Role of Immunocytochemistry using Cell Block in Cases with Malignant Pleural Effusion

Manjula Choudhury; Bidhan Chandra Das; Deba Kumar Saikia

Volume : VI, Issue : V, May - 2016

Role of Immunocytochemistry using Cell Block in Cases with Malignant Pleural Effusion

Manjula Choudhury, Bidhan Chandra Das, Deba Kumar Saikia

Abstract :

Cytological examination of serous fluids is of paramount importance in detecting cancer cells. Cytology is more sensitive than blind biopsy for detecting serosal malignancy, presumably because fluid provides a more representative sample. Cell block and immunohistochemistry are essential adjunct to cytomorphology in suspicious cases and substantially improves diagnostic accuracy. Immunohistochemistry is also useful to establish the types of malignant cases. A total of 190 pleural fluid samples received for cytopathological examination over a period of 1 year 6 months were analyzed. Cytomorphological features of neoplastic effusions were studied by MGG and PAP staining. Cell block and immunohistochemistry (EMA and Calretinin) were performed to aid the diagnosis in clinico–radiologically malignant cases. In this study of 190 samples of pleural fluid, 20 cases (10.53%) were found to be malignant and out of which metastatic adenocarcinoma was found to be most common cause of malignant effusion. Reactive mesothelial cells were the most challenging to differentiate from metastatic adenocarcinoma. Immunohistochemical staining was useful to arrive at a definitive diagnosis in difficult cases. Immunohistochemistry plays a key role to detect malignant effusions. Cell block and immunohistochemical staining must be performed in paucicellular cases and in difficult cases to differentiate metastatic epithelial cells from reactive mesothelial cells.