Cell Block- A Useful Adjunct in Cytopathology of Serous Effusions
Journal Title: National Journal of Laboratory Medicine - Year 2017, Vol 6, Issue 2
Abstract
Introduction: Use of the Cell Block (CB) technique in cytology increases the diagnostic accuracy. This technique enables cells to be retrieved in a fluid specimen to form a paraffin block, which concentrates the cells in a limited field without loss of cellular material and preserves tissue architecture. Additional sections can be obtained from CB to perform ancillary studies like Immunohistochemistry (IHC) or molecular studies. The main advantages of the technique are preservation of morphology, feasibility of performing ancillary studies and familiarity of the Haematoxylin and eosin (H&E) stain. The aim of the study was to assess the utility of CB preparation in making sound cytological decisions in samples from Serous Effusions (SF). Aim: We studied the various advantages of CB preparation along with the feasibility of the use of IHC on CB preparation in arriving at the diagnosis of Carcinomas of Unknown Primary origin (CUP). Materials and Methods: In this retrospective cross-sectional study we reviewed 30 cases of SF received over a period of one year at the Department of Pathology, of a tertiary care center. Provisional diagnoses made on Conventional Smears (CS) stained by May-Grumwald Giemsa (MGG) and Papanicolaou (Pap) stains were compared with the diagnoses revised after examining H&E stained slides and IHC done on the CB preparation. The advantages of the CB preparation and the utility of this technique in diagnosing cases of CUP were assessed. Results: A total of 30 cases of effusion samples were reviewed. Of the samples, 21 were peritoneal fluid, 08 were pleural and 01 was from a hydrocele sac. Mean age group was 55 years. Female patients formed 2/3rd of all cases. Cellularity was enhanced following CB preparation due to cell concentration. Architectural patterns were also easier to recognize in CB method in comparison to CS. The cases were grouped into 4 diagnostic categories: malignant, suspicious of malignancy, benign/no-malignant cells seen or inadequate for reporting. By the CB method, an additional 4 cases (7%) were detected as malignant. The malignant effusions were more common in females than males (ratio: 2.5:1). The most common site of primary identified was from the ovary. Out of 13 cases of malignant effusions, the primary was known in 8 cases, which included six cases of carcinoma ovary and two cases each of carcinoma of lung from male patients. In the remaining nine cases, the primary was established with the help of CB and IHC. Conclusion: The CB technique enables sediments from body fluid specimens to be retrieved and to form a paraffin block, which concentrates the cells in a limited field without loss of cellular material and preserves tissue architecture. H&E stained slides can be examined and additional sections can be used to perform ancillary studies like IHC. This study demonstrated a clear advantage of CB technique in diagnosing CUP origin over the conventional techniques of cytology. Therefore, it is recommended that CB technique be routinely employed in all cases of SF to increase the diagnostic accuracy.
Authors and Affiliations
Manoj Gopal Madakshira, Sampath Srinivasagowda Kolavadi, Vikrant Varma, Reena Bharadwaj
Keywords
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- EP ID EP376455
- DOI 10.7860/NJLM/2017/25620:2220
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