Evaluation of pleural fluid cytology for the diagnosis of malignant pleural effusion: a retrospective cohort study

Pairman, Lorna; Beckert, L; Dagger, M; Maze, Michael J.

doi:10.1111/imj.15725

Cited by 14 publications

(6 citation statements)

References 24 publications

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“…Considering the patient had persistent altered mental status with psychomotor retardation and bilateral non-pitting pedal edema, the TSH was checked, which was markedly elevated with low free T4 and T3 levels. A review of the literature revealed rare cases of pleural effusion in hypothyroidism, which were treated with timely hormonal replacement therapy [ 9 ]. Our patient had already been on oral levothyroxine since admission.…”

Section: Discussionmentioning

confidence: 99%

Thyroid Troubles: A Case of Hypothyroidism-Associated Recurrent Massive Pleural Effusion

Ansari,

Ibrahim,

Abo Baker

et al. 2024

Cureus

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Pleural effusions can be secondary to several different etiologies. Sometimes, they can be related to hypothyroidism. We present a case of massive pleural effusion resulting from hypothyroidism. A 75-year-old male with a history of liver cirrhosis, hypothyroidism, and medication non-adherence presented to the emergency department (ED) with shortness of breath and altered mental status. Physical exam and chest imaging were consistent with right-sided pleural effusion. Effusion was exudative. Multiple recurrences complicated the hospitalization despite thoracentesis and pleurodesis. Labs revealed hypothyroidism, and finally, the patient was started on hormone replacement, resulting in the resolution of the effusion. Pleural effusion is a rare manifestation of hypothyroidism, thought to be mediated by vascular endothelial factors. Pleural fluid analysis shows both exudative and transudative patterns. Hormonal replacement is the mainstay of treatment. Clinicians need to be aware of the rare etiologies of pleural effusion. Depending on the patient's presentation, due work-up should be done to ensure a timely diagnosis and management.

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Section: Discussionmentioning

confidence: 99%

Thyroid Troubles: A Case of Hypothyroidism-Associated Recurrent Massive Pleural Effusion

Ansari,

Ibrahim,

Abo Baker

et al. 2024

Cureus

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“…Our results demonstrated a higher percentage of sensitivity than previous studies. 15 This method has been applied in many systems except for pleural effusions. 6,[16][17][18] To the Indian guidelines of 2020 and a recent paper by Shidham, among malignant effusions, cytology is helpful in determining the exact type, site, and stage of the tumor.…”

Section: Discussionmentioning

confidence: 99%

Role of cytoblock on pleural effusion for diagnosis of malignant disease

Shahini,

Hoxha,

Marku

et al. 2023

Diagnostic Cytopathology

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BackgroundThoracocentesis of pleural effusion is a simple technique for pleural fluid examination through cytology. In addition to cytological examination to assess the nature of pleural fluid content, we can also perform more detailed examinations through cytoblocks of residual fluid. These paraffin‐embedded cytoblock samples are important because we can perform examinations as in other bioptic samples. In these samples, immunohistochemical and molecular analyses can be performed.MethodsTwo hundred fifty‐five cytological samples from patients with pleural effusion were examined. In cases in which the presence of malignant cells was identified in the cytological examination, as well as cases that were suspicious but not definitive for the presence of a malignant effusion, a cytoblock was prepared. Histological examination and immunohistochemical analysis were performed.ResultsAmong 255 cases with pleural effusion, 152 had the presence of malignant cells and 6 cases were suspicious, but uncertain for the presence of malignant cells, while 86 cases had inflammatory pleural effusion or other pathologies but were not malignant. After histological analysis of the cytoblock and immunohistochemical analysis, we identified 82 malignant tumors of the lung, 8 malignant tumors of the gastrointestinal tract, 15 malignant tumors of the breast, and 6 malignant tumors of the female genital tract, as well as 24 tumors of undetermined origin.ConclusionsCytoblocks are important for the diagnosis of the primary nature of malignant pleural effusions. The highest importance is primary lung tumors, as well as those tumors in which the primary site of the tumor cannot be determined clinically.

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“…Cytological evaluation is especially critical in patients with underlying malignancy as in our patient. The sensitivity of cytology for the diagnosis of B-cell lymphoma is between 42.8% and 94.5% [ 10 ]. Positive cytology may be associated with poor outcomes in patients with neoplastic pericardial disease.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Cardiac Tamponade Induced by Chronic Lymphocytic Leukemia

Raciti,

Alakhras,

Strubchevska

et al. 2023

Cureus

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While cardiac tamponade is a commonly recognized complication in solid organ malignancies and acute leukemias, instances of cardiac involvement in the context of chronic hematologic malignancies, such as chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), are rarely observed. A 66-year-old male, with a history of stage IV CLL/SLL, presented with three weeks of worsening edema, orthopnea, and dyspnea. Two days after admission, an echocardiogram revealed a large circumferential pericardial effusion. Given the concern about early signs of pericardial tamponade, the patient underwent emergent pericardiocentesis with the removal of 700 cc of sanguineous fluid. A pericardial biopsy and flow cytometry of the pericardial fluid confirmed the diagnosis of CLL/SLL with pericardial involvement. There were no signs of large cell lymphoma transformation at that point. This rare case demonstrates the importance of considering cardiac complications in CLL/SLL patients who present with worsening edema, orthopnea, and dyspnea.

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Evaluation of pleural fluid cytology for the diagnosis of malignant pleural effusion: a retrospective cohort study

Cited by 14 publications

References 24 publications

Thyroid Troubles: A Case of Hypothyroidism-Associated Recurrent Massive Pleural Effusion

Thyroid Troubles: A Case of Hypothyroidism-Associated Recurrent Massive Pleural Effusion

Role of cytoblock on pleural effusion for diagnosis of malignant disease

A Rare Case of Cardiac Tamponade Induced by Chronic Lymphocytic Leukemia

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