Key result
Cytological evaluation of 21 fluid samples with sarcomatous exfoliation revealed diverse morphologies, predominantly epithelioid to pleomorphic, often requiring IHC for accurate diagnosis.
Why the study?
Sarcomatous exfoliation in fluid cytology is extremely rare, and studies describing its characteristics from an Indian experience are lacking.
Observational (n=21)
No
Exfoliated sarcomas in body fluids present with diverse and variable morphology, often requiring IHC to confirm primary sarcoma and rule out secondary malignancies.
May prompt IHC in ambiguous fluid cytology; leaves open validation of diagnostic criteria in larger series.
Cytological evaluation of fluids for sarcomatous exfoliation is extremely rare. However, recently studies have come up describing characteristics of sarcomatous malignancies exfoliating into fluids but study from an Indian experience is still lacking. Description of clinico-pathological landscape in known cases of sarcomas, involving body fluid with emphasis on cytomorphologic details. Study includes cases reported as positive for involvement by sarcoma on fluid cytology including pleural, ascitic and cerebrospinal fluid (CSF) specimens between Jan 2016 to June 2022. Cases were retrieved and reviewed for cytomorphologic features which were subsequently correlated with its parent histology and IHC. IHC was applied on cell blocks for two cases where involvement was doubtful. In total, 21 fluid samples/cases including 4 CSF, 6 ascitic and 11 pleural fluid specimens were incorporated. Case spectrum comprised of 6 cases of Ewing Sarcoma (ES), 3 cases of rhabdomyosarcoma (RMS), 3 cases of osteosarcoma (OS), 2 cases of malignant peripheral nerve sheath tumor (MPNST), 2 cases of synovial sarcoma (SS), a case each of chondrosarcoma (CS), leiomyosarcoma (LMS) angiosarcoma (AS) and two cases of other malignancies with exfoliation of their sarcomatous component. Two cases presented as isolated latent metastasis so an IHC panel was applied to exclude involvement by secondary malignancy and prove involvement by primary diagnosed sarcoma. Majority of exfoliated sarcomas presented with epithelioidto pleomorphic morphology where at times it becomes obligatory to rule out occurrence of a secondary malignancy. It’s the first study from an Indian institute’s perspective that reflects upon such diversity of sarcomas with variability in morphology on exfoliation which can be overwhelming for a cytopathologist at times. IHC panel might be used when clinical background is unknown or when involvement is uncertain. More studies are needed that can help come up with recommendations that address such problems.
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Samanta et al. (2023) conducted an observational in Sarcomatous exfoliation in body fluids (n=21). Cytological evaluation was evaluated on Cytomorphologic features and correlation with parent histology and immunohistochemistry. Cytological evaluation of 21 fluid samples with sarcomatous exfoliation revealed diverse morphologies, predominantly epithelioid to pleomorphic, often requiring IHC for accurate diagnosis.
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