Cytodiagnosis of rheumatoid pleural effusions

Abstract

The stained smears of the deposits from one pericardial and 19 pleural effusions complicating rheumatoid arthritis were examined. On the basis of clinical and biochemical evidence it was considered that in six cases the effusions were due to the rheumatoid disease while in a further nine cases the association was considered likely. In the remaining five cases the association was considered to be due to chance as other causes for the effusions were diagnosed.On cytological examination, seven cases showed a characteristic picture of degenerating polymorphs with amorphous extracellular material and epithelioid cells many of which were multinucleate. Five others contained similar amorphous material without epithelioid cells; of these two had many plasma cells and a third numerous macrophages probably containing `droplets' of rheumatoid factor complex.Thus in 12 of 15 cases a definite diagnosis of rheumatoid effusion could be made. In the remaining five cases cytological examination confirmed that the effusions were unrelated to the rheumatoid disease.The extracellular material gave a non-specific fluorescence with labelled anti-γ globulin antisera, and since this reaction was not seen in control pleural fluid deposits, or with preparations of fibrin, it may have a confirmatory value.It is concluded that in many cases reliable cytological evidence can be found to confirm or refute a diagnosis of rheumatoid pleural or pericardial effusion. This may be helpful in the management of the rheumatoid disease.

Thoracoscopic, histological, and clinical findings in nine case of rheumatoid pleural effusion.

“…' 10 19 This is also a Thoracoscopic, histological, and clinical findings in nine cases of rheumatoid pleural effusion finding, however, in tuberculous pleurisy and malignant diseases of the pleura.2 4 The lactate dehydrogenase concentration was high but this finding is also not specific.24 RA cells from the pleural fluid were found in all our patients, in accordance with other reports,379202' but the RA cell is not specific for rheumatoid pleural effusion as this cell is also found in other diseases of the pleura.45 A unique cytological picture in rheumatoid pleural effusion has been reported. 22 24 Moreover, these findings seem to be specific, as claimed by Engel et al 25 By the technique applied for the identification of the RA cells no abnormal cell types were observed in the cytological specimens in our series.…”

Mechanisms of Pleural Involvement in Orphan Diseases

“…This layer is easily detached and leaves a denuded inflamed pleural surface, a pattern described as ‘an opened out rheumatoid nodule with palisading epithelioid cells’, and multinucleated giant cells and characteristic elongated ‘tadpole’-shaped cells on a background of granular necrotic material of decaying leukocytes; the ‘tadpole’ cells have been shown by staining to be of macrophage origin [46,50]. These histopathological findings in the pleura are considered by Naylor [19] to be pathognomonic for RA-associated PE and similar to the findings seen in RA synovitis [19,34,35]. Classic rheumatoid nodules on the pleura are seen occasionally in thoracoscopic biopsies; however, they are rarely detected in small pleural samples obtained by closed pleural biopsy [33].…”

“…The high cellular content seen in RA-associated PE has been reported to be due to exfoliation of inflammatory cells from the rheumatoid nodules [19,34,35]. …”

Clinical image: Comet cells in rheumatoid arthritis

“…Cytologic examination of the pleural fluid with Papanicolaou staining revealed amorphous, granular background material and elongated cells, with oval nuclei and a long, tadpole‐like, cytoplasmic tail, called “comet cells” (1). These cytologic features are specific to and pathognomonic of RA (2–5). Pleural disease is common in patients with RA; cytologic findings of elongated, often multinucleated, fusiform, comet‐like macrophages are typical, but rarely encountered.…”