ( windows ) were best observed in the thinner edges of the groups at the point of cell apposition. Papillary-type configurations were also present with cells displaying high N/C ratios; however, true fibrovascular cores were generally not visualized. Such groups contrast sharply with the flat (but often folded), 2-dimensional groups formed in washing specimens by nonneoplastic mesothelial cells. Mitotic activity was more readily observed on washing specimens than on effusion specimens, predominantly within the large sheets (22/27 [16/20 non-iphc cases]). Individual cells of PPM on peritoneal washing specimens had features similar to those described for effusion specimens. Subtle nuclear contour irregularities and chromatin abnormalities were best visualized at the edges of cell groups or when examining single dispersed cells. Table 1 also summarizes the important cytologic features of washing specimens in effusions. The single case of multicystic PPM in a 41-year-old man yielded a cellular sample with individual cells and flat sheets. Many of the cells totally resembled fully benign mesothelial cells. However, a proportion had cytoplasmic vacuoles. The latter were usually solitary, large, and sharply demarcated from the more peripheral, dense cytoplasm. Often, the vacuole occupied much of the cellular volume, with or without compression of the nucleus. Thus, some cells had an appearance resembling signet-ring cells. Within the sheets, the vacuoles created a honeycomb picture, with a close resemblance to areas of adenomatoid tumors. Cytologic Features of Post-IPHC Washing Specimens We reviewed 13 post-iphc washing specimens; 7 cases were positive for PPM, and 6 were negative. The specimen A volume of post-iphc washing specimens ranged from 40 to 250 ml. Washing specimens with residual tumor had several features in common. The background was uniformly bloody, often adding to the challenge of cytologic interpretation. The smears generally contained low cellularity; all smears demonstrated a marked reduction in the volume of neoplastic cells compared with the pre-iphc washing or effusion specimen. Residual tumor cells were generally present in small sheets and clusters, as well as singly Image 4. Invariably, scattered dispersed mesothelial cells with slight atypia were present in the background; however, it was often difficult to determine whether they were part of the neoplastic population. The most helpful approach was to compare the post-iphc specimen with the diagnostic material obtained before institution of this therapy. Post-IPHC cases that were positive for residual disease contained at least a scattered population of cells with cytologic features similar to those of the previous diagnostic material. Three-dimensional aggregates of atypical mesothelial cells usually indicated residual disease and were observed in 4 of 7 cases. Table 2 summarizes the important cytologic features of PPM in post-iphc washing specimens. Post-IPHC washing specimens that were negative for residual PPM typically produced smears that were paucicellular or virtually acellular with a bloody background. When mesothelial cells were present, they were generally dispersed. Rare, cohesive groups of mesothelial cells were interpreted as benign if they were present in flat 2-dimensional aggregates without significant atypia. Individual cells were interpreted as nonneoplastic if they had low N/C ratios and round, smooth nuclei. Nucleoli, when present, were small but distinct. Macronucleoli should be interpreted with suspicion. Smears B Image 4 Post intraperitoneal hyperthermic chemotherapy peritoneal washing specimens. Three-dimensional cluster (A) and a 2-dimensional sheet (B) of cohesive neoplastic mesothelial cells with macronucleoli (A and B, Papanicolaou, original magnification 600). Am J Clin Pathol 2007;128: DOI: /DV1JYBL8LLYYT4J

5 Patel et al / PRIMARY PERITONEAL MESOTHELIOMA Table 2 Cytomorphologic Features of Seven Cases of Primary Peritoneal Mesothelioma in Post Intraperitoneal Hyperthermic Chemotherapy Washing Specimens Feature Obscuring background blood Residual neoplastic mesothelial cells in small sheets, clusters, and singly Macronucleoli Hypocellular smear Variation in cell size and high nuclear/cytoplasmic ratios Rare, 3-dimensional cohesive groups No. (%) of Cases 7 (100) 7 (100) 7 (100) 6 (86) 5 (71) 4 (57) that had even rare scattered benign and/or reactive-appearing mesothelial cells were interpreted as negative for residual mesothelioma, provided that the specimen volume was adequate. Entirely acellular specimens were interpreted as nondiagnostic and unsatisfactory for evaluation owing to acellularity. Specimens of less than 20 ml that were acellular or contained benign and/or reactive-appearing mesothelial cells were interpreted as nondiagnostic and unsatisfactory for evaluation owing to insufficient volume. Cytologic Features of FNABs We examined 7 cases of PPM diagnosed by FNAB that targeted 4 abdominal masses and 3 in the omentum; 5 cases were for primary diagnosis, and 2 were for recurrence. The following types were diagnosed: epithelial type, Image 5 Omental fine-needle aspiration biopsy specimen. Three-dimensional group of cohesive neoplastic mesothelial cells with increased nuclear/cytoplasmic ratios, nuclear membrane irregularities, and macronucleoli (rapid Romanowsky, original magnification 600) Am J Clin Pathol 2007;128: DOI: /DV1JYBL8LLYYT4J5 4 cases; sarcomatoid type, 2 cases; and multicystic mesothelioma, 1 case. With the exception of the multicystic mesothelioma, all FNABs were suspicious for neoplasm at scanning power owing to hypercellularity and the architectural arrangement of the cell groups. FNAB of epithelial PPM generally yielded highly cellular smears populated by atypical cells arranged in variably cohesive 3-dimensional sheets Image 5. Tubulopapillary structures were common, accompanied by a large number of dispersed atypical cells in the background. The milieu varied greatly; most cases had a clean or slightly bloody background, whereas frank necrosis was seen in 3 of 7 cases. Mitotic figures were identified in all 7 cases, but the number varied greatly, and, on occasion, several mitoses were seen in a single high-power field Image 6. Rare foci of extracellular hyaluronic acid were present in 2 cases of epithelial PPM. This was best visualized on the rapid Romanowsky stained smears because the hyaluronic acid was bright magenta and formed homogeneous, laminar structures that appeared to entrap individual tumor cells Image 7. In other foci, mesothelial cells were arranged in acinar formations with hyaluronic acid present in the center of the group or in the cytoplasm of individual cells, mimicking adenocarcinoma with mucin production. As described by Wojcik and Naylor,14 peritoneal washing specimens in women may contain collagen balls. These structures are composed of collagen cores surrounded by mesothelial cells and are thought to be derived from the surface of the ovaries. They are pitfalls in the diagnosis of glandular Image 6 Omental fine-needle aspiration biopsy specimen. Three-dimensional group of cohesive neoplastic mesothelial cells with a conspicuous mitotic figure (rapid Romanowsky, original magnification 600).

