WSI21-134: Pleural, Pericardial, and Peritoneal Fluids

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Subspecialty Cytology

Topic Pleural, Pericardial, and Peritoneal Fluids

Presenter MGH

Toggle columns: Diagnosis

Case	Clinical history	Requester	Diagnosis
Case	Clinical history	Requester	Diagnosis
Case 1	18-year-old male. History of glioblastoma.	Iac0	Metastatic glioblastoma.
Case 2	80yo M with left-sided pleural effusion	Mlz8	Metastatic small cell lung carcinoma
Case 3	69yo F with pleural effusion	Mlz8	Metastatic breast carcinoma (h/o invasive lobular carcinoma)
Case 4	48M • kidney failure. Pleura FNA.	Iac0	Extramedullary hematopoiesis.
Case 5	Over 90-year old male with significant asbestos exposure	Lcm51	Mesothelioma
Case 6	Pericardial effusion and history of parotid mass and atrial mass	Mlz8	Metastatic Merkel cell carcinoma (from parotid primary)
Case 7	33F. Peritoneal carcinomatosis.	Iac0	SMARCB1/INI1-deficient malignant epithelioid neoplasm.
Case 8	45 y/old F Long Hx of ESRD post kidney transplant. New effusion • duodenal mass and peritoneal nodules.	Lcm51	PTLD • DLBCL type.
Case 9	41M. History of clear cell sarcoma of finger.	Iac0	Metastatic clear cell sarcoma.
Case 10	73y/old F with right pleural effusion and flank pain.	Aja51	Dx Epithelioid mesothelioma
Case 11	60 y/old F with new pleural effusion and prior "soft tissue" tumor in the arm.	Aja51	Metastatic epithelioid hemangioendothelioma
Case 12	79 yo male	Ndk6	Multiple myeloma
Case 13	50 yo female with history of metastatic carcinoma with bilateral pleural effusions	Ndk6	Metastatic ovarian carcinoma • clear cell type
Case 14	65 yo M with a history of myeloma.	Cfh13	Positive. Recurrent multiple myeloma to pleura.
Case 15	HISTORY OF MULTIPLE MYEOMA WITH PLASMACYTOMA. NOW HAS PLEURAL EFFUSIONS	Pab16	Plasma cell myeloma
Case 16	78 YO male with h/o adenocarcinoma of pyloric antrum and ascites	Ndk6	Metastatic adenocarcinoma c/w patient's known malignancy
Case 17	Hx triple negative breast cancer	Est105	Metastatic breast carcinoma
Case 18	18-year-old man	Eh441	Burkitt lymphoma
Case 19	55 yo F with a remote history of breast carcinoma.	Cfh13	Metastatic adenocarcinoma • consistent with breast primary.
Case 20	55 yo M with chronic pleural effusion.	Cfh13	Positive for malignant cells. Epithelioid hemangioendothelioma.
Case 21	52 yo F with acute respiratory failure in the setting of cocci and remote myeloma.	Cfh13	Malignant cells present • consistent with involvement by the patient's known multiple myeloma.
Case 22	68yo man with a history of oncocytic thyroid carcinoma (metastatic to one lymph node) and clear cell renal cell carcinoma	Ez278	Metastatic oncocytic carcinoma • consistent with spread from thyroid primary.
Case 23	68 yo woman with an ovarian mass	Cfh13	Positive for metastatic ovarian serous carcinoma in a background of mucinous borderline tumor.
Case 24	73 yo man with ascites noted on surveillance following a Whipple for pancreatic carcinoma	Cfh13	Malignant mesothelioma • epithelioid type.
Case 25	27 yo F with unrescetable thymic carcinoma	Ndk6	Consistent with patient's known thymic carcinoma. Immunohistochemical studies show that the malignant cells are positive for p63 and CD5 • supporting the diagnosis.
Case 26	80-year-old man	Njc35	Epithelioid mesothelioma. Fibrosis and multinucleated giant cell reaction to polarizable foreign material • consistent with talc pleurodesis. Note: Immunohistochemistry - tumor cells are positive for calretinin and WT1. They show loss of membranous/ cytoplasmic expression of merlin/NF2. They show retained expression of MTAP.
Case 27	49M • ascites fluid	Mlz8	Metastatic gastric signet ring cell adenocarcinoma
Case 28	69F. Pleural based mass.	Iac0	Epithelioid mesothelioma.
Case 29	73 yo male	Dc679	Metastatic Ewing Sarcoma
Case 30	34 yo male with left empyema and c/f lymphoma	Ndk6	High-grade B-cell lymphoma • consistent with Burkitt lymphoma
Case 31	75 yo male	Ndk6	Atypical lymphoid cells present • consistent with involvement by mantle cell lymphoma
Case 32	72 yo female with thyroid cancer with recurrent right pleural effusion	Ndk6	Metastatic carcinoma • consistent with the patient’s thyroid primary
Case 33	67F. Pelvic mass. Pelvic ascites.	Iac0	Mucinous epithelium • consistent with involvement by ovarian mucinous neoplasm. Resection: borderline mucinous neoplasm.
Case 34	62F. History of papillary thyroid carcinoma. Now with pleural effusion.	Iac0	Metastatic papillary thyroid carcinoma.
Case 35	20M. History of CNS lymphoma.	Iac0	ALK-positive anaplastic large cell lymphoma (ALCL).
Case 36	87 YOF with with recurrent advanced pulmonary adenocarcinoma who recently developed myocarditis after Pembrolizumab and pleural effusion.	Tz046	Metastatic adenocarcinoma.
Case 37	61 yo M with HIV and new axillary and mediastinal LAD	Ndk6	Positive for malignancy- HHV8-positive large cell lymphoma • consistent with primary effusion lymphoma NOTE: The pleural fluid specimen consists of abundant large • atypical lymphoid cells with oval to irregular • convoluted nuclei • dispersed chromatin • and multiple small • prominent nucleoli with a moderate amount of brightly eosinophilic cytoplasm. Immunohistochemistry reveals that the large lymphoid cells stain positively for HHV8 and CD30. CD3 shows weak staining in rare large lymphoid cells and highlights a small population of admixed small • reactive T cells. CD20 and Pax-5 are negative. In-situ hybridization for EBV (EBER) is negative. Overall • the morphologic and immunohistochemical features are consistent with HHV8-related primary effusion lymphoma. An unusual feature is the absence of EBV as most primary effusion lymphomas are co-infected by HHV8 and EBV.
Case 38	58 yo M post renal transplant with pericardial effusion	Ndk6	Suspicious for malignancy- Single cells with prominent nucleoli and coarse chromatin highly suspicious for malignant lymphoma • large cell type. PERICARDIAL FLUID CELLBLOCK: Primary effusion lymphoma (HHV8+) consistent with a post transplantation lymphoproliferative disorder (see note). Note: Immunostains on the cell block show many large atypical lymphoid cells that are positive for CD30 • MUM1 and HHV8. The large cells are negative for CD19 • CD3 • CD5 • CD10 • BCL6 • BCL2 and CD21. Rare enlarged cells are CD20+ but overall large cells are negative for CD20. CD3 and CD5 stain many admixed small T cells. MYC stains less than 10% of all cells • mostly weakly. Most large cells (approximately 90%) are positive for Ki-67 (proliferation). In situ hybridization for EBER is negative. In summary • the findings are those of a primary effusion lymphoma • which is a rare • HHV8-related large B-cell lymphoma. In this patient status post renal transplant • the lymphoma can be considered an unusual type of post transplantation lymphoproliferative disorder.