Thrall Michael J, Giampoli Ellen J
Department of Pathology and Laboratory Medicine, The Methodist Hospital, Houston, TX, USA.
Cytojournal. 2009 Aug 7;6:16. doi: 10.4103/1742-6413.54919.
Patients with cirrhosis develop ascites for physiologic reasons that are unrelated to malignant progression. However, physicians performing paracentesis in these patients, often send fluid to the cytology laboratory, sometimes specifically looking for hepatocellular carcinoma (HCC). We have investigated the diagnostic yield of these specimens.
A computerized pathology database search for all ascites fluid cases submitted to the cytology laboratory at a major liver transplant center between November 2004 and April 2008 was performed. Clinical history was obtained for each case. Patients with cirrhosis, with or without HCC, were included in the study. Cytologic diagnoses were compiled and follow-up information was obtained for cases with non-negative findings.
A total of 167 specimens from 133 patients ranging from 29 to 85 years of age (mean 56 years) were submitted over the said time period. The causes of cirrhosis included: alcohol - 44; Hepatitis C - 30; Hepatitis B - 6; non-alcoholic steatohepatitis - 7; cryptogenic - 18; other single causes - 6; and multifactorial (alcohol and hepatitis viruses) - 22. Hepatocellular carcinoma (HCC) was present or strongly suspected in 17 patients and had been previously resected in two others. The status of fifteen patients was post liver transplant, with recurrent liver failure. Human immunodeficiency virus was present in seven patients and eight patients had a history of non hepatic malignancies. Among the specimens, 162 were negative, two had atypical lymphocytes worked up for lymphoma, and three had atypical epithelioid cells; none was positive for HCC. Immunohistochemistry demonstrated a mesothelial origin for the atypical epithelioid cells in two cases; in the third case, the patient died shortly after the specimen was collected, with no radiological evidence of HCC.
Ascites fluid cytology specimens in patients with cirrhosis, even those known or suspected to have HCC, are almost always negative. Atypical cells seen in such specimens should be treated with skepticism since the likelihood that they represent peritoneal spread of HCC is low..
肝硬化患者出现腹水是由与恶性进展无关的生理原因引起的。然而，对这些患者进行腹腔穿刺术的医生常常将腹水送检细胞学实验室，有时专门查找肝细胞癌（HCC）。我们对这些标本的诊断价值进行了研究。
对2004年11月至2008年4月间提交至某大型肝移植中心细胞学实验室的所有腹水病例进行计算机化病理数据库检索。获取每个病例的临床病史。纳入有或无HCC的肝硬化患者进行研究。汇总细胞学诊断结果，并获取非阴性结果病例的随访信息。
在上述时间段内，共提交了来自133例患者的167份标本，患者年龄在29至85岁之间（平均56岁）。肝硬化的病因包括：酒精性 - 44例；丙型肝炎 - 30例；乙型肝炎 - 6例；非酒精性脂肪性肝炎 - 7例；隐源性 - 18例；其他单一病因 - 6例；多因素（酒精和肝炎病毒） - 22例。17例患者存在或高度怀疑有肝细胞癌（HCC），另外2例此前已行切除术。15例患者为肝移植术后，伴有复发性肝衰竭。7例患者感染人类免疫缺陷病毒，8例患者有非肝恶性肿瘤病史。在这些标本中，162份为阴性，2份有非典型淋巴细胞，经检查排除淋巴瘤，3份有非典型上皮样细胞；无一例HCC阳性。免疫组化显示2例非典型上皮样细胞起源于间皮；第3例患者在标本采集后不久死亡，无HCC的影像学证据。
肝硬化患者的腹水细胞学标本，即使是已知或怀疑患有HCC的患者，几乎总是阴性。对此类标本中见到的非典型细胞应持怀疑态度，因为它们代表HCC腹膜播散的可能性很低。
