Body cavity fluids

Question 1

What are the characteristics of a transudate?

Answer 1

Clear
Low specific gravity
Low protein content
No fibrin clot
Low cellular content

Question 2

What are the characteristics of an exudate?

Answer 2

Cloudy/turbid
High specific gravity
Has a fibrin clot
High cellular content

Question 3

Form due to physical disturbances of the circulation, such as a rise
in venous pressure or blood pressure caused by a heart infarct or congestive
heart failure, liver cirrhosis, malnutrition and renal failure.
- accumulate by the filtration of serum across intact capillary walls,
and a general tissue oedema is present

Answer 3

Transudates

Question 4

Form due to capillary wall damage caused by any inflammation (due to
infection, abscesses and pneumonia), tumours (such as mesothelioma and
metastatic tumours such as adenocarcinoma), foreign bodies or haemorrhage,
which irritates the serosal mucosa

Answer 4

Exudates

Question 5

EFFUSIONS

Single, sheets, solid balls or three-dimensional clusters with scalloped
periphery

Variable size and shape

Abundant foamy, vacuolated, or dense cytoplasm (cyanophilic on Pap and
basophilic with Diff-Quik stain)

A peripheral fussy zone or small blebs are seen along the periphery

Empty intercellular spaces or windows between adjoining cells

Round to oval, central or eccentric nuclei with finely granular chromatin and one
or two nucleoli
 Occasional mitotic figures

Answer 5

Reactive mesothelial cells

Question 6

EFFUSIONS

The cell population consists of lymphocytes, neutrophils and atypical plasmacytoid
cells.

LE cells are present

Answer 6

Systemic Lupus Erythematous

Question 7

These cells are neutrophils containing intracytoplasmic pale basophilic degraded
nuclear material.

Answer 7

Lupus erythematous (LE) cells

Question 8

Smears usually contain a background of amorphous, granular proteinaceous
debris mixed with epithelioid, spindle shaped, and multinucleated histiocytes

Answer 8

Rheumatoid disease

Question 9

The fluid is bloody to chocolate brown and usually composed of laden-laden
macrophages mixed with benign glandular and stromal endometrial cells.

Answer 9

Endometriosis

Question 10

Is characterized by an inflammatory infiltrate that is rich in eosinophils

Answer 10

Eosinophilic pleuritis

Question 11

The effusion usually has a turbid and yellow appearance associated with a silky
green, metallic shine.

Early in the disease, the inflammatory infiltrate contains neutrophils mixed with
reactive mesothelial cells.

As the disease progresses, ymphocytes replace the neutrophils, eventually
representing 80-100% of the cell population (pleural lymphocytosis).

Cytologic evaluation of this fluid reveals an abundance of small, mature-appearing
lymphocytes associated with few mesothelial cells

Answer 11

Tuberculosis

Question 12

They often appear as beaded or segmented, golden brown dumbbell-shaped
bodies with translucent cores.

Answer 12

Ferruginous bodies

Question 13

The fluid contains sheets of reactive and degenerated mesothelial cells
associated with a bloody and mixed inflammatory background.

The reactive cells may show marked nuclear atypia, but the nuclei are poorly
preserved, bland and exhibit disruption of the nuclear membrane.

Intranuclear vacuoles and cytoplasmic clouding and degeneration are also
evident.

Answer 13

Pulmonary infarct

Question 14

The effusion has a light yellow appearance and creamy consistency.

Cytologic material reveals a highly cellular smear composed almost exclusively of
neutrophils.

In the early stages of the inflammatory process, there are highly reactive
mesothelial cells mixed with acute inflammatory cells

Answer 14

Empyema

Question 15

High degree of cellularity
 True tissue fragments (papillae, acini, morulae)
 Cellular and nuclear pleomorphism
 Cell products (mucin, keratin, bile)
 Thick, irregular nuclear membranes
 Irregular chromatin clumping and clearing
 Large, irregular nucleoli (may be multiple)
 Intranuclear cytoplasm inclusions
 Abnormal mitotic figures
 Two or more sex chromatin bodies

Answer 15

MALIGNANT EFFUSIONS

Question 16

Malignant cells appear singly and in 3D cell clusters with smooth borders.
 The presence of a two-cell population, consisting of malignant cells and
background mesothelial cells, is a key feature.

Answer 16

Adenocarcinoma

Question 17

They typically shed as single cells, but sheets and clusters are also seen.
 Cells are large with a fair degree of dense cytoplasm and hyperchromatic
angulated nuclei.
 Well-differentiated tumours display cytoplasmic orangeophilia, keratin pearls and
anucleated squamous cells.

Answer 17

Squamous cell carcinoma

Question 18

In fluids, it usually appears as single cells, tight clusters and short chains.
 Cells have high N/C ratios, hyperchromatic nuclei with irregularly clumped
chromatin, nuclear moulding and scant cytoplasm.

Answer 18

Small cell carcinoma

Question 19

Comprise 10-20% of lung carcinomas.

 Cells are large, pleomorphic, with malignant nuclear criteria and occur singly or in small clusters.

Answer 19

Large cell carcinoma

Question 20

The tumour cells exfoliate as single cells or loosely adherent groups.
 There is marked cellular pleomorphism, binucleation, nuclear eccentricity,
eosinophilic macronucleoli, intranuclear cytoplasmic inclusions, and cytoplasm
with/without melanin pigment.

Answer 20

Malignant melanoma

Question 21

Relatively rare tumours found in the pleural
cavities of people exposed to asbestos mining.

Smears are usually very cellular showing greater cytologic atypia than reactive conditions.

Cells appear singly, in small groups or in large dense clusters with a scalloped
periphery.

Cells can be multinucleated, with enlarge nuclei with smooth contours.

Hyperchromasia is present and the chromatin is irregular with fine to coarse
granules.

The cytoplasm is abundant and dense and vacuolisation may be present.

The outer part of the cytoplasm stains green to blue and the inner denser part stains orange-red.

Prominent, irregular, macronucleoli are present

Answer 21

Malignant mesothelioma

Question 22

Rarely cause malignant effusions, but when present, the cells may be spindled
showing large and bizarre shapes, and are sometimes multinucleated with
obvious malignant criteria.

Answer 22

Sarcoma