6 Anatomic Pathology / ORIGINAL ARTICLE Image 7 Omental fine-needle aspiration biopsy specimen. Three-dimensional group of cohesive neoplastic mesothelial cells with magenta-staining cytoplasmic hyaluronic acid (rapid Romanowsky, original magnification 600). neoplasms in peritoneal fluids. Although hyaluronic acid and collagen may display similar staining qualities with rapid Romanowsky and Pap stains, hyaluronic acid is best distinguished by its typical intracellular location and presence in individual cells and cohesive aggregates. The neoplastic cells clearly resembled mesothelial cells, even at scanning low-power magnification. This impression was largely due to the plump nature of the tumor cells; the centrally placed, round nucleus; and abundant, dense cytoplasm. On closer inspection, narrow spaces at the point of cell apposition (windows) were occasionally noted. The aspirates of epithelial PPMs were composed of pleomorphic cells with markedly elevated N/C ratios, including many cells with small rims of cytoplasm. The nuclei were generally round (even when quite large) and often centrally placed and bearing prominent macronucleoli, occasionally occupying more than one third of the diameter of the nucleus. The cytoplasm was typically dense and homogeneous, with occasional small perinuclear vacuoles. Many multinucleated tumor cells were present, usually with moderate pleomorphism with rare cells demonstrating up to 10 nuclei. Alcohol-fixed Pap-stained smears revealed moderate nuclear hyperchromasia in most of the cases with minimal chromatin irregularities. Table 3 summarizes the important cytologic features of epithelial PPM in FNABs. Sarcomatoid mesothelioma was diagnosed in 2 FNAB cases. Scanning low-power magnification revealed overt evidence of malignancy in both cases; however, unlike epithelial mesotheliomas, there was no clear resemblance to mesothelial cells. The aspirates were highly cellular with loosely cohesive cell groups and many single pleomorphic cells with elongated contours. Cells had widely variable N/C ratios with large, irregular nuclei. Nuclear outlines were generally oval or spindled with scattered convoluted and irregular forms. The nuclei were hyperchromatic with coarse, unevenly distributed chromatin. Nucleoli were variably present. The cytoplasm was dense and homogeneous with tapered ends. No intercellular windows were observed. A single case of multicystic PPM was evaluated by FNAB. The aspirate was moderately cellular with cohesive aggregates of monomorphic cells with mesothelial features. The background contained areas with thick proteinaceous material; there was no necrosis or inflammation. The sheets of tumor cells were 2-dimensional and folded with an orderly arrangement around variably sized, well-defined, cystic spaces Image 8. This architectural arrangement imparted a honeycomb appearance to the groups. Tubulopapillary structures were not present. The individual cells retained many of the cytologic features typical of nonneoplastic mesothelial cells. The cells had small, central, round to ovoid nuclei without atypia and abundant, cyanophilic cytoplasm with prominent cytoplasmic vacuoles and peripheral pallor. Windows were noted at the point of cell apposition. Nuclei were normochromatic with fine, evenly distributed chromatin. Nucleoli, when present, were small and inconspicuous. Tumor cells were focally entrapped in a bland, paucicellular, collagenous stroma. Mitoses were not seen. Discussion PPMs are uncommon tumors Their cytomorphologic features have not been extensively described, although they are reported to be indistinguishable from those occurring within the thorax. 10 In our experience, the same cytomorphologic features used to distinguish reactive mesothelium from Table 3 Cytomorphologic Features of Four Cases of Epithelial Primary Peritoneal Mesothelioma in Aspiration Specimens Feature No. (%) of Cases Hypercellular smear 4 (100) Three-dimensional cohesive groups 4 (100) Tubulopapillary-like arrangements without 4 (100) fibrovascular cores Multinucleated tumor cells 4 (100) Macronucleoli 4 (100) Mitotic figures (variable numbers) 4 (100) Slightly bloody background 3 (75) Variation in cell size and high nuclear/ 3 (75) cytoplasmic ratios Am J Clin Pathol 2007;128: DOI: /DV1JYBL8LLYYT4J5 419

7 Patel et al / PRIMARY PERITONEAL MESOTHELIOMA A B Image 8 Omental fine-needle aspiration biopsy specimens of multicystic primary peritoneal mesothelioma. Two-dimensional groups of cohesive neoplastic mesothelial cells with bland appearing nuclei and prominent cytoplasmic vacuoles, resembling an adenomatoid tumor (A and B, Papanicolaou, original magnification 400). malignant mesothelioma in the thorax can be translated to the peritoneum. Cerruto et al 15 recently examined the prognostic significance of various histomorphologic parameters in PPMs treated with surgery and IPHC and concluded that nuclear/nucleolar size was useful in assessing prognosis. 15 Because our institution is a referral center for IPHC treatment of peritoneal malignancies, we see a disproportionate number of cases. This report is intended to provide a concise, practical review of the cytologic features of PPM. We have intentionally excluded any reference to the clinical, radiographic, immunohistochemical, and molecular characteristics of mesothelioma; such topics have been well covered elsewhere. 1-3,5-8,16-18 Although PPMs are rare, the diagnosis is commonly considered when pathologists are faced with a hypercellular cytologic sample from the peritoneum. In our experience, hypercellular smears from large-volume, reactive effusions may, at times, be particularly challenging. In such cases, an understanding of the typical cytologic features of PPM is helpful in discerning mesothelial neoplasms from reactive or hyperplastic proliferations. Currently, cytopathologists must rely almost exclusively on cytologic features when making this distinction. We believe that with experience, a diagnosis of PPM can be made from examination of peritoneal fluids alone, without concurrent tissue histologic confirmation, in the appropriate clinicoradiographic context. For the purpose of our study, all 49 cases of PPM had histologic confirmation of mesothelioma. Although the clinicoradiographic findings may influence the interpretation, there are no immunohistochemical stains routinely used to distinguish benign and malignant mesothelial cells. 19 In 1998, Wolanski et al 20 examined the immunoreactivity of epithelial membrane antigen and quantification of silver-stained nucleolar organizer regions (AgNORs) for their usefulness in distinguishing benign and malignant mesothelial lesions. They concluded that a combination of positive immunostaining with epithelial membrane antigen and an increased average area of AgNOR per cell resulted in increased sensitivity in detection of epithelial malignant mesotheliomas. 20 In 2007, Kato et al 21 reported the use of GLUT-1, a member of the mammalian facilitative glucose transporter family, in helping to distinguish benign and malignant mesothelial populations of cells in the context of lung and pleural lesions. They concluded that GLUT-1 was a sensitive and specific immunohistochemical marker for distinguishing benign mesothelium and malignant mesothelioma (positive in only malignant mesothelioma) but was not helpful in distinguishing malignant mesothelioma and non small cell lung carcinoma because both had positive immunostaining. 21 In some situations, a cytologic specimen from the peritoneum may demonstrate unequivocal evidence of malignancy, and the task is to assign the appropriate histogenesis, as is often the case with FNAB of PPM. FNAB of PPM typically yields highly cellular samples with frank architectural and cytologic atypia often accompanied by a tumor diathesis. Coupled with the clinical and radiographic evidence of diffuse tumor, a definitive diagnosis of malignancy can usually be made. However, ancillary studies are generally necessary to confirm the cytologic impression that the lesion is indeed mesothelial in origin Cell-block material for immunohistochemical staining should be obtained at the time of FNAB for this valuable purpose. In general, mesothelioma cells clearly resemble their nonneoplastic counterparts, even at scanning power. This is 420 Am J Clin Pathol 2007;128: DOI: /DV1JYBL8LLYYT4J5

