Exfoliation Of Malignant Cells Research Articles

Juvenile Granulosa Cell Tumour Metastasising to Pleural Cavity: Case Report of Unusual Occurrence

Among the ovarian malignancies, ovarian sex cord stromal tumours very rarely exfoliate malignant cells into serous fluid. Among the sex cord stromal tumours, very few cases of adult granulosa cell tumour infiltration of peritoneal fluid have been documented. Juvenile granulosa cell tumour usually presents as stage I with ascites and pleural effusion as a component of Meigs syndrome. Exfoliation of malignant cells in the pleural fluid is rarer and has not been described previously in the literature to the best of our knowledge. Here, we report a case of 25-year-old female patient diagnosed as juvenile granulosa cell tumour of left ovary which metastasised to pleural cavity within 5 years of diagnosis.

Mucosal Proliferations in Completely Examined Fallopian Tubes Accompanying Ovarian Low-grade Serous Tumors: Neoplastic Precursor Lesions or Normal Variants of Benign Mucosa?

Malignant transformation of the fallopian tube mucosa, followed by exfoliation of malignant cells onto ovarian and/or peritoneal surfaces, has been implicated as the origin of most pelvic high-grade serous carcinoma. Whether a parallel pathway exists for pelvic low-grade serous tumors [ovarian serous borderline tumor (SBT) and low-grade serous carcinoma (LGSC)] remains to be fully elucidated. The literature is challenging to interpret due to variation in the diagnostic criteria and terminology for cytologically low-grade proliferations of the fallopian tube mucosa, as well as variation in fallopian tube specimen sampling. Recently, a candidate fallopian tube precursor to ovarian SBT, so-called papillary tubal hyperplasia, was described in advanced stage patients. The current study was designed to identify fallopian tube mucosal proliferations unique to patients with low-grade serous ovarian tumors (serous cystadenoma, SBT, LGSC) and to determine if they may represent precursors to the ovarian tumors. Fallopian tubes were thinly sliced and entirely examined microscopically, including all of the fimbriated and nonfimbriated portions of the tubes, from patients with ovarian serous cystadenoma (35), SBT (61), and LGSC (11) and from a control population of patients with ovarian mucinous cystadenoma (28), mature cystic teratoma (18) or uterine leiomyoma (14). The slides of the fallopian tubes were examined in randomized order, without knowledge of the clinical history or findings in the ovaries or other organs. Alterations of the mucosa of the fallopian tube were classified as type 1: nonpapillary proliferation of cytologically bland tubal epithelium exhibiting crowding, stratification, and/or tufting without papillary fibrovascular cores or as type 2: papillary alterations consisting of a fibrovascular core lined by a cytologically bland layer of tubal epithelium. A third abnormality, type 3, consisted of detached intraluminal papillae, buds, or nests of epithelium that cytologically resembled the epithelial component of SBT or LGSC. Mucosal proliferations were identified in subsets of all populations, including the control populations. Overall, type 1 proliferations were in 28% to 61% of all patients and type 2 alterations in 4% to 16%. There was no statistically significant difference in the incidence of type 1 or type 2 proliferations between the class of ovarian serous tumors (benign, SBT, LGSC), between early and advanced stage SBT, or between patients with any ovarian serous tumor and the control population of nonserous diagnoses. Type 3 alterations were only identified in patients with advanced stage SBT/LGSC and not in any early stage SBT or cystadenoma. These findings suggest that type 3 alterations floating in the fallopian tube lumen represent exfoliation of tumor cells from ovarian and/or peritoneal origin. Our study did not identify a mucosal-based proliferation of the fallopian tubes that was specific to ovarian low-grade serous tumors. Cytologically bland mucosal proliferations appear to be common in fallopian tubes from patients of all ages and unrelated to ovarian tumorigenesis. A consensus on diagnostic criteria and terminology for these types of proliferations is needed, as well as further study into their etiology, including possible association with hormonal environment.

