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Emperipolesis is a cell-within-cell phenomenon distinct from phagocytosis more often described in Rosai-Dorfman disease, where usually lymphocytes or other bone marrow cells (plasma cells, erythroblasts or neutrophils) are entirely surrounded but not engulfed by macrophages as the host cell, but occasionally megakaryocytes and neoplastic could be. Mesothelial cell has been described in a couple of cases of lymphomas affecting serous membranes, but never described in pleuritis. In the present work, the first case of emperipolesis by mesothelial cells in a patient with self-limited pleural effusion was demonstrated by immunohistochemistry and Electron Microscopy studies. [ABSTRACT FROM AUTHOR]

Bilothorax is a rare condition that can lead to severe infection and death. Most cases present with right-sided pleural effusion and the etiology can be biliary obstruction, infection, or iatrogenic complications. The diagnosis of bilothorax is confirmed by the ratio of pleural fluid to serum bilirubin >1. A 33-year-old Asian female presented with progressive dyspnea from right pleural effusion, which was confirmed to be biloma by pleural fluid to serum bilirubin ratio of 15.9. Imaging showed right-sided subdiaphragmatic nodule, which was subsequently biopsied on laparoscopy revealing hemorrhagic endometriotic lesion. However, there was no obvious diaphragmatic defect connecting pleural and peritoneal cavities. Additionally, no biliary leakage was identified by magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP). The treatment included antibiotics, tube thoracostomy, ERCP with stent, thermal ablation of endometriotic nodules under laparoscopy, and hormonal therapy for endometriosis. Bilothorax is rare case itself but the etiology secondary to endometriosis makes this case particularly unique. [ABSTRACT FROM AUTHOR]

Abstract Background Chylothorax is a postoperative complication in patients with lung cancer. Diet-control approaches have been the mainstay for managing this condition. However, a surgical intervention is needed for the patients if conservative treatment is ineffective. Because of the lack of accurate indicators to assess the prognosis of the postoperative complication at an early stage, the criteria of surgical treatment were not consistent. Methods We reviewed 2942 patients who underwent pulmonary resection and lymph node dissection for primary lung cancer at our hospital between March 2021 and December 2022. The prognostic implications of clinical indicators were assessed in patients with postoperative chylothorax who were managed with a low-fat diet. Binary logistic regression was used to explore the predictive value of these indicators for patient prognosis. Results Postoperative chylothorax occurred in 108 patients and 79 patients were treated with a low-fat diet management while 29 patients were managed with TPN. In contrast to drainage volume, the pleural effusion triglyceride level after 2 days of low-fat diet exhibited enhanced predictive efficacy in predicting patient prognosis. When the pleural fluid triglyceride level of 1.33 mmol/L was used as the diagnostic threshold for prognosis, the sensitivity and specificity reached 100% and 80.6%, respectively. Conclusions The pleural effusion triglyceride level after 2 days of low-fat diet can serve as a valuable prognostic indicator in patients undergoing lung surgery and experiencing chylothorax. This predictive approach will help thoracic surgeons to identify patients with poor prognosis in a timely manner and make decision to perform necessary surgical interventions.

Background: Although pleural fluid adenosine deaminase (ADA) level >70 U/L suggestive tuberculous pleural effusion (TPE). High ADA levels can also be seen in pneumonia, empyema, lymphoma, malignancy, and rheumatoid pleuritis. Elevated pleural fluid lactate dehydrogenase (LDH) is seen in tubercular pleural effusion (TPE), parapneumonic pleural effusion (PPE), and malignant pleural effusion (MPE). Therefore, it is challenging distinguish between TPE, PPE, and MPE based on elevated pleural fluid ADA and LDH levels. In this study, we evaluated the use of pleural fluid LDH/ADA ratio as a new parameter for etiological differentiation of exudative pleural effusions. Materials and Methods: A retrospective hospital-based observational study conducted in GHCCD, Visakhapatnam. A total of 52 patients (TPE – 19, PPE – 16, and MPE – 17) with exudative pleural effusion who fulfilled inclusion criteria were taken into study. Qualitative variables have been described in the form of frequency and percentages. Median and interquartile ranges were used for nonnormal distribution values. Receiver operating curve (ROC) curves with area under the curve (AUC) were calculated. P ≤ 0.05 was considered statistically significant. Results: The mean ADA value for TPE was 75.4 U/L (25–195 U/L), PPE was 59.1 U/L (13–180 U/L), and for MPE was 35.52 U/L (10–75 U/L). The mean LDH value for TPE was 887.8 U/L (139–2213 U/L), PPE was 1128 U/L (334–3110 U/L), and for MPE was 1470 U/L (234–4285 U/L). On ROC analysis, pleural LDH/ADA ratio ≤20.81 diagnose TPE with (sensitivity – 84.2%, specificity – 63.6%) with AUC of 0.758 (95% confidence interval [CI]: 0.619–0.866) (P = 0.0001) whereas LDH/ADA ratio in the diagnosis of PPE was found to be >23.39 (sensitivity – 50%, specificity – 66.7%) with AUC of 0.535 (95% CI: 0.391–0.674) (P = 0.689) and the cutoff LDH/ADA ratio in the diagnosis of MPE was found to be >20.86 (sensitivity – 70.6%, specificity – 68.6%) with AUC of 0.724 (95% CI: 0.583–0.839) (P = 0.007). The cutoff value of the LDH/ADA ratio in PPE does not reach the statistical significant value. Conclusion: Pleural fluid LDH/ADA ratio ≤20.81 U/L is predictive of TPE, and >20.86 U/L is predictive of MPE and the cutoff value of 20.8 U/L can be used for etiological differentiation of pleural effusion.

