Fluids cytology

Dr. Francesco Carrani M.V.

Anatomy

Pleural spacePeritoneal spacePericardial sac

Mesothelial cells

Cerebro spinal spaceJoint cavity

Pathogenesis

Transudate Exudate Neoplastic Hemorragic

Various (urine, bile, chyle)

P imbalanceInflammationCompressionTrauma

Pleural space

Clinical signsdyspnea

30 – 60 ml/kgClinical emergency

Pleural space

Pleural space Technique

22 to18 G needleConnection3 ways stopcock2.5 to 20 cc syringe

Oxygen !!!!

Pleural space Technique

22 to18 G needleConnection3 ways stopcock2.5 to 20 cc syringe

Oxygen !!!!

Peritoneal space

AscitesHigh volumeCells dilutionEtiology

Heart failureHepatic failureTumorsTrauma

Peritoneal space Technique

22 to18 G needleConnection3 ways stopcock5 to 20 cc syringe

Peritoneal space Technique

Pericardial sac

Idiopathic hemopericardiumNeoplastic effusion

HemangiosarcomaChemodectomaLymphoma

TransudateExudate (septic)

Pericardial sac Technique

Right lateral recumbency

No sedation or minimal

22 to18 G needleConnection3 ways stopcock5 to 20 cc syringe

Pericardial sac Technique

Sample management

EDTA tubeDirect smearSedimentation or low rpm centrifugationFixation and rapid stainImmunocytochemical staining

Cytological examination

It is the only test allowing

Cells evaluationHISTO

Cytology The cells

Mesothelial cellsMacrophagesRed cellsNeutrophilsLymphocytesEosinophilsMast cells

Mesothelial cells

Flat ephiteliumLarge cellsCentral and round nucleusMore peripheral in activated cellsBinucleatedProminent nucleolusBasophilic cytoplasmPinkish cytoplasmic expansion

Basophilic mesothelial, binucleated, with mitosisClear mesothelial, vacuolated and sometimes granulated cytoplasm (macrophages)

Mesothelial cells

Septic effusions

Septic peritonitis

Feline infectious peritonitis

FIPYellow, viscousSome neutrophilsActivated macrophagesRed cellsSome lymphocytesMesothelial cellsNo Bacteria

Septic effusions

Septic pleuritis

Septic effusions

Septic pleuritis from actinomices bacteria

Chylous and pseudochylous effusion

MilkyTriglycerides (chyle > serum)Cholesterol (chyle < serum)

ChyleHeart diseaseTraumaInflammationHerniaVenous thrombosis

Pseudochyle

InflammationNeoplasia

Chylous and pseudochylous effusion

ChyleTriglycerides Cells

PseudochyleCholesterolNecrotic debrisCells

Chylous and pseudochylous effusion

Cells

ChyleSmall lymphocytesNeutrophilsMacrophages

PseudochyleInflammatory cellsNeoplastic cellsNeutrophilsLymphocytes

Chylous effusion

Eosinophilic backgroundSmall lymphocytesNeutrophilsMacrophagesLipid droplets

Bile effusion

Amorphous materialBluish blackGolden yellowMacrophagic inflammation

Neoplastic effusion

Not all neoplasia produce effusion

Not all neoplastic effusion carries diagnostic cells

Neoplastic effusion

Non inflammatory cells

Different from mesothelial cells

Neoplastic effusion

False positive – non neoplastic mesothelial reactivity

False negative – no exfoliation

Distinction between Mesothelioma and Carcinoma

Mesothelioma

Large groupCytoplasmic vacuolationVisible junctionsCentral nucleus

CarcinomaLarge groupCytoplasmic vacuolationTight junctionsEccentric nucleus

Neoplastic effusion

Mesothelioma (rare) Pleural Pericardial

LymphomaCarcinomaMast cellSarcoma (exfoliation rare)

Heart base hemangiosarcoma

Poor prognosis

Neoplastic effusion

Carcinoma

Pulmonary metastasis from mammary carcinoma

Carcinoma

Peritoneal effusion, Intestinal Carcinoma

Sarcoma

Pulmonary artery hemangiosarcoma

Mesothelioma

F.Carrani 2008

Questions ?