Objective: Cytospin preparations and immunocytochemistry are common methods in hospitals to evaluate malignancies in body fluids. Characteristics of malignant cells in pediatric body fluids have not been adequately evaluated. Study Design: 183 pleural, peritoneal and pericardial pediatric fluid specimens were examined by cytospin preparations and immunocytochemistry from two hospitals using similar procedural techniques. Cytologic diagnoses were correlated with the results of clinical history, histology and ancillary studies. Results: Forty cases with malignancy were identified (21.9%); the most common diagnoses were rhabdomyosarcoma and acute lymphoblastic lymphoma (9 and 8 cases, respectively). Small round cell tumors revealed similar morphology as clusters of small round cells with central nuclei and scant cytoplasm with frequent small vacuoles. Twenty-one cases were evaluated by immunocytochemistry, 12 by flow cytometry and 5 by cytogenetic analysis. CD3, CD20, TdT, CD10, desmin and myogenin were the most common markers. Staining artifacts causing interpretation difficulties were noted in 5 cases that were resolved by molecular studies and deferral for surgical specimens. Conclusions: Small round cell tumors are the most common malignancies encountered in pediatric body fluids and share a nonspecific morphology. Although immunocytochemistry is helpful to arrive at the correct diagnosis, other ancillary studies may be necessary, particularly in hematologic malignancies and other difficult cases.

Keywords:
Cytospin, Fluid cytology, Immunocytochemistry, Pediatric tumors, Serous effusions
1.
Kendall B, Dunn C, Solanki P: A comparison of the effectiveness of malignancy detection in body fluid examination by the cytopathology and hematology laboratories. Arch Pathol Lab Med 1997;121:976-979.
2.
Gupta S, Sodhani P, Jain S: Cytomorphologic profile of neoplastic effusions: an audit of 10 years with emphasis on uncommonly encountered malignancies. J Cancer Res Ther 2012;8:602-609.
3.
Dragoescu EA, Liu L: Pericardial fluid cytology: an analysis of 128 specimens over a 6-year period. Cancer Cytopathol 2013;121:242-251.
4.
Geisinger KR, Hajdu SI, Helson L: Exfoliative cytology of non-lymphoreticular neoplasms in children. Acta Cytol 1984;28:16-28.
5.
Hallman JR, Geisinger KR: Cytology of fluids from pleural, peritoneal and pericardial cavities in children: a comprehensive survey. Acta Cytol 1994;38:209-217.
6.
Wong JW, Pitlik D, Abdul-Karim FW: Cytology of pleural peritoneal and pericardial fluids in children. Acta Cytol 1997;41:467-473.
7.
Schinstine M, Abati A, Tsokos M, Fox E, Filie AC: Cytological identification of metastatic epithelial nephroblastoma in pleural fluid: report of a case and review of literature. Diagn Cytopathol 2006;34:621-625.
8.
Kilpatrick SE, Ward WG, Chauvenet AR, Pettenati MJ: The role of fine-needle aspiration biopsy in the initial diagnosis of pediatric bone and soft tissue tumors: an institutional experience. Mod Pathol 1998;11:923-928.
9.
Das DK: Serous effusions in malignant lymphomas: a review. Diagn Cytopathol 2006;34:335-347.
10.
Kundu R, Handa U, Mohan H: Role of DNA flow cytometry and immunocytochemical analysis in diagnosis of malignant effusions. Diagn Cytopathol 2012;40:887-892.
11.
Bedrossian CW: Special stains, the old and the new: the impact of immunocytochemistry in effusion cytology. Diagn Cytopathol 1998;18:141-149.
12.
Lozano MD, Panizo A, Toledo GR, Sola JJ, Pardo-Mindán J: Immunocytochemistry in the differential diagnosis of serous effusions: a comparative evaluation of eight monoclonal antibodies in Papanicolaou stained smears. Cancer 2001;93:68-72.
13.
Thomas JE, Falls E, Velasco ME, Zaher A: Diagnostic value of immunocytochemistry in leptomeningeal tumor dissemination. Arch Pathol Lab Med 2000;124:759-761.
14.
Chaudhary S, Klein M, Mehrotra B, Morgenstern NJ: Utility of immunocytochemistry in diagnosing leptomeningeal metastases from an intrahepatic cholangiocarcinoma. Diagn Cytopathol 2014;42:54-57.
15.
Arora R, Agarwal S, Mathur SR, Verma K, Iyer VK, Aron M: Utility of a limited panel of calretinin and Ber-EP4 immunocytochemistry on cytospin preparation of serous effusions: a cost-effective measure in resource-limited settings. Cytojournal 2011;8:14.
16.
Fetsch PA, Simsir A, Brosky K, Abati A: Comparison of three commonly used cytologic preparations in effusion immunocytochemistry. Diagn Cytopathol 2002;26:61-66.
17.
Koh CM: Preparation of cells for microscopy using cytospin. Methods Enzymol 2013;533:235-240.
18.
Koh CM: Preparation of cells for microscopy using ‘cell blocks'. Methods Enzymol 2013;533:249-255.
19.
Moriarty AT, Nayar R, Auger M, Kurtycz DF, Thomas N, Laucirica R, Padmanabhan V, Souers RJ, Schwartz MR, Fraig MM: Nongynecologic cytology practice patterns: a survey of participants in the College of American Pathologists interlaboratory comparison program in nongynecologic cytopathology. Arch Pathol Lab Med 2014;138:885-889.
20.
Pohar-Marinsek Z: Difficulties in diagnosing small round cell tumours of childhood from fine needle aspiration cytology samples. Cytopathology 2008;19:67-79.
21.
Gautam U, Srinivasan R, Rajwanshi A, Bansal D, Marwaha RK, Vasishtha RK: Reverse transcriptase-polymerase chain reaction as an ancillary molecular technique in the diagnosis of small blue round cell tumors by fine-needle aspiration cytology. Am J Clin Pathol 2010;133:633-645.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.