Background: Chylothorax is a postoperative complication in patients with lung cancer. Diet-control approaches have been the mainstay for managing this condition. However, a surgical intervention is needed for the patients if conservative treatment is ineffective. Because of the lack of accurate indicators to assess the prognosis of the postoperative complication at an early stage, the criteria of surgical treatment were not consistent. Methods: We reviewed 2942 patients who underwent pulmonary resection and lymph node dissection for primary lung cancer at our hospital between March 2021 and December 2022. The prognostic implications of clinical indicators were assessed in patients with postoperative chylothorax who were managed with a low-fat diet. Binary logistic regression was used to explore the predictive value of these indicators for patient prognosis. Results: Postoperative chylothorax occurred in 108 patients and 79 patients were treated with a low-fat diet management while 29 patients were managed with TPN. In contrast to drainage volume, the pleural effusion triglyceride level after 2 days of low-fat diet exhibited enhanced predictive efficacy in predicting patient prognosis. When the pleural fluid triglyceride level of 1.33 mmol/L was used as the diagnostic threshold for prognosis, the sensitivity and specificity reached 100% and 80.6%, respectively. Conclusions: The pleural effusion triglyceride level after 2 days of low-fat diet can serve as a valuable prognostic indicator in patients undergoing lung surgery and experiencing chylothorax. This predictive approach will help thoracic surgeons to identify patients with poor prognosis in a timely manner and make decision to perform necessary surgical interventions. [ABSTRACT FROM AUTHOR]

This article discusses the cytomorphology of metastatic malignant peripheral nerve sheath tumor (MPNST) in pleural fluid. The author presents a case study of a 64-year-old male with MPNST in pleural effusion, describing the detailed cytopathological and immunohistochemical characteristics of the tumor. The article emphasizes the importance of evaluating clinical history and utilizing ancillary studies to ensure accurate cytological diagnoses. The study contributes to the limited understanding of the cytomorphology of MPNST in metastatic cases. [Extracted from the article]

Background: The cytological analysis of body fluids is the preliminary investigation performed for the diagnostic evaluation of body fluids, helping the physician make the diagnosis and plan proper treatment. The International System for Reporting Serous Fluid Cytology (ISFRSFC) was created using best international practises, current literature and expert consensus to make a uniform reporting system for serous fluids. Aims: The present study was conducted with the aim of recategorising the effusion fluids as per the guidelines prescribed by ISRFRC, knowing the distribution of cases into various categories and assessing their feasibility in day-to-day reporting. Patients and Methods: This study was performed on serous fluids (ascitic, pleural, peritoneal and pericardial) received over a period of 5 years, from January 2017 to April 2022, in the cytology unit of the Department of Pathology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi. Wherever possible, clinicoradiological and histopathological data were obtained and correlated with cytological findings. Serous fluids were categorised into reporting formats as prescribed by ISRFRC and its feasibility was assessed in day-to-day reporting. Results: A total of 1115 cases of serous effusion fluid were examined. The male-to-female ratio was 1:1.12. Pleural fluid constituted the majority of the sample (436, 39.10%). Overall, 56 (5.02%) cases were non-diagnostic (ND), 1013 (90.85%) cases were negative for malignancy, 8 (0.72%) were atypia of undetermined significance, 11 (0.99%) were suspicious of malignancy and 27 (2.42%) were malignant (MAL). Conclusion: The current study emphasises the significance of cytological analysis of serous fluid as a comprehensive diagnostic investigation that also aids in determining the cause and monitoring the disease process. With the introduction of ISFRSFC, serous fluid reporting is now uniform and more comprehensive, both for cytopathologists and clinicians.

