Gupta Ruchika, Mathur Sandeep R, Iyer Venkateswaran K, Kumar A Sudheer, Seth Amlesh
Departments of Pathology & Urology, All India Institute of Medical Sciences, New Delhi, India.
Cytojournal. 2010 Apr 6;7:4. doi: 10.4103/1742-6413.62256.
Effusions, especially peritoneal, are seen in less than 2% of patients with renal cell carcinoma (RCC). Since the tumor cells in RCC are bland and nondescript, the involvement of serous effusions is difficult to diagnose. An accurate recognition of malignant effusion and differentiation from reactive mesothelial cells is imperative. A 55-year-old male presented with gradually progressive ascites. Cytospin preparations from ascitic fluid showed reactive mesothelial cells admixed with few smooth-contoured clusters of cells with moderate cytoplasm, vesicular nuclei with prominent nucleolus. He had undergone nephrectomy for papillary RCC two years earlier. Another 36-year-old man underwent left nephrectomy for suspected RCC. Intra-operative ascitic fluid was sent for cytologic examination and showed numerous reactive mesothelial cells along with few clusters of cells with scant to moderate amount of cytoplasm, vesicular nucleus and a small nucleolus. Considering the histomorphology of the primary renal tumor in both cases, a cytologic diagnosis of malignant peritoneal effusion, morphologically compatible with RCC was rendered. RCC, due to its bland cytologic features, is easily overlooked in effusions. In a known patient, the cytopathologist must be extra vigilant to pick up the few cell clusters present in the fluid preparations and differentiate them from reactive mesothelial cells. A close inspection of the cytologic features and comparison with the histopathology of the primary tumor helps in making an accurate diagnosis.
积液，尤其是腹腔积液，在不到2%的肾细胞癌（RCC）患者中可见。由于RCC中的肿瘤细胞形态温和且无特征性，浆液性积液的累及难以诊断。准确识别恶性积液并与反应性间皮细胞进行鉴别至关重要。一名55岁男性出现逐渐加重的腹水。腹水的细胞离心涂片显示反应性间皮细胞与少数轮廓光滑的细胞簇混合，这些细胞簇具有中等量的细胞质、泡状核和明显的核仁。他两年前因乳头状RCC接受了肾切除术。另一名36岁男性因疑似RCC接受了左肾切除术。术中腹水送检进行细胞学检查，显示大量反应性间皮细胞以及少数细胞簇，这些细胞簇的细胞质含量少至中等、核呈泡状且有小核仁。考虑到这两个病例中原发性肾肿瘤的组织形态学，做出了恶性腹腔积液的细胞学诊断，形态学上与RCC相符。由于RCC的细胞特征温和，在积液中很容易被忽视。对于已知患者，细胞病理学家必须格外警惕，以识别液体制片中存在的少数细胞簇，并将它们与反应性间皮细胞区分开来。仔细检查细胞学特征并与原发性肿瘤的组织病理学进行比较有助于做出准确诊断。
