The photos are not diagnostic of carcinoma or mesothelioma. The small possibility of CLL/small lymphocytic lymphoma involving pleura cannot be ruled out by cytologic examination. Check clinical history, hemograms and discuss with clinicians before deciding on whether to run flow cytometry on additional fresh specimen.

 大部分图片辨认困难，猜：淋巴瘤不除外。

 多谢张老师!

 会诊意见：

两次胸水涂片：染色过深，影响观察。见多量淋巴细胞、单核细胞、个别核优势细胞，成团性不明显，考虑为增生间皮细胞。

引流物切片：见多量淋巴细胞，单核细胞，高度变性细胞，部分为幼稚淋巴样，核型不整，核仁明显，应考虑小细胞型恶性淋巴瘤，需行免疫组化染色进一步确诊。并见少量核优势，淡染，但核仁明显的细胞，考虑为增生间皮细胞。

 AE1/AE3（＋）；抗间皮（—）；CK（＋）；;CEA（—）;TTF-1（—）

淋巴标记：标记T散在阳性，标记B成片阳性；CD5（—）;CD23（—）;Cyclind-1（—）； Bcl-2（＋）

 

  细胞学及组织学均未见典型肿瘤细胞

 未见恶性肿瘤细胞

Lymphocytes of varying sizes (mostly small lymphocytes) admixed with fibrin clots and trapped reactive mesothelia (large cells with vesicular nuclei and plump eosipnophilic cytoplasm) - these are not diagnostic of carcinoma. However, rarely, abundant small lymphocytes in recurrent pleural effusion may be the result of involvement by low grade CLL or small lymphocytic lymphoma. Check the clinical history and see if there was leukemia and indolent lymphoma. If the pleural effusion keeps recurring, flow cytometry may be considered to rule out CLL/small lymphocytic lymphoma involvement. Immunohistochemical stains are not as helpful as flow cytometry.

 细胞学及组织学均未见典型肿瘤细胞，建议复查。

 

第二次胸水

 

 

引流物：灰红色软组织一块，大小2.5X1.5X0.1CM.