Introduction: Cytological analysis of body fluids has become an important part of the diagnosis and management of patients. The examination of fluids can categorize the fluids into inflammatory and neoplastic. Material and Methods: This research is a hospital-based observational study of one year, beginning in July 2022 and ending in June 2023. A total of 200 cases were studied in the Central Laboratory, SIMS, Hapur, UP. Result: Out of 200 cases, the most common fluid was peritoneal fluid, followed by pleural fluid. There was a male predominance in the study. The mean age was 45 ± 15 years The most common cause of the benign ascitic effusion was alcoholic liver disease and commonest malignancy was metastatic adenocarcinoma The commonest cause of pleural effusion was tuberculosis. Conclusion: The study of body fluids is a routine diagnostic test that offers a cheap and rapid diagnosis, which aids clinicians in treatment. [ABSTRACT FROM AUTHOR]

Objective: Thoracocentesis is a less invasive and expensive procedure than pleural biopsy, enabling sample collection for cytological evaluation. Cell blocks prepared from these samples provide histopathological diagnoses; further, immunohistochemistry (IHC) can be performed for subtyping malignancies, guiding the clinician in choosing the appropriate treatment modality for the patient. We aimed to determine the various histological subtypes of malignancies using cell block IHC and compare the cell block and conventional cytology methods for diagnosing malignant pleural effusion. Material and Methods: All pleural fluid samples from the clinically suspicious cases of malignancy collected at the Department of Pathology, Government Medical College Kottayam, India, during 18 months, except duplicate and inadequate samples, were included in this prospective observational study. IHC was performed on cell blocks that were positive for malignancy. Results: This study analyzed 630 samples, of which 121 cell blocks demonstrated the presence of malignancy. Overall, 80%, 13%, and 7% of cases were negative, suspicious, and positive for malignancy based on conventional cytology, and 81%, 0%, and 19% were negative, suspicious, and positive for malignancy based on cell blocks, respectively. Among all malignancies, adenocarcinomas from the lung (56%) were the most common, followed by adenocarcinomas from the breast (6%), squamous cell carcinomas (5%), and adenocarcinomas from the ovary (3%). Cell blocks helped detect more malignancies (19%) than conventional cytology (7%), despite a moderate agreement between both methods. Conclusion: Adenocarcinomas were the most common cause of malignant pleural effusions, and the most frequent site of origin was the lungs. Cell blocks helped diagnose more malignancies than conventional cytology. [ABSTRACT FROM AUTHOR]

This article presents a study that investigated the potential of adenosine deaminase (ADA) as an early indicator for tuberculous pleural effusion (TPE). The study found that TPE patients had significantly higher ADA levels in their pleural fluid compared to controls. The study also examined the correlation between ADA levels and other biomarkers, such as interferon-gamma (IFN¿), but found a weak correlation. The findings suggest that ADA could be a promising diagnostic marker for TPE, but more research is needed to improve diagnostic protocols. [Extracted from the article]

Retained hemothorax (RH) is a commonly encountered and potentially severe complication of intrapleural bleeding that can organize with lung restriction. Early surgical intervention and intrapleural fibrinolytic therapy have been advocated. However, the lack of a reliable, cost-effective model amenable to interventional testing has hampered our understanding of the role of pharmacological interventions in RH management. Here, we report the development of a new RH model in rabbits. RH was induced by sequential administration of up to three doses of recalcified citrated homologous rabbit donor blood plus thrombin via a chest tube. RH at 4, 7, and 10 days post-induction (RH4, RH7, and RH10, respectively) was characterized by clot retention, intrapleural organization, and increased pleural rind, similar to that of clinical RH. Clinical imaging techniques such as ultrasonography and computed tomography (CT) revealed the dynamic formation and resorption of intrapleural clots over time and the resulting lung restriction. RH7 and RH10 were evaluated in young (3 mo) animals of both sexes. The RH7 recapitulated the most clinically relevant RH attributes; therefore, we used this model further to evaluate the effect of age on RH development. Sanguineous pleural fluids (PFs) in the model were generally small and variably detected among different models. The rabbit model PFs exhibited a proinflammatory response reminiscent of human hemothorax PFs. Overall, RH7 results in the consistent formation of durable intrapleural clots, pleural adhesions, pleural thickening, and lung restriction. Protracted chest tube placement over 7 d was achieved, enabling direct intrapleural access for sampling and treatment. The model, particularly RH7, is amenable to testing new intrapleural pharmacologic interventions, including iterations of currently used empirically dosed agents or new candidates designed to safely and more effectively clear RH. [ABSTRACT FROM AUTHOR]

