1. Cytology of Body Fluid Pleural peritoneal pericardial
Visceral and parietal
Mesothelial cells
Tissue culture medium
Normal: minimal fluid

3. Pathology of Body Cavity
Air; - pneumothorax
- pneumoperitoneum
- pneumopericardium
Effusion; - pleural effusion
- peritoneal effusion (ascites)
- pericardial effusion

4. Pathology of Body Cavity
Transudate (여출액);
Filtration of serum due to ↑osmotic pressure of circulating blood
(hypoproteinemia, LC, kidney and heart dis. …)
Exudate (삼출액);
Active loss of blood component due to
↑vascular permeability of damaged capillaries
(inflammation, cancers …)

5. Transudate
Exudate
Gross
Clear
Turbid
Specific gravity
< 1.015
> 1.015
Protein
< 3g/dl
> 3g/dl
LDH
< serum
> serum
Fibrin clot
Absent
Present
Cell
Few; Mesothelial
Many; Mesothelial,
WBC, RBC,
tumor cells…

6. Transudate
Exudate
Exudate

7. NL Cell Components in Effusion
Mesothelial cells
Macrophages
Leukocytes

8. 1. Mesothelial Cells Almost absent in normal state
Sheets composed of polygonal cells when scraped from the surface
Mesothelial reaction → mesothelial hyperplasia
Mesothelial cells (about 20㎛);
- well-demarcated cytoplasm
- Single or aggregated
- Rounded cells with large round & central nuclei
- Chromatin: finely granular
Reactive mesothelial cells; coarse, irregular chromatin with prominent nucleoli

10. Peripheral foaminess
Vacuolated mesothelial cells

14. Characteristics of Mesothelial Cell Clusters
Presence of intercellular windows (cytoplasmic molding)
Absence of common cell borders; irregular margins of cell clusters with individual cell borders
Pseudo-acinus

15. Mesothelial cells
Adenocarcinoma

16. 2. Macrophages Cell size similar to mesothelial cells (10~20 ㎛)
Single or loose aggregates,
but no cytoplasmic molding
Foamy cytoplasm
Indistinct cytoplasmic borders
Eccentric nuclei with frequent kidney shape and multi-nucleated

17. Cytokeratin MØ
Cytokeratin
CD-68

18. 3. Leukocytes
Lymphocytes; present frequently, numerous lymphocytes in lymphoma, leukemia, and Tbc
PMN cells; indicates inflammatory reaction
Eosinophils; allergic disease, asthma, cancer, pneumothorax, idiopathic in 40% of cases
Plasma cells; chronic inflammation, multiple myeloma, Hodgkin’s disease

19. Mesothelioma Most common in pleura Asbestos exposure Carcinomatous,
Fibrosarcomatous,
and mixed (biphasic)

21. Calretinin

22. Mesothelioma Cytology; Profuseness of cells in body cavity smear
Mesothelial cell clusters, frequent
Larger and irregular clusters than reactive
Full spectrum of mesothelial cells from malignant mesothelial cells to reactive and normal mesothelial cells

26. Criteria for Mesothelial Differentiation
Lack of a ‘foreign’ population
Structure of cell aggregates
Cytoplasmic characteristics
Cell-to-cell relationships
Vacuoles
Collagen basement membrane
Glycogen

27. Structure of Cell Aggregates
Mesothelioma,
cuboidal cells with rounded nuclei
Adenocarcinoma,
columnar cells with elongated nuclei

28. Cytoplasmic Characteristics
Usually abundant, dense and basophilic
Often shows a tinctorial gradation from green at the periphery to reddish orange at the peri-nuclear zone

29. Cell-to-Cell relationships
Brush-like border of microvilli
“Window” effect between adjacent cells
Cell engulfment

30. Characteristics of Mesothelial Cell Clusters
Presence of intercellular windows (cytoplasmic molding)
Absence of common cell borders; irregular margins of cell clusters with individual cell borders
Pseudo-acinus
→ Cell culture effect

32. Immuno-profiles of Malignant Mesothelioma
Cytokeratin
Calretinin
WT1
TTF-1

33. Metastatic Adenocarcinoma
Lung Carcinoma
CEA
TTF-1
Cytokeratin
Calretinin

34. Adenocarcinoma,
CEA
Mesothelioma,
CEA
EMA
Calretinin
CK 5/6

35. Metastatic Cancer
Primary Sites of Metastatic Cancer of Body Cavities in Adults
Body cavity
Male
Female
Pleural
Lung
GI tract
Lymphoma
Breast
Ovary
Peritoneal
Pericardial

36. Pleural, adenocarcinoma
forming cell clumps, lung primary
Ascites, serous adenocarcinoma, ovary primary

37. Pleural fluid;
adenocarcinoma,
breast primary, ductal type

38. Ascites; adenocarcinoma, breast primary, lobular type

39. Metastatic Ca from breast

40. Malignant Lymphoma;
typically do not form clumps,
karyorrhectic nuclei (mercury-drop appearance),
often need immunohistochemistry
for definite diagnosis