Adult granulosa cell tumor presenting as metastases to the pleural and peritoneal cavity

Ovarian tumors of sex-cord stromal derivation rarely exfoliate malignant cells in serous effusions. Adult granulosa cell tumor (AGCT) often presents as a stage I disease and association with ascites is about 10%. AGCT is rarely known to exfoliate tumor cells in the ascitic fluid. Exfoliation of malignant cells in the pleural fluid is rarer and has not been described previously in literature to the best of our knowledge. We report a case of AGCT presenting as stage IV disease with exfoliation of malignant cells in the pleural and ascitic fluid with exudative effusions. We wish to emphasize on cytomorphologic features of AGCT to differentiate the same from malignant epithelial tumors. A precise diagnosis in such a case may be possible on serous body fluid cytology with a combined clinical and cytopathologic approach.

Primary fallopian tubal transitional cell carcinoma with exfoliation of malignant cells in cervical Pap smear

Primary fallopian tubal carcinoma is a rare (0.2- 0.5%) gynecological malignancy. A primary transitional cell carcinoma (TCC) of the fallopian tube accounts for about 10% of primary fallopian tubal carcinomas. Exfoliation of cells of primary fallopian tubal TCC in cervical Pap smear has not been described previously. The present case is of a 52 years old female, who presented with episodic spotting per vaginum. Cervical Pap smear revealed clusters of malignant cells. Total abdominal hysterectomy with bilateral salpingo ophrectomy was performed. A tumor was found in the right fallopian tube occluding its fimbrial end. On microscopy, the tumor was confirmed to be a TCC. Therefore, if cervical Pap smear is positive for malignant cells and the cervical biopsy is negative, the patient should be investigated for a gynecological malignancy higher up in the gynecological tract. Though rare, a possibility of primary fallopian tubal malignancy should be considered in these cases.

Look ma, no blades

Look ma, no blades

False-negative peritoneal cytology in metastatic ovarian carcinoma

Seventy-nine laparotomies for disseminated intraperitoneal ovarian carcinoma were reviewed to determine the frequency and possible causes of false-negative peritoneal cytology. Negative peritoneal cytology (defined as any reading other than positive) was found in 16 of 79 cases (20%). False-negative cytology occurred more frequently with peritoneal washings (48%) than with ascites (6%; P less than .001); with second-look surgery (50%) than at primary surgery (12%; P = .004); with peritoneal metastasis less than 0.5 cm (50%) than with metastasis greater than 0.5 cm (16%; P = .02); and with bloody cytology specimens (25%) rather than specimens without blood (0%; P = .06). Volume of peritoneal specimen, architectural grade, cytologic grade, and stage of disease (III versus IV), did not affect the frequency of false-negative cytology. The high prevalence of negative cytology associated with peritoneal washings, small tumor size, and second-look surgery suggests that negative cytology is a result of poor distribution of peritoneal washings and infrequent exfoliation of malignant cells rather than misinterpretation of malignant cells present in cytology specimens.

The effect of calculi on transitional epithelium. A clinical and cytological study.

An analysis has been made of the 9 false-positive cytologic diagnoses in 4000 samples of urine from 1500 patients. They could be traced to 23 patients who had stones in their urinary tract. After removal of the stones the urinary cytology became negative. Thorough clinical examination excluded malignancy. The histological findings in one of these patients offers a possible explanation for the exfoliation of malignant cells and gives support ot the hypothesis that stones can cause reversible changes of the urothelium with the appearance of a malignancy. A casual relationship between stones in the urinary tract and the development of urothelial cancer could not be established.

Irradiation effects on malignant cells in smears from oral cancers; a preliminary report.

The cytological expression of radiation effect on malignant cells reflects accentuation of the unaltered morphology of the individual neoplasms, degeneration or complete destruction, maturation, and in about 50% of the cases, a temporary decrease in cohesiveness of the malignant tissue. Malignant cells were present in oral smears at the completion of irradiation in the majority of oral carcinomas, but sometimes disappeared after treatment. No cytological conversions were noted after the eighth week from the time of institution of irradiation. Destruction of malignant cells by irradiation appears to be much more important than does radiation-induced tumor differentiation. Increased exfoliation of malignant cells was noted in one-half of the cases, between the ninth and eighteenth days of treatment, probably due to decreased cohesiveness of the neoplastic tissue rather than to stimulation by irradiation. Abundant exfoliation of carcinoma cells may indicate an increased likelihood of metastases. (auth)