Background: The cytological analysis of body fluids is the preliminary investigation performed for the diagnostic evaluation of body fluids, helping the physician make the diagnosis and plan proper treatment. The International System for Reporting Serous Fluid Cytology (ISFRSFC) was created using best international practises, current literature and expert consensus to make a uniform reporting system for serous fluids. Aims: The present study was conducted with the aim of recategorising the effusion fluids as per the guidelines prescribed by ISRFRC, knowing the distribution of cases into various categories and assessing their feasibility in day-to-day reporting. Patients and Methods: This study was performed on serous fluids (ascitic, pleural, peritoneal and pericardial) received over a period of 5 years, from January 2017 to April 2022, in the cytology unit of the Department of Pathology, ABVIMS, Dr. Ram Manohar Lohia Hospital, New Delhi. Wherever possible, clinicoradiological and histopathological data were obtained and correlated with cytological findings. Serous fluids were categorised into reporting formats as prescribed by ISRFRC and its feasibility was assessed in day-to-day reporting. Results: A total of 1115 cases of serous effusion fluid were examined. The male‑to‑female ratio was 1:1.12. Pleural fluid constituted the majority of the sample (436, 39.10%). Overall, 56 (5.02%) cases were non‑diagnostic (ND), 1013 (90.85%) cases were negative for malignancy, 8 (0.72%) were atypia of undetermined significance, 11 (0.99%) were suspicious of malignancy and 27 (2.42%) were malignant (MAL). Conclusion: The current study emphasises the significance of cytological analysis of serous fluid as a comprehensive diagnostic investigation that also aids in determining the cause and monitoring the disease process. With the introduction of ISFRSFC, serous fluid reporting is now uniform and more comprehensive, both for cytopathologists and clinicians. [ABSTRACT FROM AUTHOR]

Thoracentesis is a fundamental procedure in interventional pulmonology, providing both diagnostic and therapeutic value. This review article offers a comprehensive analysis of thoracentesis, delving into pleural anatomy, procedural techniques, indications, and recent advancements. The article details the evolution of thoracentesis, including the crucial role of ultrasound guidance and emerging approaches that enhance precision and minimize complications. It addresses the wide range of indications for thoracentesis in diverse clinical scenarios, from the diagnosis of pleural effusions to therapeutic drainage of pleural collections. Furthermore, this review explores the management of coagulopathy and anticoagulation pertaining to thoracentesis. It will also provide strategies for preventing and managing complications, ensuring that thoracentesis remains a well-tolerated procedure with minimal risks. This article concludes by examining future directions in thoracentesis, including potential innovations and trends that will shape the landscape of interventional pulmonary medicine. This review serves as an essential resource for pulmonologists, interventional radiologists, and healthcare professionals, offering a comprehensive update on thoracentesis.

Calprotectin (CP) is a calcium and zinc binding protein that is widely measured on faecal samples but its determination in other biological fluids might be of interest. The aim of this work was to validate the measurement of CP in pleural fluid by chemiluminescence.

Tuberculosis (TB) is a worldwide burden whose total control and eradication remains a challenge due to factors including false positive/negative diagnoses associated with the poor sensitivity of the current diagnostics in immune-compromised and post-vaccinated individuals. As these factors complicate both diagnosis and treatment, the early diagnosis of TB is of pivotal importance towards reaching the universal vision of a TB-free world. Here, an aptasensor for signaling an interferon gamma (IFN-γ) TB biomarker at low levels is reported. The aptasensor was assembled through gold–thiol interactions between poly(3,4-propylenedioxythiophene), gold nanoparticles, and a thiol-modified DNA aptamer specific to IFN-γ. The aptasensor sensitively detected IFN-γ in spiked pleural fluid samples with a detection limit of 0.09 pg/mL within a linear range from 0.2 pg/mL to 1.2 pg/mL. The good performance of the reported aptasensor indicates that it holds the potential for application in the early diagnosis of, in addition to TB, various diseases associated with IFN-γ release in clinical samples. [ABSTRACT FROM AUTHOR]

