Title: Ascitic fluid cytology and its implications in the clinical approach
Authors: Dr S P Tathe, Dr S N Parate, Dr S A Meshram, Dr AA Randale, Dr MA Bhatkule
DOI: https://dx.doi.org/10.18535/jmscr/v6i12.99
Abstract
Ascitis is a consequence or complication of a number of diseases. It often presents as a common diagnostic and therapeutic dilemma to the pathologists and physicians. Both non neoplastic and neoplastic causes of ascitis can be identified by the relatively non invasive technique of ascitic fluid cytology. The present study aims to assess the value of ascitic fluid cytology in the differential diagnosis of ascitis and its usefulness in the patient management.
This prospective study was conducted from June 2014 to June2018. Total 1600 patients with ascitis were included in the study. Total cell count of ascitic fluid was done with improved Neubauers counting chamber. Smears were studied for cell type and cellular features.
Most common cause of ascitis was cirrhosis [80.7%]. Malignant ascitis was noted in 4.5% cases. It was mostly (98.6%) due to metastasis from ovarian, gastrointestinal, unknown primary and pancreatic malignancies. The conditions like spontaneous bacterial peritonitis, eosinophilic ascitis and filarial ascitis were readily diagnosed by total cell count and ascitic fluid cytology. Ascitic fluid cytology was useful not only in the diagnosis but also to assess the response to treatment in these cases.
The careful cytomorphological examination of ascitic fluid is a valuable, simple, rapid, inexpensive and reliable technique in the differential diagnosis of ascitis, particularly in resource limited settings.
Keywords: Ascitic fluid cytology, ascitis, cirrhosis, spontaneous bacterial peritonitis.
References
- Huang LL, Xia HH, Zhu SL. Ascetic fluid analysis in the differential diagnosis of ascitis. Focus on cirrhotic ascitis. JCTH.2: 58-64,2014.
- Anita B, & Ahuja JM. Evaluation of coelomic fluids and its clinical correlation with cytologic diagnosis. J Cytol Histol. 7(2): 1-19, 2016.
- Bibbo M, Tacheva RD, Naylor B. Pleural, peritoneal and pericardial effusions. In: Comprehensive Cytopathology. Bibbo M, Wilbur DC editors.4th Elsevier Saunders: 409-449, 2015.
- Cibas ES. Pleural, pericardial and peritoneal fluids. In: Cytology: Diagnostic principles and clinical correlate. Cibas ES and Ducatman BS editors.3rd Philadelphia: Elsevier:129-153,2009.
- Gupta S, Sodhani P, Jain S. Cytomorphological profile of neoplastic effusions: an audit of 10 years with emphasis on uncommonly encountered malignancies. J Can Res Ther. 8(4): 602-609,2012.
- Hwangbo Y, Jung JH, Shim J, Kim BH, Jung SH, Lee CK et al. Etiology and laboratory analysis of ascitis in patients who underwent diagnostic paracentesis. Korean J Hepatol. 13(2):185-95,2007.
- Bodal VK, Bansal P, Bal MS, Suri AK, Bhagat R, Kaur N et al. Analysis of ascitic fluid for cytological and biochemical findings. RRJMSH. 2(4):98-104,2013.
- Sharma M, Sharma A, Khajuria A, Gandhi S. Evaluation of pathological body fluids: an important diagnostic aid. IJBMR. 6(2):18-24, 2017.
- Shalimar & Acharya SK. Difficult to treat spontaneous bacterial peritonitis. Tropical Gastroenterol. 34(1): 7-13, 2013.
- Sanai FM & Bzeizi KI. Systematic review: tuberculous peritonitis- presenting features, diagnostic stratergies and treatment. Aliment Pharmacol Ther. 22: 685-700.2005.
- Sharma MP & Bhatia V. Abdominal tuberculosis. Indian J Med Res. 120: 305-315, 2004.
- Dowerah E & Das S. Cytological evaluation of peritoneal fluid with special reference to malignancy. IJBR. 5(6): 396-99, 2014.
- Agrawal Shefali, Vohra S, Rawat S, Kashyap V. Eosinophilic ascitis: A diagnostic and therapeutic challenge. World J gastrointest Surg. 8(9):656-659,2016.
- Gupta P, Singla R, Kumar S, Singh N, Nagpal P, Kar P. Eosinophilic ascitis, a rare presentation of eosinophilic gastroenteritis. JAPI. 60: 53-55, 2012.
- Shah KS, Bhate PA, Solanke D, Pandey V, Ingle MA, Kane S, Sawant P. Non chylous filarial ascitis: a rare case report. World J clin Infect Dis. 5(1): 11-13, 2015.
- Khan N, Sherwani RK, Afroz N, Kapoor S. Cytodiagnosis of malignant effusion and determination of primary site. J Cytol. 22(3):107-110, 2005.
- Patel NP, Taylor CA, Levine EA, Trupiano JK, Giesinger KR. Cytomorphologic features of primary peritoneal mesothelioma in effusion, washing and fine needle aspiration biopsy specimens. Am J Clin Pathol. 128: 414-422, 2007.