Serous fluids and washings: morphological and
immunohistochemical patterns in
reactive and neoplastic conditions
Prof. Ben Davidson, MD PhD, Department of Pathology, Norwegian Radium Hospital, Oslo
University Hospital, Oslo, Norway; Dr. Gareth Rowland, MB, BCh, FRCPath, University Hospital of Wales, Heath, Cardiff, UK
Disclosure/ Acknowledgement
Serous effusions
• Frequent clinical finding
• Pleural, peritoneal, pericardial
• May be the first presentation of malignancy or only site of
metastasis
• Far-reaching clinical implications
The main questions
• Is it benign or malignant?
• If benign, can we reach a specific diagnosis?
• If malignant, is it primary or metastatic? Diagnosis?
Differential diagnosis
• Primary tumors
Malignant mesothelioma
Primary peritoneal carcinoma
Hematological cancers
Sarcoma (rare)
• Metastases
Carcinomas
Other
Depending on
• Age and gender
• Previous history
• Other clinical findings
• Geography
Differential diagnosis
Davidson, Firat, Michael (eds.), Serous Effusions – Etiology, Diagnosis, Prognosis and Therapy (Springer 2011)
Is it epithelial (or epithelioid)?
Melanoma Sarcoma
And this?
Angiosarcoma Germ cell tumor
The pattern of the smear- revisited
The pattern of the smear- revisited
The pattern of the smear- revisited
The pattern of the smear- revisited
• Mesothelial atypia: Pulmonary infarct, pancreatitis, radiation,
chemotherapy, cirrhosis, heart failure, renal failure/uremia
Macrophages
Endometriosis
Ancillary methods
• EM
• IHC
• Flow cytometry
• PCR
• FISH
• Cytogenetics
• CGH and gene expression arrays
• NGS
Davidson, Firat, Michael (eds.), Serous Effusions – Etiology, Diagnosis, Prognosis and Therapy (Springer 2011)
Potential new markers
• PAX2
• Claudins
• BAP1
• MUC4
• CD24
• MMP7
• Tenascin-X
