Pleural Liposarcoma Mimicking Carcinoma in Pleural Effusion Cytology

Dağlı, Adile Ferda; Pehlivan, Sultan; Ozercan, Melhmet Resat

doi:10.1159/000325185

Cited by 10 publications

(4 citation statements)

References 13 publications

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“…A predominance of pleomorphic cells either singly scattered or arranged in clusters was present in dedifferentiated liposarcoma, osteosarcoma, chondrosarcoma (high‐grade and dedifferentiated), and undifferentiated sarcoma. The cytologic features of dedifferentiated liposarcoma in effusions are described as mostly singly scattered large cells with vacuolated cytoplasm 3,25 . In the absence of a prior known malignancy, the vacuolated nature of these malignant cells in peritoneal fluid could lead to a misdiagnosis of adenocarcinoma or carcinoma, as seen in 1 of our cases of dedifferentiated liposarcoma and in a case report by Dagli et al 25 Osteosarcomas involving fluid cytology are extremely rare and show singly scattered tumor cells and occasional clusters of tumor cells with scant to moderate amounts of cytoplasm, enlarged nuclei with irregularly clumped chromatin, and small nucleoli 26,27 .…”

Section: Discussionmentioning

confidence: 57%

“…The cytologic features of dedifferentiated liposarcoma in effusions are described as mostly singly scattered large cells with vacuolated cytoplasm. 3,25 In the absence of a prior known malignancy, the vacuolated nature of these malignant cells in peritoneal fluid could lead to a misdiagnosis of adenocarcinoma or carcinoma, as seen in 1 of our cases Cancer Cytopathology October 2021 of dedifferentiated liposarcoma and in a case report by Dagli et al 25 Osteosarcomas involving fluid cytology are extremely rare and show singly scattered tumor cells and occasional clusters of tumor cells with scant to moderate amounts of cytoplasm, enlarged nuclei with irregularly clumped chromatin, and small nucleoli. 26,27 Osteoid, if present, could serve as a useful clue for arriving at the correct diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Bone and soft tissue sarcomas in cerebrospinal fluid and effusion: A 20‐year review at our institution

Sharma

Thangaiah

Shetty

et al. 2021

Cancer Cytopathology

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BACKGROUND:The literature on bone and soft tissue sarcomas (BSTSs) involving effusions and cerebrospinal fluid (CSF) is very limited. METHODS: A computerized search for fluid cytology with a sarcoma diagnosis from 2000 to 2020 was performed. All available cases, including the clinical follow-up, were reviewed. RESULTS: A total of 57 fluids specimens from 36 BSTSs were identified (9 rhabdomyosarcomas, 6 angiosarcomas, 5 epithelioid hemangioendotheliomas, 3 dedifferentiated liposarcomas, 2 chondrosarcomas, 1 extraskeletal myxoid chondrosarcoma, 3 Ewing sarcomas, 2 undifferentiated sarcomas, 3 osteosarcomas, 1 synovial sarcoma, and 1 hybrid low-grade fibromyxoid sarcoma/sclerosing epithelioid fibrosarcoma).There were 22 males and 14 females. The age range was 4 to 82 years (median, 45 years). Sites of involvement included pleural fluid (n = 38), peritoneal fluid (n = 14), and CSF (n = 5). Twenty-four cytology cases were available for review. The cytologic features were nonspecific and ranged from dyshesive to clusters of round, epithelioid, pleomorphic, and occasionally spindle-shaped malignant cells that could easily mimic other non-BSTS malignant tumors. The diagnosis of BSTS was made by comparison with a prior specimen and/or ancillary studies (molecular or immunohistochemical stains). The prognosis was poor because 95% of the patients died of their disease. CONCLUSIONS: The incidence of BSTS in fluid cytology is extremely rare, and it can have cytologic features similar to those of non-BSTS malignancies. Although, in most cases, a comparison with a prior known BSTS specimen may suffice, the use of ancillary studies is extremely helpful in arriving at the correct diagnosis. However, in cases with no known prior malignancy, including BSTS in the differential diagnosis is prudent for preventing misdiagnosis.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Bone and soft tissue sarcomas in cerebrospinal fluid and effusion: A 20‐year review at our institution

Sharma

Thangaiah

Shetty

et al. 2021

Cancer Cytopathology

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“…Different sarcoma types, detected in the pleural, peritoneal, and pericardial fluids, have been described in English scientific literature [11,12,13,14,15]. However, only 5 cases have been classified as vascular-type soft-tissue tumors.…”

Section: Discussionmentioning

confidence: 99%

Cytomorphological Features of Epithelioid Hemangioendothelioma in Ascitic Fluid with Radiological, Clinical and Histopathological Correlations