8 Anatomic Pathology / ORIGINAL ARTICLE particularly true of multicystic mesothelioma, a rare tumor with bland cytomorphologic features most often affecting women of reproductive age Excluding this rare subtype, features most helpful in establishing a diagnosis of PPM include a background tumor diathesis, large 3-dimensional groups, a high N/C ratio in a subset of tumor cells, hyperchromasia, macronucleoli, and cell-in-cell engulfment. The presence of significant nuclear pleomorphism within a single multinucleated cell was a distinct feature of malignancy; we have not observed this feature in reactive mesothelial proliferations. In effusion specimens, the cell groupings may be smaller than in FNABs, mitoses may be scant, and necrosis is usually absent. Cells suspended in ascitic fluid may begin to degenerate and lose chromatin detail, making interpretation more difficult. In addition, although most cases of PPM manifest clinically with signs and symptoms indicating malignancy or radiographically with apparent diffuse tumor, occasionally, patients may merely have ascites. Effusion specimens from such patients, with no clinical suspicion of malignancy, should be interpreted cautiously because clinical evidence of tumor is often cited as an important criterion for establishing the diagnosis. 27 Evaluating post-iphc specimens for the presence of residual PPM is certainly a difficult task. Because the washing specimens are often quite bloody from the extensive cytoreductive surgery, it is important to apply a limited amount of material to the glass slide to ensure proper fixation and preservation of morphologic detail during the preparation process. Applying excess material will produce a suboptimal smear that is too thick with poor preservation. Given well-prepared material, the interpretation may still present a challenge. An inexperienced pathologist may be uncertain what degree of cytologic atypia may be secondary to the direct toxic effects of the IPHC. In our experience, reactive mesothelial cells in this setting manifest the typical reactive changes seen in other contexts, including maintenance of low N/C ratios with round, normochromatic nuclei. Nucleoli, if present, are small. We have generally not observed dramatic chemotherapy-induced changes in post-iphc mesothelial cells. This may be due to the specific protocol used at our institution that has a short duration of IPHC (about 2 hours) and the subsequent posttherapy washing. However, it is likely that the cytologic findings may vary depending on the particular treatment method used. 6,12,13,28 In 1988, Geisinger et al 29 reported findings regarding Tenckhoff catheter fluid cytology in the context of patients receiving intraperitoneal chemotherapy for ovarian cancers. They found that nuclear irregularities and hyperchromasia may be prominent in benign mesothelial cells from Tenckhoff catheters exposed intraperitoneally to cytotoxic chemotherapy. This is in contrast with our current observations regarding the presence of only typical reactive changes in post-iphc mesothelial cells. The presence of hypercellular, 3-dimensional groupings of cells indicates residual disease in post-iphc washing specimens. If the population is dispersed, it is especially helpful to compare the current cytologic features with those of the previous material. Wide variation in cell and nuclear size, scattered cells with high N/C ratios, and macronucleoli are evidence of residual tumor. There will be cases with insufficient evidence to conclude whether residual tumor is present. For example, if only rare, scattered, atypical cells are identified, we recommend using the term rare atypical mesothelial cells present and stating the significance this might represent, such as suspicious for residual mesothelioma. However, in our experience, a definitive diagnosis can be made in the majority of cases. Post-IPHC smears that are essentially acellular, but with at least rare scattered benign and/or reactive-appearing mesothelial cells, should be interpreted as negative for residual mesothelioma rather than as inadequate or nondiagnostic, provided that the specimen volume was adequate. Low-volume specimens (<20 ml) with only blood present on the smears are insufficient for interpretation. The rarity of PPM makes these neoplasms unfamiliar to most pathologists. However, cytologic features can be diagnostic in a majority of cases. We present features of PPM in peritoneal effusion specimens, washing specimens, post- IPHC washing specimens, and FNABs that, in our experience, we find to be the most useful in helping to make or exclude a diagnosis of PPM. The cytomorphologic features listed in Tables 1 through 3 are intended to be used in combination to allow for a confident diagnosis of PPM in the appropriate clinicoradiographic context. From the Departments of 1 Pathology and 2 General Surgery, Wake Forest University School of Medicine, Winston-Salem, NC. Address reprint requests to Dr Geisinger: Dept of Pathology, Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC * Drs Taylor and Trupiano are now with the Departments of Pathology, Forsyth Medical Center, Winston-Salem, and William Beaumont Hospital, Royal Oak, MI, respectively. References 1. Kannerstein M, Churg J. Peritoneal mesothelioma. Hum Pathol. 1977;8: Antman K, Shemin R, Ryan L, et al. Malignant mesothelioma: prognostic variables in registry of 180 patients, the Dana-Farber Cancer Institute and Brigham and Women s Hospital experience over two decades, J Clin Oncol. 1988;6: Goldblum J, Hart WR. Localized and diffuse mesotheliomas of the genital tract and peritoneum in women: a clinicopathologic study of nineteen true mesothelial neoplasms, other than adenomatoid tumors, multicystic mesotheliomas, and localized fibrous tumors. Am J Surg Pathol. 1995;19: Am J Clin Pathol 2007;128: DOI: /DV1JYBL8LLYYT4J5 421

9 Patel et al / PRIMARY PERITONEAL MESOTHELIOMA 4. Kho-Duffin J, Tao LC, Cramer H, et al. Cytologic diagnosis of malignant mesothelioma, with particular emphasis on the epithelial noncohesive cell type. Diagn Cytopathol. 1999;20: Taub RN, Keohan ML, Chabot JC, et al. Peritoneal mesothelioma. Curr Treat Options Oncol. 2000;1: Loggie BW. Malignant peritoneal mesothelioma. Curr Treat Options Oncol. 2001;2: Kerrigan SA, Turnnir RT, Clement PB, et al. Diffuse malignant epithelial mesotheliomas of the peritoneum in women: a clinicopathologic study of 25 patients. Cancer. 2002;15: Trupiano JK, Geisinger KR, Willingham MC, et al. Diffuse malignant mesothelioma of the peritoneum and pleura, analysis of markers. Mod Pathol. 2004;17: Geisinger KR, Stanley MW, Raab SS, et al. Modern Cytopathology. Philadelphia, PA: Churchill Livingstone; 2004: Geisinger KR, Stanley MW, Raab SS, et al. Modern Cytopathology. Philadelphia, PA: Churchill Livingstone; 2004: Baker PM, Clement PB, Young RH. Malignant peritoneal mesothelioma in women: a study of 75 cases with emphasis on their morphologic spectrum and differential diagnosis. Am J Clin Pathol. 2005;123: Loggie BW, Fleming RA, McQuellon RP, et al. Prospective trial for the treatment of malignant peritoneal mesothelioma. Am Surg. 2001;67: Loggie BW, Fleming RA, Geisinger KR. Cytologic assessment before and after intraperitoneal hyperthermic chemotherapy for peritoneal carcinomatosis. Acta Cytol. 1996;40: Wojcik EM, Naylor B. Collagen balls in peritoneal washings: prevalence, morphology, origin and significance. Acta Cytol. 1992;36: Cerruto CA, Brun EA, Chang D, et al. Prognostic significance of histomorphologic parameters in diffuse malignant peritoneal mesothelioma. Arch Pathol Lab Med. 2006;130: Friedman MT, Gentile P, Tarectecan A, et al. Malignant mesothelioma: immunohistochemistry and DNA ploidy analysis as methods to differentiate mesothelioma from benign reactive mesothelial cell proliferation and adenocarcinoma in pleural and peritoneal effusions. Arch Pathol Lab Med. 1996;120: Ordonez NG. Role of immunohistochemistry in distinguishing epithelial peritoneal mesotheliomas from peritoneal and ovarian serous carcinomas. Am J Surg Pathol. 1998;22: Ordonez NG. The immunohistochemical diagnosis of epithelial mesothelioma. Hum Pathol. 1999;30: Churg A, Colby TV, Cagle P, et al. The separation of benign and malignant mesothelial proliferations. Am J Surg Pathol. 2000;24: Wolanski KD, Whitaker D, Shilkin KB, et al. The use of epithelial membrane antigen and silver-stained nucleolar organizer regions testing in the differential diagnosis of mesothelioma from benign reactive mesothelioses. Cancer. 1998;82: Kato Y, Tsuta K, Seki K, et al. Immunohistochemical detection of GLUT-1 can discriminate between reactive mesothelium and malignant mesothelioma. Mod Pathol. 2007;20: Weiss SW, Tavassoli FA. Multicystic mesothelioma: an analysis of pathologic findings and biologic behavior in 37 cases. Am J Surg Pathol. 1988;12: Ross MJ, Welch WR, Scully RE. Multilocular peritoneal inclusion cysts (so-called cystic mesotheliomas). Cancer. 1989;64: Devaney K, Kragel PJ, Devaney EJ. Fine-needle aspiration cytology of multicystic mesothelioma. Diagn Cytopathol. 1992;8: Silverman JF, Geisinger KR. Fine Needle Aspiration Biopsy of the Thorax and Abdomen. New York, NY: Churchill Livingstone; 1996: Sawh RN, Malpica A, Deavers MT, et al. Benign cystic mesothelioma of the peritoneum: a clinicopathologic study of 17 cases and immunohistochemical analysis of estrogen and progesterone receptor status. Hum Pathol. 2003;34: Kerrigan SA, Cagle P, Churg A. Malignant mesothelioma of the peritoneum presenting as an inflammatory lesion: a report of four cases. Am J Surg Pathol. 2003;27: Park BJ, Alexander HR, Libutti SK, et al. Treatment of primary peritoneal mesothelioma by continuous hyperthermic peritoneal perfusion (CHPP). Ann Surg Oncol. 1999;6: Geisinger KR, Ng LW, Hopkins MB, et al. Tenckhoff catheter cytology in patients with ovarian cancer. Cancer. 1988;62: Am J Clin Pathol 2007;128: DOI: /DV1JYBL8LLYYT4J5

Diagnostic Challenge. Department of Pathology,

Diagnostic Challenge. Department of Pathology, Cytology of Pleural Fluid as a Diagnostic Challenge Paavo Pääkkö,, MD, PhD Chief Physician and Head of the Department Department of Pathology, Oulu University Hospital,, Finland Oulu University Hospital

More information

Cytology : first alert of mesothelioma? Professor B. Weynand, UCL Yvoir, Belgium

Cytology : first alert of mesothelioma? Professor B. Weynand, UCL Yvoir, Belgium Cytology : first alert of mesothelioma? Professor B. Weynand, UCL Yvoir, Belgium Introduction 3 cavities with the same embryologic origin the mesoderme Pleura Exudates Pleura Peritoneum Pericardium 22%