Calprotectin (CP) is a calcium and zinc binding protein that is widely measured on faecal samples but its determination in other biological fluids might be of interest. The aim of this work was to validate the measurement of CP in pleural fluid by chemiluminescence. LIAISON®XL, a fully automated chemiluminescence analyzer, was used for CP quantification on pleural fluid. A validation protocol was designed using both quality control materials provided by the manufacturer and pools of pleural fluid samples. Stability, imprecision, bias, linearity, detection capability and carry over effect were evaluated. CP was stable on pleural fluid at least one week, under refrigerated conditions, and four weeks at −80 °C. The observed intra- and inter-day imprecision was between 2.2 and 6.49 %, with a negative bias under 5.51 %. The linearity of the method was verified up to 2,000 ng/mL. The LoQ for the assay was 48.52 ng/mL. A statistically significant carry-over effect was observed after measuring CP concentrations above the upper limit of linearity, but given the observed magnitude, a clinically relevant impact should not be expected. DiaSorin Liaison® calprotectin assay allows reliable measurement of CP in pleural fluid. [ABSTRACT FROM AUTHOR]

Background Pleural effusion may occur in different infections or as a complication of pulmonary disease, malignant disease. Exudative pleural effusion results from local or systemic disease that directly injure the pleural surface. To know intrapleural pathology, correct diagnosis of pleural effusion is essential. For this many parameters have been proposed for segregation of exudates from transudates. Cholinesterase level in pleural effusion of diverse etiologies helps to differentiate between transudates and exudates. Methods The study was conducted in the Department of General Medicine, SCB Medical College & Hospital, Cuttack during the period from June 2019 to September 2020. 100 consecutive patients admitted were included in the study group. Thoracocentesis was done in all patients and samples were sent for biochemical, microbiological and cytological tests. Cholinesterase estimation was done by photometer 5010V5+. Final diagnosis was done by clinical, biochemical, cytological and microbiological results. Results Out of 100 cases, 78 cases were male and 22 cases were females, with male: female ratio 3.4:1. Tubercular effusion was the most common cause followed by congestive cardiac failure. Fever was the most common clinical presentation (62%). The mean total cell count was more in exudate (2911.820+/- 1511.48). The pleural fluid cholinesterase level of 943.5U/L was 96% sensitive and 93% specificity. Conclusion Pleural fluid cholinesterase level of 943.5U/dl gives a more reasonable sensitivity and specificity (96% sensitive and 93% specific) to differentiate from exudates and transudates, while that of 981U/dl is more specific(92.6% sensitive and >99% specific ) and can be taken as taken as gold standard as specificity approaches 100%. The result of present study revealed that pleural fluid cholinesterase is the most accurate parameter for the differentiation of transudates and exudates. [ABSTRACT FROM AUTHOR]

Background and Objective: Tribal populations are the least well-off groups in society, and because of their ignorance, they are ill-equipped to take advantage of government possibilities. Hence, the study aimed to evaluate the level of ADA in Serum and Pleural Fluid and find its role in early diagnosis of Pulmonary Tuberculosis (PTB) among Tribal and Non-Tribal Populations. Method: 76 participants in the study were split into two groups. Group-I includes 35 healthy control participants, and Group-II consists of 41 PTB patients, with 28 sputum-negative (-ve AFB) patients and 13 sputum-positive (+ve AFB) patients between the age of 18 to 65. In both patient groups, ADA levels were determined in serum and pleural fluid at the Pacific Institute of Medical Sciences in Umarda, Udaipur. Results: The ADA level in Serum and pleural fluid were significantly higher in sputum positive (+ve AFB) patients, 35.62±2.41 IU/L and 29.27±3.20 IU/L as compared to sputum negative (-ve AFB) patients, 57.40±32.14 IU/L and 55.94±18.60 IU/L. Further, serum ADA and Pleural Fluid ADA levels among tribal males were higher as compared to tribal females and among non-tribal females, it was higher as compared to non-tribal males. Conclusion: In the area of Udaipur where tuberculosis is quite prevalent among Tribal Population, ADA level in serum and pleural fluid is helpful as a quick and precise test for the early detection of PTB as ADA is an extremely sensitive, precise, affordable, quick, and easily accessible. [ABSTRACT FROM AUTHOR]

