浆膜腔积液细胞病理学诊断阳性病例分析

A comparative study of the cytological classification vs.pathomorphological classification in diagnosis of dropsy of serous cavity

目的探讨恶性浆膜腔积液细胞学分型诊断与病理学分型诊断偏差的原因。方法235例恶性浆膜腔积液标本,行HE染色后显微镜观察,细胞学分型诊断并对积液里常见的转移癌(肺腺癌、肺鳞癌、肺小细胞未分化癌、卵巢腺癌、胃癌、乳腺癌)进行癌细胞总量等14项细胞形态学指标观察。结果①细胞学分型与病理学分型不符情况:5例中、低分化鳞癌和1例大细胞未分化癌细胞学误诊为腺癌,5例可疑癌胸水及4例可疑癌腹水由于涂片中恶性细胞数量少或癌细胞不典型而未能分型诊断。②不同原发部位及不同病理类型来源的癌细胞在积液涂片各有一些特点:卵巢癌细胞数量较多且以大细胞群存在(占86.11%),肺腺癌、肺小细胞未分化癌及乳腺癌以中、小细胞群为多见;胃癌有表现为单个散在细胞(44.83%),部分病例有成群或成团(55.17%);肺鳞癌多以单个散在为主。结论浆膜腔积液细胞学诊断及观察指标能较好地鉴别各种肿瘤细胞的形态特征,为临床确诊原发恶性肿瘤提供有价值的诊断依据。

Objective To review the error factors in diagnosis of dropsy of serous cavity using cytological classification vs. pathomorphological classification. Methods 235 samples of malignant dropsy of serous cavity were observed under microscope after HE staining. The cytological classification diagnosis was performed. Fourteen cytomorphological exponents, such as cancer cell amount, of the common metastatic cancer （adenocarcinoma of lung, squamous cell carcinoma of lung, small cell lung undifferentiated carcinoma, adenocarcinoma of ovary, canter of stomach, canter of breast） in the pleural fluid were observed. Results ① Degree of observer disagreement in cytological classification vs. pathological classification： 5 cases of middle, poorly differentiated squamous cell carcinoma and one case of large undifferentiated cell canter were misdiagnosed as adenoeaceinoma, five cases with doubted canter pleural fluid and four cases with doubted cancer ascites could not be class diagnosed because of the slightly amount of malignant cells or because the cancer cells were not prominent in the smears. ② Variability were found in pleural smears from different primary sites and different pathological classification： 86.11% of ovarian cancer samples were with large amounts of cells, and the cells occurred in large clusters; the cells in adenocarcinoma of lung, small cell lung undifferentiated cancer and cancer of breast occurred in middle and small clusters; the cells in 44.83% of the stomach cancer samples were monomorphic, and 55.17% of them occurred in clusters and mass; the cells in squarnous cell carcinoma of lung samples were relatively monomorphic. Conclusion Cytologic classification and the observed exponents can correctly diagnose and identify the cytological features of different neoplasm cells in pleural fluid, which can be of utmost importance in clinical diagnosis of primary malignant neoplasm.