More information

Cytopathology Case Presentation #8

Cytopathology Case Presentation #8 Cytopathology Case Presentation #8 Emily E. Volk, MD William Beaumont Hospital, Troy, MI Jonathan H. Hughes, MD Laboratory Medicine Consultants, Las Vegas, Nevada Clinical History 44 year old woman presents

More information

Case of the. Month October, 2012

Case of the. Month October, 2012 Case of the Month October, 2012 Case The patient is a 47-year-old male with a 3-week history of abdominal pain. A CT scan of the abdomen revealed a suggestion of wall thickening at the tip of the appendix

More information

Metastatic Lobular Carcinoma of the Breast Presenting as a Frontal Scalp Mass and

Metastatic Lobular Carcinoma of the Breast Presenting as a Frontal Scalp Mass and Metastatic Lobular Carcinoma of the Breast Presenting as a Frontal Scalp Mass and Masquerading as Lymphoma: A Potential Pitfall in Aspiration Cytology Lauren Altman 1, Summer Student; Raptis George 2,

More information

MALIGNANT MESOTHELIOMA UPDATE ON PATHOLOGY AND IMMUNOHISTOCHEMISTRY

MALIGNANT MESOTHELIOMA UPDATE ON PATHOLOGY AND IMMUNOHISTOCHEMISTRY MALIGNANT MESOTHELIOMA CLASSIFICATION MALIGNANT MESOTHELIOMA UPDATE ON PATHOLOGY AND IMMUNOHISTOCHEMISTRY Sisko Anttila, MD, PhD Jorvi Hospital Laboratory of Pathology Helsinki University Hospital Espoo,

More information

Case presentation. Awatif Al-Nafussi

Case presentation. Awatif Al-Nafussi Case presentation Awatif Al-Nafussi Case History 49 year old DVT & small PE June 08, Pelvic mass Ca125 33 Laparotomy-TAHBSO, drainage of ascites Ovarian carcinoma Clinical diagnosis Multiple specimens

More information

Carcinosarcoma of the Ovary

Carcinosarcoma of the Ovary Carcinosarcoma of the Ovary A Rare Finding Presented By: Kathryn Kiely Anisa I. Kanbour School of Cytotechnology of the University of Pittsburgh Medical Center Pittsburgh, PA Patient History 55 year old

More information

Cytology of Malignant Mesothelioma

Cytology of Malignant Mesothelioma 31 Cytology of Malignant Mesothelioma Richard M. DeMay Because patients with mesotheliomas frequently present with effusions, cytologic examination of the effusion fluid may be the first diagnostic study.

More information

MALIGNANT MESOTHELIOMA UPDATE ON PATHOLOGY AND IMMUNOHISTOCHEMISTRY

MALIGNANT MESOTHELIOMA UPDATE ON PATHOLOGY AND IMMUNOHISTOCHEMISTRY MALIGNANT MESOTHELIOMA UPDATE ON PATHOLOGY AND IMMUNOHISTOCHEMISTRY Sisko Anttila, MD, PhD Jorvi Hospital Laboratory of Pathology Helsinki University Hospital Espoo, Finland 2nd Nordic Conference on Applied

More information

Effusions: Mesothelioma and Metastatic Cancers

Effusions: Mesothelioma and Metastatic Cancers Effusions: Mesothelioma and Metastatic Cancers Malignant Mesothelioma Incidence: 2,500 cases/year ~60-80% pts with pleural MM relationship with asbestos exposure Other risk factors: radiation, other carcinogens,

More information

Today s Topics. Tumors of the Peritoneum in Women

Today s Topics. Tumors of the Peritoneum in Women Today s Topics Tumors of the Peritoneum in Women Charles Zaloudek, M.D. Department of Pathology 505 Parnassus Ave., M563 University of California, San Francisco San Francisco, CA USA charles.zaloudek@ucsf.edu

More information

The Use of Immunohistochemistry to Distinguish Reactive Mesothelial Cells From Malignant Mesothelioma in Cytologic Effusions

The Use of Immunohistochemistry to Distinguish Reactive Mesothelial Cells From Malignant Mesothelioma in Cytologic Effusions The Use of Immunohistochemistry to Distinguish Reactive Mesothelial Cells From Malignant Mesothelioma in Cytologic Effusions Farnaz Hasteh, MD 1 ; Grace Y. Lin, MD, PhD 1 ; Noel Weidner, MD 1 ; and Claire

More information

ATLAS OF HEAD AND NECK PATHOLOGY THYROID PAPILLARY CARCINOMA

ATLAS OF HEAD AND NECK PATHOLOGY THYROID PAPILLARY CARCINOMA Papillary carcinoma is the most common of thyroid malignancies and occurs in all age groups but particularly in women under 45 years of age. There is a high rate of cervical metastatic disease and yet

More information

DESMOPLASTIC SMALL ROUND CELL TUMOR: A RARE PATHOLOGY PUZZLE

DESMOPLASTIC SMALL ROUND CELL TUMOR: A RARE PATHOLOGY PUZZLE DESMOPLASTIC SMALL ROUND CELL TUMOR: A RARE PATHOLOGY PUZZLE Ryan Granger University of Rhode Island Cytotechnology program May 2, 2015 ASCT Annual Meeting Nashville, Tennessee DESMOPLASTIC SMALL ROUND

More information

PRIMARY SEROUS CARCINOMA OF PERITONEUM: A CASE REPORT

PRIMARY SEROUS CARCINOMA OF PERITONEUM: A CASE REPORT PRIMARY SEROUS CARCINOMA OF PERITONEUM: A CASE REPORT Dott. Francesco Pontieri (*) U.O. di Anatomia Patologica P.O. di Rossano (CS) Dott. Gian Franco Zannoni Anatomia Patologica Facoltà di Medicina e Chirurgia

More information

ALTHOUGH excellent accounts have been published in recent years of

ALTHOUGH excellent accounts have been published in recent years of THE EXFOLIATIVE CYTOLOGY OF DIFFUSE MALIGNANT MESOTHELIOMA BERNARD NAYLOR Department of Pathology, University of Michigan, Ann Arbor, Michigan, U.S.A. PLATE~ LXXXVI-XCI ALTHOUGH excellent accounts have

More information

ORIGINAL ARTICLES. Materials and Methods

ORIGINAL ARTICLES. Materials and Methods ORIGINAL ARTICLES Cytomorphologic Features of Metastatic Urothelial Carcinoma in Serous Effusions Cheng Cheng Huang, M.D., PH.D., 1 Anoja Attele, M.D., 1 and Claire W. Michael, M.D. 2 * Metastatic urothelial

More information

Practical Effusion Cytology

Practical Effusion Cytology Practical Effusion Cytology A Community Pathologist s Approach to Immunocytochemistry in Body Fluid Cytology Emily E. Volk, MD William Beaumont Hospital Troy, MI College of American Pathologists 2004.

More information

MALIGNANT MESOTHELIOMA: A TYPICAL PRESENTATION IN AN ATYPICAL PATIENT

MALIGNANT MESOTHELIOMA: A TYPICAL PRESENTATION IN AN ATYPICAL PATIENT MALIGNANT MESOTHELIOMA: A TYPICAL PRESENTATION IN AN ATYPICAL PATIENT Written by: Karyn Varley MS, SCT(ASCP) The donating laboratory would like to remain anonymous. PATIENT HISTORY 28 year old female Lived

More information

Diagnosis of Mesothelioma Pitfalls and Practical Information

Diagnosis of Mesothelioma Pitfalls and Practical Information Diagnosis of Mesothelioma Pitfalls and Practical Information Mary Beth Beasley, M.D. Mt Sinai Medical Ctr Dept of Pathology One Gustave L Levy Place New York, NY 10029 (212) 241-5307 mbbeasleymd@yahoo.com

More information

PATHOLOGY OF THE PLEURA: Mesothelioma and mimickers Necessity of Immunohistochemistry. M. Praet

PATHOLOGY OF THE PLEURA: Mesothelioma and mimickers Necessity of Immunohistochemistry. M. Praet PATHOLOGY OF THE PLEURA: Mesothelioma and mimickers Necessity of Immunohistochemistry M. Praet Pathology of the Pleura Normal serosa: visceral and parietal layers Inflammation Neoplasia: Primary: mesothelioma