Pleural effusion occurs in both benign and malignant pleural disease. In malignant pleural effusions, the diagnostic accuracy and sensitivity of pleural fluid cytology is less than perfect, particularly for the diagnosis of malignant pleural mesothelioma, but also in some cases for the diagnosis of metastatic pleural malignancy with primary cancer in the lung, breast or other sites. Extracellular vesicles (EVs) carry an enriched cargo of microRNAs (miRNAs) which are selectively packaged and differentially expressed in pleural disease states. To investigate the diagnostic potential of miRNA cargo in pleural fluid extracellular vesicles (PFEVs), we evaluated methods for isolating the extracellular vesicle (EV) fraction including combinations of ultracentrifugation, size‐exclusion chromatography (SEC) and ultrafiltration (10 kDa filter unit). PFEVs were characterized by total and EV–associated protein, nanoparticle tracking analysis and visualisation by transmission electron microscopy. miRNA expression was analyzed by Nanostring nCounter® in separate EV fractions isolated from pleural fluid with or without additional RNA purification by ultrafiltration (3 kDa filter unit). Optimal PFEV yield, purity and miRNA expression were observed when PFEV were isolated from a larger volume of pleural fluid processed through combined ultracentrifugation and SEC techniques. Purification of total RNA by ultrafiltration further enhanced the detectability of PFEV miRNAs. This study demonstrates the feasibility of isolating PFEVs, and the potential to examine PFEV miRNA cargo using Nanostring technology to discover disease biomarkers. [ABSTRACT FROM AUTHOR]

Gastrointestinal stromal tumours (GISTs) are rarely encountered in pleural fluid samples. We report a case of GIST metastatic to pleural fluid almost two decades after the original diagnosis. Careful screening by a cytotechnologist, consideration of the clinical history, and judicious use of immunohistochemical stains facilitated the uncommon diagnosis. [ABSTRACT FROM AUTHOR]

Tuberculous pleurisy (TP) is one of the most common forms of extrapulmonary tuberculosis, but its diagnosis is challenging. Lipoarabinomannan (LAM) antigen is a biomarker for Mycobacterium tuberculosis (Mtb) infection. LAM detection has potential as an auxiliary diagnostic method for TP. We have successfully generated five rabbit anti-LAM monoclonal antibodies (BJRbL01, BJRbL03, BJRbL20, BJRbL52, and BJRbL76). Here, anti-LAM antibodies were tested to detect LAM in the pleural fluid and plasma of patients with TP by sandwich enzyme-linked immunosorbent assays (ELISAs). The results revealed that all of the anti-LAM antibodies were successfully used as capture and detection antibodies in sandwich ELISAs. The BJRbL01/BJRbL01-Bio pair showed better performance than the other antibody pairs for detecting mycobacterial clinical isolates and had a limit of detection of 62.5 pg/mL for purified LAM. LAM levels were significantly higher in the pleural fluid and plasma of patients with TP than in those of patients with malignant pleural effusion or the plasma of non-TB, and LAM levels in the pleural fluid and plasma were positively correlated. Moreover, LAM levels in the pleural fluid sample were significantly higher in confirmed TP patients than in clinically diagnosed TP patients. Our studies provide novel LAM detection choices in the pleural fluid and plasma of TP patients and indicate that LAM detection assay has an auxiliary diagnostic value for TP, which may help to improve the diagnosis of TP. [ABSTRACT FROM AUTHOR]

Abstract Pleural effusion occurs in both benign and malignant pleural disease. In malignant pleural effusions, the diagnostic accuracy and sensitivity of pleural fluid cytology is less than perfect, particularly for the diagnosis of malignant pleural mesothelioma, but also in some cases for the diagnosis of metastatic pleural malignancy with primary cancer in the lung, breast or other sites. Extracellular vesicles (EVs) carry an enriched cargo of microRNAs (miRNAs) which are selectively packaged and differentially expressed in pleural disease states. To investigate the diagnostic potential of miRNA cargo in pleural fluid extracellular vesicles (PFEVs), we evaluated methods for isolating the extracellular vesicle (EV) fraction including combinations of ultracentrifugation, size‐exclusion chromatography (SEC) and ultrafiltration (10 kDa filter unit). PFEVs were characterized by total and EV–associated protein, nanoparticle tracking analysis and visualisation by transmission electron microscopy. miRNA expression was analyzed by Nanostring nCounter® in separate EV fractions isolated from pleural fluid with or without additional RNA purification by ultrafiltration (3 kDa filter unit). Optimal PFEV yield, purity and miRNA expression were observed when PFEV were isolated from a larger volume of pleural fluid processed through combined ultracentrifugation and SEC techniques. Purification of total RNA by ultrafiltration further enhanced the detectability of PFEV miRNAs. This study demonstrates the feasibility of isolating PFEVs, and the potential to examine PFEV miRNA cargo using Nanostring technology to discover disease biomarkers.

