Chen L M, Chao T Y, Chiang J H, Nieh S, Chang J Y, Hwang S H, Hseuh E J, Wang C C
Department of Internal Medicine, Army General Hospital, Taichung, Taipei, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1996 Oct;58(4):248-53.
Cytologic examination of pericardial effusions (PE) has been uncommonly reported in the literature. Fewer reports have studied the role of immunocytochemistry in diagnosis of PE. We described our experience, according to cytologic examination and immunocyto-chemical staining of PE.
Over a four-year period, 50 PE specimens from 36 patients were examined cytologically by Wright-Giemsa stain and/or Papanicolaou stain, at Tri-Service General Hospital. Immunocytochemical stainings were further performed to ensure the cell nature.
Eighteen of these patients had benign etiologies; the others suffered from malignant diseases. Sixteen cases, including eight benign and eight malignant, received pericardial biopsy for comparison. Commonly encountered cells in PE with any kind of etiology included neutrophils, lymphocytes macrophages and mesothelial cells. Cancer cells were additionally seen in malignant PE, but not in all cases with cancers. Furthermore, reactive mesothelial cells and macrophages were sometimes not easily distinguished from cancer cells, and reactive lymphocytes frequently mimicked hematopoietic malignancies. Further, the nature of small round tumor cells can hardly be ensured by morphologic examination only. Immunocytochemical studies were successfully used to solve these dilemmas in some suspicious cases.
This study showed that cytology together with clinical information and immunocytochemistry can achieve excellent sensitivity and specificity in identification of malignant PE. The use of immunocytochemistry can even ensure the nature of certain cancers such as small cell carcinoma and B cell lymphoma.
心包积液（PE）的细胞学检查在文献中报道较少。研究免疫细胞化学在PE诊断中作用的报告更少。我们根据PE的细胞学检查和免疫细胞化学染色描述了我们的经验。
在四年时间里，三军总医院对36例患者的50份PE标本进行了Wright-Giemsa染色和/或巴氏染色的细胞学检查。进一步进行免疫细胞化学染色以确定细胞性质。
这些患者中有18例病因良性；其他患者患有恶性疾病。16例患者（包括8例良性和8例恶性）接受了心包活检以作比较。任何病因的PE中常见的细胞包括中性粒细胞、淋巴细胞、巨噬细胞和间皮细胞。恶性PE中还可见癌细胞，但并非所有癌症病例都能见到。此外，反应性间皮细胞和巨噬细胞有时不易与癌细胞区分，反应性淋巴细胞常模仿造血系统恶性肿瘤。而且，仅通过形态学检查很难确定小圆形肿瘤细胞的性质。免疫细胞化学研究成功用于解决一些可疑病例中的这些难题。
本研究表明，细胞学检查结合临床信息和免疫细胞化学在识别恶性PE方面可实现极佳的敏感性和特异性。免疫细胞化学的应用甚至可以确定某些癌症的性质，如小细胞癌和B细胞淋巴瘤。
