From the Department of Pathology, University of Michigan Hospital and Health System, Ann Arbor.
Arch Pathol Lab Med. 2024 Apr 1;148(4):409-418. doi: 10.5858/arpa.2023-0049-RA.
CONTEXT.—: Pleural effusions are common cytologic specimens that can be leveraged to make diagnoses of malignancy that drive appropriate patient management. However, the overlap in morphologic features of reactive mesothelial proliferations, mesotheliomas, and adenocarcinomas can create diagnostic pitfalls in the cytologic evaluation of pleural fluids.
OBJECTIVE.—: To review the morphologic spectrum of benign and malignant mesothelial proliferations in pleural effusions, as well as relevant clinicoradiologic contexts and ancillary tests.
DATA SOURCES.—: Existing scientific and clinical literature as of January 2023.
CONCLUSIONS.—: We can leverage the knowledge of several overlapping morphologic features, clinicoradiologic scenarios, and immunohistochemical studies to enhance the diagnostic accuracy of pleural effusion cytology to appropriately delineate cases of adenocarcinoma, reactive mesothelial proliferation, and mesothelioma. Earlier diagnosis through cytology, particularly in cases of mesothelioma, may positively impact patient treatment options and prognosis.
胸腔积液是常见的细胞学标本，可以通过诊断恶性肿瘤来指导适当的患者管理。然而，反应性间皮增生、间皮瘤和腺癌在形态特征上存在重叠，这可能会给胸腔积液的细胞学评估带来诊断上的困难。
回顾胸腔积液中良性和恶性间皮增生的形态谱，以及相关的临床影像学背景和辅助检查。
截至 2023 年 1 月的现有科学和临床文献。
我们可以利用一些重叠的形态特征、临床影像学情况和免疫组织化学研究的知识，提高胸腔积液细胞学诊断的准确性，以便正确区分腺癌、反应性间皮增生和间皮瘤。通过细胞学更早地诊断，特别是在间皮瘤的情况下，可能会对患者的治疗选择和预后产生积极影响。