More information

Malignant Peritoneal Mesothelioma in Women A Study of 75 Cases With Emphasis on Their Morphologic Spectrum and Differential Diagnosis

Malignant Peritoneal Mesothelioma in Women A Study of 75 Cases With Emphasis on Their Morphologic Spectrum and Differential Diagnosis Anatomic Pathology / MALIGNANT PERITONEAL MESOTHELIOMA IN WOMEN Malignant Peritoneal Mesothelioma in Women A Study of 75 Cases With Emphasis on Their Morphologic Spectrum and Differential Diagnosis Patricia

More information

Update on Mesothelioma

Update on Mesothelioma November 8, 2012 Update on Mesothelioma Intro incidence and nomenclature Update on Classification Diagnostic specimens Morphologic features Epithelioid Histology Biphasic Histology Immunohistochemical

More information

Basic Professional Training Program for Associate Medical Technologist

Basic Professional Training Program for Associate Medical Technologist Basic Professional Training Program for Associate Medical Technologist Basic Cytology Part 2 (Preparartion and normal morphology) Normal Morphology in Liquid based Gynecologic Cytology Speaker: Mr. Fung

More information

Effusion cytology. Dr Alpha Tsui Royal Melbourne Hospital 2008

Effusion cytology. Dr Alpha Tsui Royal Melbourne Hospital 2008 Effusion cytology Dr Alpha Tsui Royal Melbourne Hospital 2008 General points: -large unilateral effusion (>1 litre) in the elderly is highly suspicious for malignancy -effusions associated with malignancies

More information

Protocol applies to all primary borderline and malignant epithelial tumors, and malignant mesothelial neoplasms of the peritoneum.

Protocol applies to all primary borderline and malignant epithelial tumors, and malignant mesothelial neoplasms of the peritoneum. Peritoneum Protocol applies to all primary borderline and malignant epithelial tumors, and malignant mesothelial neoplasms of the peritoneum. Protocol revision date: January 2004 No AJCC/UICC staging system

More information

J of Evidence Based Med & Hlthcare, pissn- 2349-2562, eissn- 2349-2570/ Vol. 2/Issue 33/Aug. 17, 2015 Page 5063

J of Evidence Based Med & Hlthcare, pissn- 2349-2562, eissn- 2349-2570/ Vol. 2/Issue 33/Aug. 17, 2015 Page 5063 PERITONEAL MALIGNANT MESOTHELIOMA: A RARE S. R. Dhamotharan 1, S. Shanthi Nirmala 2, F. Celine Foustina Mary 3, M. Arul Raj Kumar 4, R. Vinothprabhu 5 HOW TO CITE THIS ARTICLE: S. R. Dhamotharan, S. Shanthi

More information

Notice of Faculty Disclosure

Notice of Faculty Disclosure The Diagnosis of Malignant Mesothelioma Andrew Churg, MD Department of Pathology University of British Columbia Vancouver, BC, Canada achurg@mail.ubc.ca Notice of Faculty Disclosure In accordance with

More information

Fine Needle Aspiration Cytologic Features of Well-Differentiated Papillary Mesothelioma in the Pleura

Fine Needle Aspiration Cytologic Features of Well-Differentiated Papillary Mesothelioma in the Pleura The Korean Journal of Pathology 2009; 43: 583-8 DOI: 10.4132/KoreanJPathol.2009.43.6.583 Fine Needle Aspiration Cytologic Features of Well-Differentiated Papillary Mesothelioma in the Pleura - A Case Report

More information

Immunohistochemistry on cytology specimens from pleural and peritoneal fluid

Immunohistochemistry on cytology specimens from pleural and peritoneal fluid Immunohistochemistry on cytology specimens from pleural and peritoneal fluid Dr Naveena Singh Consultant Pathologist Bart health NHS Trust London United Kingdom Disclosures and Acknowledgements I have

More information

The Value of Thyroid Transcription Factor-1 in Cytologic Preparations as a Marker for Metastatic Adenocarcinoma of Lung Origin

The Value of Thyroid Transcription Factor-1 in Cytologic Preparations as a Marker for Metastatic Adenocarcinoma of Lung Origin Anatomic Pathology / TTF-1 IN CYTOLOGY OF BODY FLUIDS The Value of Thyroid Transcription Factor-1 in Cytologic Preparations as a Marker for Metastatic Adenocarcinoma of Lung Origin Jonathan L. Hecht, MD,

More information

Cytological Diagnosis of Malignant Pleural Mesothelioma: A Cautionary Note for Lawyers in Asbestos Litigation

Cytological Diagnosis of Malignant Pleural Mesothelioma: A Cautionary Note for Lawyers in Asbestos Litigation Cytological Diagnosis of Malignant Pleural Mesothelioma: A Cautionary Note for Lawyers in Asbestos Litigation Edward Casmere and Joshua Lee Law360 March 7, 2014 For a variety of reasons, lawyers in asbestos

More information

Classificazioni citologiche: verso uno schema internazionale unificato?

Classificazioni citologiche: verso uno schema internazionale unificato? Cytology and molecular biology for thyroid nodules diagnos6c categories to clinical ac6ons From Classificazioni citologiche: verso uno schema internazionale unificato? A. Crescenzi Diagnostic categories

More information

Protocol for the Examination of Specimens From Patients With Tumors of the Peritoneum

Protocol for the Examination of Specimens From Patients With Tumors of the Peritoneum Protocol for the Examination of Specimens From Patients With Tumors of the Peritoneum Protocol applies to all primary borderline and malignant epithelial tumors and malignant mesothelial neoplasms of the

More information

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH

JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH How to cite this article: DEBNATH S, MISRA V, SINGH PA, SINGH M. LOW GRADE CYSTIC MESOTHELIOMA OF RECTUS SHEATH.Journal of Clinical and Diagnostic Research [serial

More information

Malignant Mesothelioma in Body Fluids - with Special Reference to Differential Diagnosis from Metastatic Adenocarcinoma -

Malignant Mesothelioma in Body Fluids - with Special Reference to Differential Diagnosis from Metastatic Adenocarcinoma - The Korean Journal of Pathology 2009; 43: 458-66 DOI: 10.4132/KoreanJPathol.2009.43.5.458 Malignant Mesothelioma in Body Fluids - with Special Reference to Differential Diagnosis from Metastatic Adenocarcinoma

More information

Cytology of Effusion Fluids. Cytology of Effusion Fluids. Types of Effusion Fluids. Anatomy. Causes of Effusions. Sampling of Effusion Fluids

Cytology of Effusion Fluids. Cytology of Effusion Fluids. Types of Effusion Fluids. Anatomy. Causes of Effusions. Sampling of Effusion Fluids Cytology of Effusion Fluids John W. Wong, MD, FRCPC Sunnybrook Health Sciences Centre Assistant Professor, Laboratory Medicine and Pathobiology Faculty of Medicine, University of Toronto November 10, 2012

More information

Something Old, Something New.

Something Old, Something New. Something Old, Something New. Michelle A. Fajardo, D.O. Loma Linda University Medical Center Clinical Presentation 6 year old boy, presented with hematuria Renal mass demonstrated by ultrasound & CT scan

More information

The develpemental origin of mesothelium

The develpemental origin of mesothelium Mesothelioma Tallinn 14.12.06 Henrik Wolff Finnish Institute of Occupational Health The develpemental origin of mesothelium Mesodermal cavities (pleura, peritoneum and pericardium ) are lined with mesenchymal

More information

3-F. Pathology of Mesothelioma

3-F. Pathology of Mesothelioma 3-F. Pathology of Mesothelioma Kouki Inai Professor of Department of Pathology, Graduate School of Biomedical Science, Hiroshima University Introduction Mesothelioma is a peculiar type of malignancy, which

More information

Video Microscopy Tutorial 5

Video Microscopy Tutorial 5 Video Microscopy Tutorial 5 Lool Alikes in Effusion Cytology:Review of Diagnostic Challenges Claire Michael, MD There are no disclosures necessary. Look-Alikes in Effusion Cytology: Review of Diagnostic

More information

Deciduoid Mesothelioma:

Deciduoid Mesothelioma: Deciduoid Mesothelioma: Cytologic Presentation and Diagnostic Pitfalls Cheng Cheng Huang, M.D. and Claire W. Michael, M.D.* We report two cases of malignant deciduoid mesothelioma (MDM), a very rare variant

