PMID- 28387003
OWN - NLM
STAT- MEDLINE
DCOM- 20180416
LR  - 20180416
IS  - 1365-2303 (Electronic)
IS  - 0956-5507 (Linking)
VI  - 28
IP  - 4
DP  - 2017 Aug
TI  - Cytomorphological changes induced by intraperitoneal chemotherapy present 
      important diagnostic pitfalls in peritoneal fluid cytology.
PG  - 299-306
LID - 10.1111/cyt.12424 [doi]
AB  - OBJECTIVE: Intraperitoneal chemotherapy (IP ChT) is an emerging modality in the 
      treatment of advanced gastric adenocarcinoma with peritoneal disease. Cytological 
      evaluation of peritoneal fluid specimens from patients undergoing IP ChT is 
      important in clinical management. However, direct intraperitoneal exposure to 
      chemotherapeutic agents induces cytomorphological changes in benign constituents 
      of peritoneal fluid, presenting particular challenges to accurate cytological 
      interpretation. These morphological changes have not been well characterised in 
      the literature. We systematically reviewed the cytomorphological features in 
      immunocytochemically-confirmed positive and negative IP ChT peritoneal fluid 
      samples to elucidate the degree of morphological overlap between malignant and 
      reactive cells. METHODS: We reviewed 39 peritoneal fluid samples of patients 
      treated with IP ChT, and scored specific cytomorphological parameters of both 
      benign and malignant cells with the aid of relevant immunocytochemical 
      interrogation. RESULTS: The present findings show a significant degree of 
      morphological overlap between reactive and malignant cells. Abnormal, "exploding" 
      mitotic figures, nuclear membrane irregularities, multi-nucleation and 
      cytoplasmic vacuolation were commonly observed in negative fluid specimens. The 
      most helpful feature that favoured malignant cells was the increased 
      nuclear-to-cytoplasmic ratio. A background inflammatory milieu of eosinophils 
      and/or neutrophils was seen in 45-58% of post IP ChT peritoneal fluid specimens. 
      The presence of pseudoparakeratotic cells, a novel observation in post IP ChT 
      fluid specimens is also described. CONCLUSIONS: The extent of reactive 
      cytomorphological anomalies arising from treatment with IP ChT poses unique 
      diagnostic challenges and may prompt a malignant or 'atypical' diagnosis in 
      benign reactive samples.
CI  - (c) 2017 John Wiley & Sons Ltd.
FAU - Mok, Y
AU  - Mok Y
AUID- ORCID: 0000-0003-0151-2203
AD  - Department of Pathology, National University Health System, Singapore, Singapore.
FAU - Nga, M E
AU  - Nga ME
AD  - Department of Pathology, National University Health System, Singapore, Singapore.
LA  - eng
PT  - Journal Article
DEP - 20170407
PL  - England
TA  - Cytopathology
JT  - Cytopathology : official journal of the British Society for Clinical Cytology
JID - 9010345
SB  - IM
MH  - Ascitic Fluid/*pathology
MH  - Cell Nucleus/pathology
MH  - Cohort Studies
MH  - Cytodiagnosis/*methods
MH  - Humans
MH  - Immunohistochemistry
MH  - Inflammation/pathology
MH  - Injections, Intraperitoneal
MH  - Peritoneal Neoplasms/diagnosis/*drug therapy/pathology
OTO - NOTNLM
OT  - cytology
OT  - gastric adenocarcinoma
OT  - intraperitoneal chemotherapy
OT  - peritoneal fluid
EDAT- 2017/04/08 06:00
MHDA- 2018/04/17 06:00
CRDT- 2017/04/08 06:00
PHST- 2017/02/09 00:00 [accepted]
PHST- 2017/04/08 06:00 [pubmed]
PHST- 2018/04/17 06:00 [medline]
PHST- 2017/04/08 06:00 [entrez]
AID - 10.1111/cyt.12424 [doi]
PST - ppublish
SO  - Cytopathology. 2017 Aug;28(4):299-306. doi: 10.1111/cyt.12424. Epub 2017 Apr 7.