A Pleural effusion cytology is vital for treating metastatic breast cancer; however, concerns have arisen regarding the low accuracy and inter-observer variability in cytologic diagnosis. Although artificial intelligence-based image analysis has shown promise in cytopathology research, its application in diagnosing breast cancer in pleural fluid remains unexplored. To overcome these limitations, we evaluate the diagnostic accuracy of an artificial intelligence-based model using a large collection of cytopathological slides, to detect the malignant pleural effusion cytology associated with breast cancer. This study includes a total of 569 cytological slides of malignant pleural effusion of metastatic breast cancer from various institutions. We extracted 34,221 augmented image patches from whole-slide images and trained and validated a deep convolutional neural network model (DCNN) (Inception-ResNet-V2) with the images. Using this model, we classified 845 randomly selected patches, which were reviewed by three pathologists to compare their accuracy. The DCNN model outperforms the pathologists by demonstrating higher accuracy, sensitivity, and specificity compared to the pathologists (81.1% vs. 68.7%, 95.0% vs. 72.5%, and 98.6% vs. 88.9%, respectively). The pathologists reviewed the discordant cases of DCNN. After re-examination, the average accuracy, sensitivity, and specificity of the pathologists improved to 87.9, 80.2, and 95.7%, respectively. This study shows that DCNN can accurately diagnose malignant pleural effusion cytology in breast cancer and has the potential to support pathologists. [ABSTRACT FROM AUTHOR]

Objectives: The diagnosis of tuberculosis pleural effusion (TPE) remains challenging, traditional diagnostic tests have limited diagnostic efficacy. This study aimed to assess the diagnostic performance of pleural fluid (PF) lipoarabinomannan (LAM) in TPE. Methods: A diagnostic method for PF LAM (LAM-PF) was established using LEDBIO's AIMLAM kit. The diagnostic performance of LAM-PF was evaluated in 162 HIV-negative patients with suspected TPE. Results: The LAM-PF method established in this study exhibited good linearity and recovery rate, with a limit of detection (LOD) of 2.90 pg/mL. Using a cut-off value of 5.33 pg/mL, the sensitivity and specificity of LAM-PF in diagnosing TPE (n = 128) were 47.7% and 100.0%, respectively. The sensitivity in patients with probable TPE (n = 29) and definite TPE (n = 99) were 41.4% and 49.5%, respectively. LAM-PF displayed a significantly higher sensitivity in probable TPE compared to other tuberculosis detection methods. Combined testing of adenosine deaminase (ADA)and LAM increased the detection sensitivity of TPE to 68.0%, and the area under the curve was 0.84 (0.77–0.89). Conclusion: This study successfully established a method for detecting LAM in PF, which exhibited favorable diagnostic performance for TPE, particularly in challenging cases of probable TPE. Combined detection of LAM and ADA in PF significantly improves TPE diagnostic efficiency.

The characteristics of patients with pleural amyloidosis (PA) are poorly known. A systematic review was performed of studies reporting clinical findings, pleural fluid (PF) characteristics, and the most effective treatment of PA. Case descriptions and retrospective studies were included. The review included 95 studies with a total sample of 196 patients. The mean age was 63 years, male/female ratio was 1.6:1, and 91.9% of patients were >50 years. The most common symptom was dyspnea (88 patients). PF was generally serious (63%), predominantly lymphocytic, and with the biochemical characteristics of transudates (43.4%) or exudates (42.6%). Pleural effusion was generally bilateral (55%) and <1/3 of the hemithorax (50%), although in 21% pleural effusion (PE) exceeded 2/3. Pleural biopsy was performed in 67 patients (yield: 83.6%; 56/67) and was positive in 54% of exudates and 62.5% of unilateral effusions. Of the 251 treatments prescribed, only 31 were effective (12.4%). The combination of chemotherapy and corticosteroids was effective in 29.6% of cases, whereas talc pleurodesis was effective in 21.4% and indwelling pleural catheter in 75% of patients (only four patients). PA is more frequent in adults from 50 years of age. PF is usually bilateral, serous, and indistinctly a transudate or exudate. A pleural biopsy can aid in diagnosis if effusion is unilateral or an exudate. Treatments are rarely effective and there may be definitive therapeutic options for PE in these patients. [ABSTRACT FROM AUTHOR]