More information

Breast Fine Needle Aspiration Cytology Reporting : A Study of Application of Probabilistic Approach

Breast Fine Needle Aspiration Cytology Reporting : A Study of Application of Probabilistic Approach 54 Original Study Indian Medical Gazette FEBRUARY 2013 Breast Fine Needle Aspiration Cytology Reporting : A Study of Application of Probabilistic Approach Amrish N. Pandya, Professor & Head, IHBT Department,

More information

Effusions of the Serous Cavities

Effusions of the Serous Cavities Effusions of the Serous Cavities Annika Dejmek Professor/Consultant in Cytopathology Clinical Pathology; Department of Laboratory Medicine, Malmö, Lund University 5th EFCS Tutorial Trondheim 2012 Pleura

More information

TUMORS OF THE TESTICULAR ADNEXA and SPERMATIC CORD

TUMORS OF THE TESTICULAR ADNEXA and SPERMATIC CORD TUMORS OF THE TESTICULAR ADNEXA and SPERMATIC CORD Victor E. Reuter, MD Memorial Sloan-Kettering Cancer Center reuterv@mskcc.org 66 th Annual Pathology Seminar California Society of Pathologists Short

More information

Renal Cell Carcinoma: Advances in Diagnosis B. Iványi, MD

Renal Cell Carcinoma: Advances in Diagnosis B. Iványi, MD Renal Cell Carcinoma: Advances in Diagnosis B. Iványi, MD Department of Pathology University of Szeged, Hungary ISUP Vancouver Classification of Renal Neoplasia Am J Surg Pathol 37:14691489, 2013 13 histologic

More information

More than 2,500 people are diagnosed with mesothelioma in the UK each year.

More than 2,500 people are diagnosed with mesothelioma in the UK each year. This information is an extract from the booklet Understanding mesothelioma. You may find the full booklet helpful. We can send you a free copy see page 5. Contents Introduction Pleural mesothelioma Peritoneal

More information

The Role of Genetic Testing in the Evaluation of Thyroid Nodules. Thyroid Cancer and FNA. Thyroid Cancer. Pure Follicular Cancers.

The Role of Genetic Testing in the Evaluation of Thyroid Nodules. Thyroid Cancer and FNA. Thyroid Cancer. Pure Follicular Cancers. Where does Molecular Analysis of FNA Specimens fit into the evaluation of thyroid nodules? The Role of Genetic Testing in the Evaluation of Thyroid Nodules Ultrasound TSH Risk factors Jill E. Langer, MD

More information

INFLAMMATION AND REACTIVE CHANGES IN CERVICAL EPITHELIUM

INFLAMMATION AND REACTIVE CHANGES IN CERVICAL EPITHELIUM INFLAMMATION AND REACTIVE CHANGES IN CERVICAL EPITHELIUM Inflammation is a response of a tissue to injury, often caused by invading microorganisms. The suffix which indicates inflammation is "-itis" (the

More information

Disclosures. Learning Objectives. Effusion = Confusion. Diagnosis Of Serous Cavity Effusions - Beware The Mesothelial Cell!

Disclosures. Learning Objectives. Effusion = Confusion. Diagnosis Of Serous Cavity Effusions - Beware The Mesothelial Cell! Disclosures Diagnosis Of Serous Cavity Effusions - Beware The Mesothelial Cell! No Relevant Financial Relationships with Commercial Interests Syed Z. Ali, M.D. Syed Z. Ali, M.D. Associate Professor of

More information

Male. Female. Death rates from lung cancer in USA

Male. Female. Death rates from lung cancer in USA Male Female Death rates from lung cancer in USA Smoking represents an interesting combination of an entrenched industry and a clearly drug-induced cancer Tobacco Use in the US, 1900-2000 5000 100 Per Capita

More information

MESOTHELIAL LESIONS OF THE PERITONEUM

MESOTHELIAL LESIONS OF THE PERITONEUM 1 MESOTHELIAL LESIONS OF THE PERITONEUM Philip B. Clement, MD Departments of Pathology, Vancouver General Hospital and the University of British Columbia 2 Mesothelial lesions are commonly encountered

More information

Outline. Workup for metastatic breast cancer. Metastatic breast cancer

Outline. Workup for metastatic breast cancer. Metastatic breast cancer Metastatic breast cancer Immunostain Update: Diagnosis of metastatic breast carcinoma, emphasizing distinction from GYN primary 1/3 of breast cancer patients will show metastasis 1 st presentation or 20-30

More information

Cytopathology of Pleural Mesotheliomas

Cytopathology of Pleural Mesotheliomas Cytopathology of Pleural Mesotheliomas Gia-Khanh Nguyen, MD Key Words: Pleural mesothelioma; Epithelial mesothelioma; Sarcomatous mesothelioma; Mixed mesothelioma; Exfoliative cytology; Fineneedle aspiration

More information

Polyps. Hyperplasias. CAP 2011: Course AP104. The High Risk Benign Endometrium. Mutter and Nucci 1

Polyps. Hyperplasias. CAP 2011: Course AP104. The High Risk Benign Endometrium. Mutter and Nucci 1 Course AP104 Endometrial Hyperplasia A morphologic Definition Hyperplasias Hormonal Effect or Precancer? George L. Mutter, MD Harvard Medical School and Brigham and Women s Hospital Boston, MA Endometrial

More information

Distinguishing benign from malignant mesothelial

Distinguishing benign from malignant mesothelial ORIGINAL ARTICLE IMP3 and GLUT-1 Immunohistochemistry for Distinguishing Benign From Malignant Mesothelial Proliferations Anna F. Lee, MDCM, PhD,*w Allen M. Gown, MD,wz and Andrew Churg, MD*w Abstract:

More information

The evolving pathology of solitary fibrous tumours. Luciane Dreher Irion MREH / CMFT / NSOPS

The evolving pathology of solitary fibrous tumours. Luciane Dreher Irion MREH / CMFT / NSOPS The evolving pathology of solitary fibrous tumours Luciane Dreher Irion MREH / CMFT / NSOPS Historical review Haemangiopericytoma (HPC) first described primarily as a soft tissue vascular tumour of pericytic

More information

LYMPHOMA. BACHIR ALOBEID, M.D. HEMATOPATHOLOGY DIVISION PATHOLOGY DEPARTMENT Columbia University/ College of Physicians & Surgeons

LYMPHOMA. BACHIR ALOBEID, M.D. HEMATOPATHOLOGY DIVISION PATHOLOGY DEPARTMENT Columbia University/ College of Physicians & Surgeons LYMPHOMA BACHIR ALOBEID, M.D. HEMATOPATHOLOGY DIVISION PATHOLOGY DEPARTMENT Columbia University/ College of Physicians & Surgeons Normal development of lymphocytes Lymphocyte proliferation and differentiation:

More information

MAJOR PARADIGM SHIFT IN EARLY 1990S IN UNDERSTANDING RENAL CANCER

MAJOR PARADIGM SHIFT IN EARLY 1990S IN UNDERSTANDING RENAL CANCER Renal tumours WHO 4 MAJOR PARADIGM SHIFT IN EARLY 1990S IN UNDERSTANDING RENAL CANCER Molecular differential pathology of renal cell tumours G. KOVACS A CLASSIFICATION BASED ON UNDERSTANDING THE GENETIC

More information

Case Report of Renal Cell Carcinoma Diagnosed in Voided Urine Confirmed by CD10 Immunocytochemistry

Case Report of Renal Cell Carcinoma Diagnosed in Voided Urine Confirmed by CD10 Immunocytochemistry Novel Insights from Clinical Practice DOI: 10.1159/000326940 Received: January 6, 2011 Accepted: February 21, 2011 Published online: July 22, 2011 Case Report of Renal Cell Carcinoma Diagnosed in Voided

More information

ASBESTOS EXPOSURE AND SARCOMATOID MALIGNANT PLEURAL MESOTHELIOMA Gorantla Sambasivarao 1, Namballa Usharani 2, Tupakula Suresh Babu 3

