Ch. 5 - Peritoneal Washings Flashcards
What tumors is peritoneal washing useful for detecting?
Gynecologic malignancies, pancreatic, gastric
What criteria may be used for adequacy in peritoneal washing?
No consensus criteria, but benign mesothelial cells or obviously malignant cells should be seen.
How does the appearance of mesothelium in peritoneal washing differ from in exfoliative fluid cytology?
They often are dislodged in large folded flat sheets.
What are collagen balls?
Spherical masses of collagen surrounded by flattened mesothelial cells. Quite common (seen in half of specimens)
What should be considered if ciliated epithelial cells are observed in a peritoneal wash?
Endosalpingiosis (tubal-type epithelium).
Describe the cytology of serous adenofibromas.
Tubal-type glands similar to endosalpingiosis and sometimes with psammoma bodies.
Describe the cytology of endometriosis.
Siderophages, endometrial glandular and stromal cells (may be hard to distinguish; easier on cell block)
What is the significance of seeing psammoma bodies in peritoneal washings?
Can be seen on many malignancies but also in mesothelial hyperplasia. Do NOT call malignancy just on the basis of psammoma bodies.
What role does peritoneal washing play in the staging of ovarian cancer?
Positive peritoneal washings will upgrade Ia/b to Ic, and IIa/b to IIc.
Recall the criteria for the major stages of ovarian cancer (I, II, III, IV)
I: Limited to ovaries
II: Pelvic extension
III: Extra pelvic extension including LNs and superficial liver
IV: Distant mets including pleura, parenchymal liver
Describe the cytology of serous carcinoma and borderline tumor.
Serous carcinoma is usually quite obvious with micropapillary architecture, atypia, and psammoma bodies.
Serous boroderline tumor has much less atypia and more vacuoles.
Under what conditions may an endometrial cancer be detectable by peritoneal washing cytology?
Direct invasion, LVI, or through retrofallopian spread.
Describe the cytology of endometrioid adenocarcinoma.
Clusters and isolated cells with enlarged nuclei, coarse chromatin, nuclear pleomorphism, and little cytoplasm. Look for tubular glands and squamous morules.
What role does PWC play in cervical cancer?
More often positive in cervical adenocarcinoma than squamous cell carcinoma.
Briefly, what is “second-look” cytology?
Peritoneal washing following primary cytoreduction and adjuvant therapy, meant to monitor for residual disease. It has quite low sensitivity however…
