Correlation between Peritoneal Mesothelial Cell Cytology and Peritoneal Histopathology with Respect to Prognosis in Patients on Continuous Ambulatory Peritoneal Dialysis

Abstract

Background: Sclerosing encapsulating peritonitis (SEP) is a serious complication seen in patients on long-term continuous ambulatory peritoneal dialysis (CAPD). We have previously reported that mesothelial cells in effluent dialysate significantly increased in size as the duration of CAPD progressed. In this study, we investigated the relationship between mesothelial cytology, histopathology of the peritoneum, and clinical outcomes of 34 CAPD patients. Methods: When peritoneal dialysis catheters were inserted (n = 7) or removed (n = 27), a peritoneal biopsy was performed and results compared with mesothelial cytology in effluent dialysate. Results: A significant positive correlation was noted between the duration of CAPD and the surface area of peritoneal mesothelial cells (r = 0.721, p < 0.0001). The surface area of mesothelial cells in peritoneal sclerosis (n = 9; 584 ± 97 µm²) was significantly greater than in peritoneal fibrosis (n = 14; 389 ± 26 µm², p < 0.05), pathologic acute peritonitis (n = 3; 223 ± 10 µm², p < 0.005), and normal peritoneum (n = 7; 247 ± 12 µm², p < 0.001). The surface area in sclerosing peritonitis (n = 1; 1,200 µm²) was greater than that of all the others. Giant cells were found in the 1 case with sclerosing peritonitis and in 3 of 9 cases with peritoneal sclerosis, although they were found in only 1 of 14 patients with peritoneal fibrosis and in none of those with pathologic acute peritonitis or normal peritoneum. As the surface area of mesothelial cells increased to more than 400 µm² and giant cells appeared in the effluent, the frequency of peritoneal sclerosis and/or clinical SEP increased. Conclusion: An increase in the mesothelial cell surface area and the emergence of giant cells in the effluent indicate advanced peritoneal histopathology, and may be useful indicators to determine appropriate timing of discontinuation of CAPD to prevent the development of SEP.

Continuous Inflammation and Ascites 10 Months after the Initiation of Peritoneal Dialysis

“…Steroids have been shown to aid in the recuperation of the digestive tract function in various ways and to have an effect on the prognosis (11). Many studies have demonstrated the usefulness of steroids in stage 1 (pre-EPS period) and 2 (inflammation period) EPS (5,12). In the present case, after 21 days of steroid therapy, the CA125 level in the dialysate increased, whereas the IL-6 in the dialysate declined.…”

“…Although there is still no clear evidence, peritoneal lavage is considered to be a risk factor for EPS, as many EPS cases have occurred after discontinuing PD (7,(12)(13)(14). Many recent articles have reported the importance of peritoneal lavage, recommending the procedure for six months or more following the discontinuation of PD (5,(12)(13)(14).…”

“…Many recent articles have reported the importance of peritoneal lavage, recommending the procedure for six months or more following the discontinuation of PD (5,(12)(13)(14). Patients with a history of PD of six years or longer are recommended to undergo peritoneal lavage for at least six months, especially when presenting with high PET results (15).…”

Mesothelial metaplasia in European pond turtle, Emys orbicularis (Testudines: Emydidae) infected with Spiroxys contortus (Nematoda: Spirurida)

“…Pathogenic significance of hypertrophic mesothelial cells has been assessed in peritoneal effluent in humans but also in ex vivo human peritoneal cell cultures (Bajo et al, 2004). Although the presence of hypertrophic mesothelial cells in peritoneal effluent has been considered a marker for peritoneal sclerosis (Yamamoto et al, 1998), other authors have found no remarkable functional abnormalities suggestive of severe peritoneal damage (Izumotani et al, 2001). However, Bajo et al (2004) conclude that the presence of hypertrophic mesothelial cells is not necessarily a marker of sclerosing peritonitis and that such cells may be observed in cultures from new peritoneal effluent patients with no peritoneal function abnormalities.…”

Discriminant Analysis between Malignant Mesothelioma and Reactive Mesothelium Using Nuclear Three-Dimensional Analysis Is Useful for Morphologically Suspicious Cases

“…Malignant epithelial cells of the epithelial and mixed types often develop in the coelomic fluid. MM from the coelomic fluid is morphologically similar to reactive mesothelium (RM) which develops under pathological conditions, such as infectious diseases, liver diseases (e.g., cirrhosis and hepatitis), peritoneal dialysis, chronic inflammation, tumors, chemotherapy, and radiation therapy [3,4,5,6,7,8], precluding preoperative discrimination [3,9,10,11,12,13,14]. …”