ASBESTOS EXPOSURE AND SARCOMATOID MALIGNANT PLEURAL MESOTHELIOMA Gorantla Sambasivarao 1, Namballa Usharani 2, Tupakula Suresh Babu 3 ASBESTOS EXPOSURE AND SARCOMATOID MALIGNANT PLEURAL MESOTHELIOMA Gorantla Sambasivarao 1, Namballa Usharani 2, Tupakula Suresh Babu 3 HOW TO CITE THIS ARTICLE: Gorantla Sambasivarao, Namballa Usharani,

More information

A 70-year old Man with Pleural Effusion

A 70-year old Man with Pleural Effusion Mesothelioma Diagnosis: Pitfalls and Latest Updates S Klebe and DW Henderson Recommendations Indisputable malignant cells on cytomorphological criteria which demonstrate a mesothelial phenotype, which

More information

Diagnosis Of Serous Cavity Effusions - Beware The Mesothelial Cell! Effusion = Confusion

Diagnosis Of Serous Cavity Effusions - Beware The Mesothelial Cell! Effusion = Confusion Diagnosis Of Serous Cavity Effusions - Beware The Mesothelial Cell! Effusion = Confusion Syed Z. Ali, M.D. Professor of Pathology and Radiology The Johns Hopkins Hospital Baltimore, Maryland Diagnostic

More information

H istochem istry in the Diagnosis o f M alignant M esotheliom a *

H istochem istry in the Diagnosis o f M alignant M esotheliom a * A n n a l s o f C l i n i c a l L a b o r a t o r y S c i e n c e, Vol. 3, No. 3 Copyright 1973, Institute for Clinical Science H istochem istry in the Diagnosis o f M alignant M esotheliom a * MILTON

More information

Pathology of the Female Peritoneum, Common and Uncommon Problems

Pathology of the Female Peritoneum, Common and Uncommon Problems Pathology of the Female Peritoneum, Common and Uncommon Problems An Update on Gynecologic Pathology Florence, Italy Anaís Malpica, M.D. Professor of Pathology Pathology of the Female Peritoneum Keratin

More information

20 Diagnostic Cytopathology, Vol 36, No 1 ' 2007 WILEY-LISS, INC.

20 Diagnostic Cytopathology, Vol 36, No 1 ' 2007 WILEY-LISS, INC. Utility of WT-1, p63, MOC31, Mesothelin, and Cytokeratin (K903 and CK5/6) Immunostains in Differentiating Adenocarcinoma, Squamous Cell Carcinoma, and Malignant Mesothelioma in Effusions Robert T. Pu,

More information

Objectives. Mylene T. Truong, MD. Malignant Pleural Mesothelioma Background

Objectives. Mylene T. Truong, MD. Malignant Pleural Mesothelioma Background Imaging of Pleural Tumors Mylene T. Truong, MD Imaging of Pleural Tumours Mylene T. Truong, M. D. University of Texas M.D. Anderson Cancer Center, Houston, TX Objectives To review tumors involving the

More information

National Coverage Determination (NCD) for Tumor Antigen by Immunoassay - CA 125 (190.28)

National Coverage Determination (NCD) for Tumor Antigen by Immunoassay - CA 125 (190.28) National Coverage Determination (NCD) for Tumor Antigen by Immunoassay - CA 125 (190.28) Tracking Information Publication Number Manual Section Number 100-3 190.28 Manual Section Title Tumor Antigen by

More information

EDUCATIONAL COMMENTARY PERIPHERAL BLOOD CELL MORPHOLOGY IN SEPTICEMIA

EDUCATIONAL COMMENTARY PERIPHERAL BLOOD CELL MORPHOLOGY IN SEPTICEMIA Learning Objectives Upon completion of this exercise participants will be able to: identify morphologic features of mature and immature leukocytes. distinguish extracellular and intracellular bacteria

More information

Cytology of Lymph Nodes

Cytology of Lymph Nodes Indications Cytology of Lymph Nodes Lymph node enlargement That was easy Mary Anna Thrall Don Meuten Indications Lymph node enlargement Suspect metastasis Normal sized lymph nodes are Normal Do NOT aspirate

More information

H. Richard Alexander, Jr., M.D. Department of Surgery and The Greenebaum Cancer Center University of Maryland School of Medicine Baltimore, Md

H. Richard Alexander, Jr., M.D. Department of Surgery and The Greenebaum Cancer Center University of Maryland School of Medicine Baltimore, Md Major Advances in Cancer Prevention, Diagnosis and Treatment~ Why Mesothelioma Leads the Way H. Richard Alexander, Jr., M.D. Department of Surgery and The Greenebaum Cancer Center University of Maryland

More information

INTRAPERITONEAL HYPERTHERMIC CHEMOTHERAPY (IPHC) FOR PERITONEAL CARCINOMATOSIS AND MALIGNANT ASCITES. INFORMATION FOR PATIENTS AND FAMILY MEMBERS

INTRAPERITONEAL HYPERTHERMIC CHEMOTHERAPY (IPHC) FOR PERITONEAL CARCINOMATOSIS AND MALIGNANT ASCITES. INFORMATION FOR PATIENTS AND FAMILY MEMBERS INTRAPERITONEAL HYPERTHERMIC CHEMOTHERAPY (IPHC) FOR PERITONEAL CARCINOMATOSIS AND MALIGNANT ASCITES. INFORMATION FOR PATIENTS AND FAMILY MEMBERS Description of Treatment A major difficulty in treating

More information

Information Model Requirements of Post-Coordinated SNOMED CT Expressions for Structured Pathology Reports

Information Model Requirements of Post-Coordinated SNOMED CT Expressions for Structured Pathology Reports Information Model Requirements of Post-Coordinated SNOMED CT Expressions for Structured Pathology Reports W. Scott Campbell, Ph.D., MBA James R. Campbell, MD Acknowledgements Steven H. Hinrichs, MD Chairman

More information

Académie internationale de Pathologie - Division arabe XX ème congrès 24-26 novembre 2008 Alger. Immunohistochemistry in malignant mesotheliomas

Académie internationale de Pathologie - Division arabe XX ème congrès 24-26 novembre 2008 Alger. Immunohistochemistry in malignant mesotheliomas Académie internationale de Pathologie - Division arabe XX ème congrès 24-26 novembre 2008 Alger Immunohistochemistry in malignant mesotheliomas Françoise Thivolet-Béjui Groupement Hospitalier Est Lyon-Bron

More information

Case based applications part III

Case based applications part III Case based applications part III Los Angeles Society Of Pathologists January 25, 2014 Sanja Dacic, MD, PhD University of Pittsburgh Medical Center 1 CASE 1 A 44-year-old woman with multiple lung nodules.

More information

Pleural and Pericardial fluids a one year analysis

Pleural and Pericardial fluids a one year analysis Pleural and Pericardial fluids a one year analysis Dr Olafsdottir Dr J Williams Department of Cytology, Llandough Hospital Contents Background Standards Aims/Questions Investigation group Results Conclusions

More information

Introduction: Tumor Swelling / new growth / mass. Two types of growth disorders: Non-Neoplastic. Secondary / adaptation due to other cause.

Introduction: Tumor Swelling / new growth / mass. Two types of growth disorders: Non-Neoplastic. Secondary / adaptation due to other cause. Disorders of Growth Introduction: Tumor Swelling / new growth / mass Two types of growth disorders: Non-Neoplastic Secondary / adaptation due to other cause. Neoplastic. Primary growth abnormality. Non-Neoplastic

More information

Lung Carcinomas New 2015 WHO Classification. Spasenija Savic Pathology

Lung Carcinomas New 2015 WHO Classification. Spasenija Savic Pathology Lung Carcinomas New 2015 WHO Classification Spasenija Savic Pathology ***EXPECTED SPRING 2015*** This authoritative, concise reference book provides an international standard for oncologists and pathologists

More information

Case Report Pleural Mesothelioma Presenting as Periumbilical Metastasis: The First Clinical Documentation

Case Report Pleural Mesothelioma Presenting as Periumbilical Metastasis: The First Clinical Documentation Volume 2013, Article ID 198729, 4 pages http://dx.doi.org/10.1155/2013/198729 Case Report Pleural Mesothelioma Presenting as Periumbilical Metastasis: The First Clinical Documentation R. F. Falkenstern-Ge,

More information

Luis D. Carcorze Soto, MD PGY-3

Luis D. Carcorze Soto, MD PGY-3 Luis D. Carcorze Soto, MD PGY-3 Peritoneal Surface Malignancies Peritoneum Patient Selection Operative Technique HIPEC EPIC Primary: Primary Peritoneal Carcinoma Malignant Peritoneal Mesothelioma Metastatic:

More information

Fact sheet 10. Borderline ovarian tumours. The difficult cases. What is borderline ovarian cancer (BOC)?