Enbom

Abasolo²,

Dixon³

et al. 2014

Acta Cytologica

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Background: Epithelioid hemangioendothelioma (EHE) is an uncommon vascular soft-tissue tumor. Five cases of EHE in body fluids have been documented in the literature, all of them occurring in pleural effusions. This is the first description of cytomorphological features of EHE cells in ascitic fluid, accompanied by corresponding histopathological findings, clinical, and radiological data. Case Report: Our patient presented with several liver masses, peritoneal involvement, bilateral pleural effusions, and massive ascites. EHE was suspected on cytological examination of the ascitic fluid and was confirmed by immunohistochemical studies. Simultaneously, a liver mass was identified and diagnosed on biopsy as EHE, affording accurate histopathological correlation. Cytologically, EHE cells appear relatively bland, often obscured by reactive mesothelial cells, and dispersed singly or clustered. They often possess intracytoplasmic vacuoles, referred to as ‘blister' or ‘signet ring' cells. High-power examination shows slightly misshapen mildly hyperchromatic nuclei with inconspicuous nucleoli. Immunohistochemically, EHE cells express strong positivity with vascular markers (CD31, CD34 and factor VIII). They are nonreactive with mesothelial markers (calretinin and WT-1). Conclusion: Recognition of the possibility of EHE cells in fluid by morphology should prompt proper immunohistochemical work-up to ensure an accurate diagnosis and timely patient management.

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“…Both described high-grade cytological features including marked pleomorphism, nuclear irregularity, and distinct red nucleoli, but no cytological evidence of lipomatous differentiation (ie, atypical adipocytes or lipoblasts) was discussed. Vacuolated cells, most likely being lipoblasts, were present in the case reports from Dagli et al 12 and Geisinger et al 13 Although the primary tumor from these case reports were myxoid liposarcoma and pleomorphic liposarcoma, lipoblastic and high-grade tumor components were present together on cytological examination 12,13 (Table 3).…”

Section: Discussionmentioning

confidence: 92%

Liposarcoma Involving Serous Fluid Cavities—A Case Series Illustrating Clinical Implications and the Diagnostic Role of Exfoliative Cytology

Ng,

2023

Int J Surg Pathol

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Introduction: Cytological diagnosis of sarcomas requires detailed cytomorphological assessment and integration of immunocytochemistry and/or molecular testing. The role of exfoliative cytology, as compared to aspiration cytology, is less understood. This case series describes well-differentiated/dedifferentiated liposarcomas in effusions, with cytomorphological features, ancillary test results and clinical outcomes detailed. Methods: A computerized search of the department pathology archives was performed for sarcomatous effusions with histological diagnosis or clinical history of well-differentiated/dedifferentiated liposarcoma. Clinical progress, cytology slides, immunocytochemistry and molecular test results were reviewed. Results: Six patients were identified. In 5 patients with clinical follow up, 4 (80%) were deceased within 5 months of malignant effusion. One patient was alive with 12 years disease-free survival after radical resection with adjuvant radiotherapy. Three patients showed dedifferentiation on histology, and high-grade (dedifferentiated) tumor cells were present in effusion cytology of 2 patients. Two showed well-differentiated components only on biopsy, but high-grade (dedifferentiated) tumor cells were identified in cytology. The high-grade tumor cells displayed marked nuclear irregularity, enlargement, size variation, with macronucleoli and multinucleation. Well-differentiated lipomatous components were demonstrated in 4 patients (66.7%), comprising of multivacuolated lipoblasts and atypical lipocytes. CDK4 and MDM2 immunoreactivity in all 3 cases with cell blocks, and CDK4 and MDM2 amplification in one were successfully demonstrated. Conclusion: Lipomatous and dedifferentiated components can be sampled and cytomorphologically identified on effusion fluids of liposarcomas, with sufficient cellularity for immunocytochemistry and molecular testing. Although generally associated with poor prognosis, long disease-free survival with sarcomatous effusion is possible with radical surgery and adjuvant treatment.

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Pleural Liposarcoma Mimicking Carcinoma in Pleural Effusion Cytology

Cited by 10 publications

References 13 publications

Bone and soft tissue sarcomas in cerebrospinal fluid and effusion: A 20‐year review at our institution

Bone and soft tissue sarcomas in cerebrospinal fluid and effusion: A 20‐year review at our institution

Cytomorphological Features of Epithelioid Hemangioendothelioma in Ascitic Fluid with Radiological, Clinical and Histopathological Correlations

Liposarcoma Involving Serous Fluid Cavities—A Case Series Illustrating Clinical Implications and the Diagnostic Role of Exfoliative Cytology

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