الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Serous effusions are pathologic, regardless of their composition or aetiology. Despite that only 10-20% of effusions are due to underlying malignancy; the presence of malignant cells in effusions has serious implications for the patient as it often indicates grave prognosis and poor outcome. Malignant serous effusions can often be the first presentation of malignant tumours or their metastasis. The commonest primary malignant tumour of the body serous cavities is malignant mesothelioma, however, metastatic malignancy is far more common.
Serous effusion cytology represents one of the most challenging fields of diagnostic cytopathology. A major diagnostic problem confronting cytopathologists in every day practice is the distinction between atypical reactive mesothelial cells, malignant mesothelioma and metastatic adenocarcinoma in effusions. This is often difficult because of the atypical features of reactive mesothelial cells -which occur in response to microbiological, physical, chemical or metabolic insults- the subtle diagnostic features of some neoplasms, the misleading cytological abnormalities in many cases and the marginal morphologic distinction between reactive and malignant cells.
Conventional smearing, despite being a simple procedure, has lots of drawbacks, which include cellular overcrowding, artefacts due to poor fixation, preparation or staining techniques, in addition to abundance of inflammatory cells and paucity of representative cells.
Since its introduction nearly a century ago, the cell block technique has been used routinely in cytopathology. It has gained acceptance as an adjunct to conventional smears because of the many distinctive advantages offered; it enables the retrieval of cells and tissue fragments to form a paraffin block which is later processed as a tissue biopsy with preservation of architectural patterns and cytomorphological details. Moreover, cell blocks concentrate cellular elements in smaller fields which facilitates microscopic evaluation and they enhance cellularity and increase the diagnostic yield of malignancy compared to conventional smears. Cell blocks provide archival material for additional sections to perform ancillary studies, the most practical of which is the immunohistochemistry, which is considered the most accurate diagnostic technique. However, the diagnostic value of a single marker is questionable and the use of immunomarker panels is recommended.
The current study aimed at evaluating the diagnostic role of the cell block technique in serous effusions by comparing it to conventional smears as regards the cytomorphological features, the cellularity, the architecture and the diagnostic yield of malignant cells. This was followed by the application of an immunohistochemical marker panel composed of Ber-EP4, EMA E29, D2-40 and desmin on cell block sections.
In the present work, a total of 270 body cavity fluid samples were examined, each sample was assessed by both conventional smearing and cell block method. Based on Mair’s point scoring system, 62 diagnostically adequate and diagnostically superior cases were selected to comprise the material of the current study.
Among the 62 effusion cytology cases, the age of the patients ranged from 20 to 82 years, with a mean age of 57.19 years. The maximum number of samples (n =18, 29%) were from patients in the age group of (51-60) years, while the least number of samples (n=1, 1.6%) were from patients in the age group of (20-30) years. Female patient samples (37 cases (59.7%)) outnumbered male patient samples (25 cases (40.3%)). Out of these 62 cases, 44 cases (71%) were of pleural effusion, 16 cases (25.8%) were of peritoneal effusion and only 2 cases (3.2%) had pleuropericardial effusion. Patients with pleural effusion presented most commonly complaining of dyspnea (43 cases (97.7%)), chest pain (8 cases (18.2%)) and cough (7 cases (15.9%)). Thirty four cases (77.3%) had positive history of malignancy, the commonest site of origin of the primary tumour was from the lung (11 cases, 32.35%). All 16 patients with peritoneal effusion presented with abdominal distension (100%), and 6 cases (37.5%) presented with associated abdominal pain. Among these 16 cases, 13 cases (81.25%) had positive history of malignancy, of which the primary tumour was ovarian in 5 cases (38.46%). As for the 2 cases that presented by pleuropericardial effusion, one case presented by dyspnea (50%) while the other complained of cough (50%). One of those two cases had a history of lung cancer.