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Serous fluids and washings: morphological and
immunohistochemical patterns in
reactive and neoplastic conditions
Prof. Ben Davidson, MD PhD, Department of Pathology, Norwegian Radium Hospital, Oslo
University Hospital, Oslo, Norway; Dr. Gareth Rowland, MB, BCh, FRCPath, University Hospital of Wales, Heath, Cardiff, UK
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Disclosure/ Acknowledgement
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Serous effusions
• Frequent clinical finding
• Pleural, peritoneal, pericardial
• May be the first presentation of malignancy or only site of
metastasis
• Far-reaching clinical implications
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The main questions
• Is it benign or malignant?
• If benign, can we reach a specific diagnosis?
• If malignant, is it primary or metastatic? Diagnosis?
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Differential diagnosis
• Primary tumors
Malignant mesothelioma
Primary peritoneal carcinoma
Hematological cancers
Sarcoma (rare)
• Metastases
Carcinomas
Other
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Depending on
• Age and gender
• Previous history
• Other clinical findings
• Geography
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Differential diagnosis
Davidson, Firat, Michael (eds.), Serous Effusions – Etiology, Diagnosis, Prognosis and Therapy (Springer 2011)
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Is it epithelial (or epithelioid)?
Melanoma Sarcoma
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And this?
Angiosarcoma Germ cell tumor
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The pattern of the smear- revisited
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The pattern of the smear- revisited
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The pattern of the smear- revisited
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The pattern of the smear- revisited
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• Mesothelial atypia: Pulmonary infarct, pancreatitis, radiation,
chemotherapy, cirrhosis, heart failure, renal failure/uremia
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Macrophages
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Endometriosis
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Ancillary methods
• EM
• IHC
• Flow cytometry
• PCR
• FISH
• Cytogenetics
• CGH and gene expression arrays
• NGS
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Davidson, Firat, Michael (eds.), Serous Effusions – Etiology, Diagnosis, Prognosis and Therapy (Springer 2011)
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Potential new markers
• PAX2
• Claudins
• BAP1
• MUC4
• CD24
• MMP7
• Tenascin-X