Department of Pathology, New York University Langone Medical Center, New York, New York.
Department of Pathology, University of Chicago, Chicago, Illinois.
Cancer Cytopathol. 2022 Mar;130(3):183-188. doi: 10.1002/cncy.22545. Epub 2021 Dec 27.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which is responsible for coronavirus disease 2019 (COVID-19), is known to cause severe respiratory infections with occasional accompanying pleural effusion (PE), pericardial effusion (PCE), or peritoneal effusion (PTE). The effect of COVID-19 on effusion cytology is not yet known. This study aimed to examine the cytomorphologic features and workup of effusion fluids in patients with active COVID-19 infection versus those in recovery.
PE (n = 15), PCE (n = 1), and PTE samples (n = 20) from hospitalized patients with a SARS-CoV-2 infection (from June 1, 2020, to December 30, 2020) were reviewed. Effusion fluids with metastatic carcinoma were excluded. Differential cell counts, cytomorphology, and relevant immunostains for effusion fluids were retrospectively evaluated and compared between patients with active infection (positive on a SARS-CoV-2 nucleic acid amplification test [NAAT] within 2 months; n = 23) and those in the recovery phase from COVID-19 (negative on a SARS-CoV-2 NAAT for >2 months; n = 13).
The cytology diagnoses were negative for malignancy (n = 31), atypical (n = 4), and suspicious for malignancy (n = 1). Active infection cases showed more atypical mesothelial cells than recovery cases (P < .05); some had enlarged nuclei, prominent nucleoli, occasional multinucleation, and bizarre nuclei. Immunostains were performed more often in active infection cases than recovery cases (47.8% vs 7.7%; P < .05). Differential cell counts (available for 28 cases) showed no significant differences between the active infection and recovery groups.
This study found atypical and bizarre mesothelial cells more often in effusions of cases with active COVID-19 infection in comparison with patients in recovery. It is important for cytopathologists to become familiar with the cytomorphologic effects of SARS-CoV-2 on effusion cytology so that these cases can be properly triaged.
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）可引起 2019 年冠状病毒病（COVID-19），已知其可引起严重的呼吸道感染，偶尔伴有胸腔积液（PE）、心包积液（PCE）或腹腔积液（PTE）。COVID-19 对积液细胞学的影响尚不清楚。本研究旨在检查活动性 COVID-19 感染患者与恢复期患者的胸腔积液、心包积液和腹腔积液的细胞形态学特征和检查结果。
回顾性分析了 2020 年 6 月 1 日至 2020 年 12 月 30 日期间住院的 SARS-CoV-2 感染患者的胸腔积液（n=15）、心包积液（n=1）和腹腔积液（n=20）。排除了转移性癌性胸腔积液。对活动性感染患者（在 2 个月内 SARS-CoV-2 核酸扩增试验[NAAT]阳性；n=23）和 COVID-19 恢复期患者（SARS-CoV-2 NAAT 检测结果为阴性超过 2 个月；n=13）的胸腔积液、心包积液和腹腔积液的差异细胞计数、细胞形态学和相关免疫染色进行了回顾性评估和比较。
细胞学诊断为恶性肿瘤阴性（n=31）、不典型（n=4）和疑似恶性肿瘤（n=1）。与恢复期患者相比，活动性感染患者的非典型间皮细胞更多（P<.05）；部分患者的细胞核增大，核仁明显，偶有多核，核型奇异。与恢复期患者相比，活动性感染患者的免疫组化染色更频繁（47.8%比 7.7%；P<.05）。差异细胞计数（可用于 28 例）显示，活动性感染组与恢复期组之间无显著差异。
与恢复期患者相比，本研究发现活动性 COVID-19 感染患者的胸腔积液中更常出现非典型和奇异的间皮细胞。细胞病理学家熟悉 SARS-CoV-2 对胸腔积液细胞学的影响非常重要，以便对这些病例进行适当的分类。
