Page 611 - Clinical Hematology_ Theory _ Procedures ( PDFDrive )

CHAPTER 29 ■ Body Fluid Analysis 595

Examples of Cellular Abnormalities Encountered in Pleural and Peritoneal
TABLE 29.7
(Abdominal) Fluids

Condition Cellular Characteristics

Bacterial In ammation

Acute Many neutrophils, histiocytes, and mesothelial cells
May display bacteria

Chronic Some neutrophils and eosinophils

Many lymphocytes, plasma cells, and histiocytes

Reactive mesothelial cells

May display bacteria

Chronic granulomatous Elongated or round multinuclear giant cells

in ammation (e.g., tuberculo- Histiocytes, lymphocytes, and plasma cells

sis, sarcoidosis, fungal infec- Some neutrophils

tions, rheumatoid arthritis) Many reactive mesothelial cells

Amorphous background material from the center of granulomas

May display fungi (special stain), if fungal in ammations

May display tuberculous bacilli (special stains), if tuberculosis

Malignant mesothelioma Abundant number of cells (single or cluster)

Gland-like peculiar multinucleated cells present

Clusters of cells are made of more than 4–5 cells

Calci ed bodies

Occasional psammoma bodies

Metastatic tumors Malignant cells (single or clusters)

Cytoplasm may display intracellular vacuole, associated with mucin in adenocarcinoma, or
squamous cell carcinoma

Intracellular mucin appears as large paranuclear vacuole containing granular blue material
Nucleus may be marginated

Sarcomas have very large elongated cells with oval to rod-shaped nuclei, small nucleoli and
coarse chromatin, and abundant cytoplasm—elongated and nely reticular to granular

Poorly differentiated sarcomas have very large tumor cells with large pleomorphic nuclei

After chemotherapy or Atypical mesothelial cells

radiation therapy Increased number of histiocytes

Viral infections Many lymphocytes, plasma cells, histiocytes, and mesothelial cells

than 10% o total WBCs) may signi y that air or blood has Normally, a small number o cells are sloughed into the

been introduced into the pleural space (e.g., repeated tho- serous cavities.

racenteses, pneumothorax, and traumatic hemothorax). T ese cells vary in appearance, requently mani esting

However, it is not diagnostically signi cant. Eosinophilia atypical or reactive changes, and usually cause the most di -

may also be mani ested in parasitic or ungal diseases, pul- culty during the evaluation o cell types. It is extremely di -

monary in arction, and polyarteritis nodosa. cult to distinguish between mononuclear phagocytes and

intermediate orms o mesothelial cells. T ere ore, they may
Plasma Cells be mistaken or malignant cells.

Te plasma cells resemble those encountered in the Mesothelial cells may appear as single cells, in clusters, or

bone marrow. An increase in plasma cells accompanies as sheets. Clustering o cells may be caused by centri ugation

an increase in lymphocytes in patients with multiple and may closely resemble malignant cells. Clumps o benign

myeloma. Plasma cells may also be seen in e usions rom mesothelial cells can be di erentiated rom malignant cells by

patients with tuberculosis, rheumatoid arthritis, malig- comparing the appearance o the cells in the clump with other

nancy, Hodgkin’s disease, or other conditions associated more easily distinguished mesothelial cells in the same smear.

with lymphocytosis. In addition, a uni orm, regular arrangement o cells that dis-

play enestrations (openings or windows) between the cyto-
Mesothelial Cells plasmic membranes o these cells usually indicates that they

Mesothelial cells (middle lining o cells) orm the lining are benign.

o the pleural, pericardial, and peritoneal cavities. In vivo, Mesothelial cells have a large overall size and average

the cells orm a single-cell layer or sheet o uni orm cells. rom 12 to 30 µm in diameter. Benign mesothelial cells can