Background: Cytological examination of body fluids has increasingly gained acceptance in clinical medicine to such an extent that a positive diagnosis made is often considered definitive diagnosis. It is of utmost importance to identify primary site and type of malignancy. The aim of this study is to compare the diagnostic efficiency & morphological features of cell block & conventional smear method in malignant fluid samples. This study also evaluates the usefulness of immunohistochemistry on cell blocks in identifying the primary site of malignancy

Methods: Cell blocks & conventional Smears from 30 malignant fluid samples were prepared. Morphological features (like cellularity, nuclear features, cytoplasmic features & pattern) and final diagnosis were compared in both. Immunohistochemistry was performed on cell blocks to identify the primary site of malignancy. The results obtained by immunohistochemistry were compared to the final histopathological diagnosis of the primary malignancy.

Results & Discussion: The morphological features were found to be superior in cell block method compared to conventional smear method. The diagnostic efficiency of cell block was 86.7% whereas that of conventional smear was only 80%. Combined diagnostic efficiency of the two methods was 96.7%. Immunohistochemistry done on cell blocks could identify the primary malignancy or atleast suggest two or three possible sites of primary in all 30 cases.

Conclusions: Cell block in conjunction with smears helps increase the accuracy of fluid diagnosis. The better morphological features and the use of immunohistochemistry to help identify primary site of malignancy gives a more definitive diagnosis by the cell block method.

Keywords: Cell block, Conventional smear, Immunohistochemistry.

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Dr Deepthy Vijayaraghavan

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