Fact sheet 10. Borderline ovarian tumours. The difficult cases. What is borderline ovarian cancer (BOC)? For this reason, some doctors prefer the term borderline ovarian tumour rather than borderline ovarian cancer. Fact sheet 10 Borderline ovarian tumours We, Ovacome, are a support network for people affected

More information

Ovarian mucinous lesions. Ovarian mucinous lesions: Common diagnostic dilemmas. Ovarian mucinous lesions: problematic issues

Ovarian mucinous lesions. Ovarian mucinous lesions: Common diagnostic dilemmas. Ovarian mucinous lesions: problematic issues Ovarian mucinous lesions Ovarian mucinous lesions: Common diagnostic dilemmas Karuna Garg, MD University of California San Francisco Intestinal or usual type Seromucinous (Endocervical mucinous or Mullerian

More information

Diseases. Inflammations Non-inflammatory pleural effusions Pneumothorax Tumours

Diseases. Inflammations Non-inflammatory pleural effusions Pneumothorax Tumours Pleura Visceral pleura covers lungs and extends into fissures Parietal pleura limits mediastinum and covers dome of diaphragm and inner aspect of chest wall. Two layers between them (pleural cavity) contains

More information

Histologic Classification and Differential Diagnosis of Mesothelioma

Histologic Classification and Differential Diagnosis of Mesothelioma THE YALE JOURNAL OF BIOLOGY AND MEDICINE 54 (1981), 173-180 Histologic Classification and Differential Diagnosis of Mesothelioma DARRYL CARTER, M.D. Department of Pathology, Yale University School of Medicine,

More information

PRODYNOV. Targeted Photodynamic Therapy of Ovarian Peritoneal Carcinomatosis ONCO-THAI. Image Assisted Laser Therapy for Oncology

PRODYNOV. Targeted Photodynamic Therapy of Ovarian Peritoneal Carcinomatosis ONCO-THAI. Image Assisted Laser Therapy for Oncology PRODYNOV Targeted Photodynamic Therapy of Ovarian Peritoneal Carcinomatosis ONCO-THAI Image Assisted Laser Therapy for Oncology Inserm ONCO-THAI «Image Assisted Laser Therapy for Oncology» Inserm ONCO-THAI

More information

Atypical uterine leiomyoma: a case report and review of the literature

Atypical uterine leiomyoma: a case report and review of the literature Manxhuka-Kerliu et al. Journal of Medical Case Reports (2016) 10:22 DOI 10.1186/s13256-016-0800-3 CASE REPORT Open Access Atypical uterine leiomyoma: a case report and review of the literature Suzana Manxhuka-Kerliu

More information

The Benign Endometrial Hyperplasia Sequence

The Benign Endometrial Hyperplasia Sequence Page 1 Slide 1 Introduction A mini lecture from www.endometrium endometrium.org The Benign Endometrial Hyperplasia Sequence This is Dr. George Mutter, I am a gynecologic pathologist at Harvard Medical

More information

OBJECTIVES By the end of this segment, the community participant will be able to:

OBJECTIVES By the end of this segment, the community participant will be able to: Cancer 101: Cancer Diagnosis and Staging Linda U. Krebs, RN, PhD, AOCN, FAAN OCEAN Native Navigators and the Cancer Continuum (NNACC) (NCMHD R24MD002811) Cancer 101: Diagnosis & Staging (Watanabe-Galloway

More information

Diagnostic Pitfalls In Thoracic Tumors

Diagnostic Pitfalls In Thoracic Tumors 1376 Diagnostic Pitfalls In Thoracic Tumors Neda Kalhor, MD Cesar A. Moran, MD, FASCP WEEKEND OF PATHOLOGY AMERICAN SOCIETY FOR CLINICAL PATHOLOGY 33 W Monroe Ste 1600 Chicago, IL 60603 Program Content

More information

Gastrointestinal Oncology Peritoneal Mesothelioma

Gastrointestinal Oncology Peritoneal Mesothelioma Gastrointestinal Oncology Two Decades of Progress in the Management of a Rare Disease Paul H Sugarbaker, MD, FACS, FRCS Medical Director, Center for Gastrointestinal Malignancies, MedStar Washington Hospital

More information

P L E U R A L M E S O T H E L I O M A

P L E U R A L M E S O T H E L I O M A For media outside the US, UK and Canada only P L E U R A L M E S O T H E L I O M A 1. Overview 2. What is pleural mesothelioma? 3. How common is pleural mesothelioma? 4. What are the risk factors for pleural

More information

Angiosarcoma, Radiation-Associated Angiosarcoma, and Atypical Vascular Lesion. David R. Lucas, MD

Angiosarcoma, Radiation-Associated Angiosarcoma, and Atypical Vascular Lesion. David R. Lucas, MD Angiosarcoma, Radiation-Associated Angiosarcoma, and Atypical Vascular Lesion N Angiosarcoma, one of the least common sarcomas, has become increasingly important because of its association with radiation

More information

Validation of BRAF Mutational Analysis in Thyroid Fine Needle Aspirations: A Morphologic- Molecular Approach

Validation of BRAF Mutational Analysis in Thyroid Fine Needle Aspirations: A Morphologic- Molecular Approach Validation of BRAF Mutational Analysis in Thyroid Fine Needle Aspirations: A Morphologic- Molecular Approach Kerry C. Councilman, MD Assistant Professor University of Colorado Denver Goals: BRAF Mutation

More information

HKCPath Anatomical Pathology Peer Review and Scores : PDF version for download

HKCPath Anatomical Pathology Peer Review and Scores : PDF version for download AP2003R1 http://hkcpath.org. Correspondence: pkhui@ha.org.hk 1of 10 07/08/2003 HKCPath Anatomical Pathology Peer Review and Scores : PDF version for download AP141 Bone Marrow: Metastatic Carcinoma from

More information

Omental mesothelioma as a diagnostic and therapeutic challenge: A case report

Omental mesothelioma as a diagnostic and therapeutic challenge: A case report www.edoriumjournals.com Case in Images OPEN ACCESS Omental mesothelioma as a diagnostic and therapeutic challenge: A case report Cihan Akgul Ozmen, Yekta Tuzun, Hatice Ozturkmen Akay, Hasan Nazaroglu ABSTRACT

More information

Cytoreduction and hyperthermic intraperitoneal chemotherapy for the treatment of pseudomyxoma

Cytoreduction and hyperthermic intraperitoneal chemotherapy for the treatment of pseudomyxoma Medical Policy Cytoreduction and Hyperthermic Intraperitoneal Chemotherapy for the Treatment of Pseudomyxoma Peritonei and Peritoneal Carcinomatosis of Gastrointestinal Origin, and Peritoneal Mesothelioma

More information

A. Pericardial smear. Examination of the pericardial aspirate can provide useful diagnostic information.

A. Pericardial smear. Examination of the pericardial aspirate can provide useful diagnostic information. 5. PERICARDIUM Heart is encased by the pericardium which has a visceral layer (a) covering the heart and the parietal layer (b). In normal states it is thin, transparent and the myocardium can be seen

More information

Histopathology of Colorectal Cancer after Neoadjuvant Chemoradiation Therapy

Histopathology of Colorectal Cancer after Neoadjuvant Chemoradiation Therapy The Open Pathology Journal, 2009, 3, 91-98 91 Open Access Histopathology of Colorectal Cancer after Neoadjuvant Chemoradiation Therapy Maura O Neil * and Ivan Damjanov Department of Pathology and Laboratory

More information

A succesfull case of HIPEC in a peritoneal mesothelioma patient

A succesfull case of HIPEC in a peritoneal mesothelioma patient A succesfull case of HIPEC in a peritoneal mesothelioma patient Firmino, NLJ¹²; Miranda, E¹³; Oliveira, DA ²; Lima, MBA ¹²; Diniz, AF ¹²; Gomes, GES ¹²; Azevedo, LW ¹²; Soares,MC¹²; Gomes, ASA³. ¹Pernambuco

More information