Simple Summary: Lung cancer is the biggest killer among cancers. Its mortality is related to delayed diagnosis which is often achieved in the advanced stages of the disease when surgery is no longer an option. Innovative treatments are now available for patients carrying specific genetic or immunological signatures. Tissue biopsy represents the gold standard sample to identify such life-changing therapeutic targets but obtaining it is not always easy, is often risky, and requires accurate radiological and clinical preliminary study. In this scenario, extracellular vesicles (EV), submicron particles released by both tumor and host cells, have been shown to carry strategical effectors and modulators of cancer development and to realize intercellular signaling. EV have been applied as a biosensor of disease showing high performance in both diagnosis and screening of lung cancer. As reviewed herein, circulating EV and especially those detected in body fluids in direct contact with lung cancer—bronchoalveolar lavage and pleural fluids—might convey not only tumor features but also key drivers of disease. Lung cancer still represents the main cause of cancer death worldwide. The poor survival is mainly related to the diagnosis which is often obtained in advanced stages when the disease is unresectable and characterized by the worst prognosis. Only in the last decades have great discoveries led to the development of new therapies targeted to oncogenes and to boost the host immune response against the tumor. Tumor identification and molecular/immunological characterization rely on bioptic samples which represent the gold standard for diagnosis. Nonetheless, less invasive procedures providing small samples will be more and more common in the future. Extracellular vesicles (EV), submicron particles released by any cell type, are candidates for diagnostic and prognostic biomarkers. EV are mediators of intercellular communication and can convey cytokines, miRNAs, antigens, and many other factors of tumorigenesis. This review summarizes the most appealing findings on lung-cancer-related EV, debating the evidence on circulating versus airway EV as potential biomarkers in disease management and the main studies on the role of these particles on lung cancer pathogenesis. Overall, the available results point toward a wide range of possible applications, supported by the promising achievements of genotyping on BAL fluid EV and proteomic analysis on pleural effusion EV. Nonetheless, the study of lung EV is still affected by remarkable methodological issues, especially when in vitro evidence is translated into humans. Whether EV still represent an "information fog" or can be useful in lung cancer management will be discussed, with possible hints on how to improve their usage. [ABSTRACT FROM AUTHOR]

Autosomal dominant polycystic kidney disease (ADPKD) has cystic fluid accumulations in the kidneys, liver, pancreas, arachnoid spaces as well as non-cystic fluid accumulations including pericardial effusions, dural ectasia and free fluid in the male pelvis. Here, we investigate the possible association of ADPKD with pleural effusion. ADPKD subjects (n = 268) and age-gender matched controls without ADPKD (n = 268) undergoing body magnetic resonance imaging from mid-thorax down into the pelvis were independently evaluated for pleural effusion by 3 blinded expert observers. Subjects with conditions associated with pleural effusion were excluded from both populations. Clinical and laboratory data as well as kidney, liver and spleen volume, pleural fluid volume, free pelvic fluid and polycystic kidney disease genotype were evaluated. Pleural effusions were observed in 56 of 268 (21%) ADPKD subjects compared with 21 of 268 (8%) in controls (p < 0.0001). In a subpopulation controlling for renal function by matching estimated glomerular filtration rate (eGFR), 28 of 110 (25%) ADPKD subjects had pleural effusions compared to 5 of 110 (5%) controls (p < 0.001). Pleural effusions in ADPKD subjects were more prevalent in females (37/141; 26%) than males (19/127,15%; p = 0.02) and in males were weakly correlated with the presence of free pelvic fluid (r = 0.24, p = 0.02). ADPKD subjects with pleural effusions were younger (48 ± 14 years old vs. 43 ± 14 years old) and weighed less (77 vs. 70 kg; p ≤ 0.02) than those without pleural effusions. For ADPKD subjects with pleural effusions, the mean volume of fluid layering dependently in the posterior–inferior thorax was 19 mL and was not considered to be clinically significant. Pleural effusion is associated with ADPKD, but its role in the pathogenesis of ADPKD requires further evaluation. [ABSTRACT FROM AUTHOR]

A 48-year-old male patient presented with dialysis dependent renal failure with biopsy showing crescentic glomerulonephritis and Positron emission tomography–computed tomography (PET-CT scan) revealing features of pericardial, pulmonary tuberculosis with positive urinary GeneXpert test for tuberculosis bacilli. Clinicians should keep in mind the atypical presentations of tuberculosis while managing rapidly progressive renal failure especially in tropical countries with high prevalence of tuberculosis.

Tuberculosis (TB) is a worldwide burden whose total control and eradication remains a challenge due to factors including false positive/negative diagnoses associated with the poor sensitivity of the current diagnostics in immune-compromised and post-vaccinated individuals. As these factors complicate both diagnosis and treatment, the early diagnosis of TB is of pivotal importance towards reaching the universal vision of a TB-free world. Here, an aptasensor for signaling an interferon gamma (IFN-γ) TB biomarker at low levels is reported. The aptasensor was assembled through gold–thiol interactions between poly(3,4-propylenedioxythiophene), gold nanoparticles, and a thiol-modified DNA aptamer specific to IFN-γ. The aptasensor sensitively detected IFN-γ in spiked pleural fluid samples with a detection limit of 0.09 pg/mL within a linear range from 0.2 pg/mL to 1.2 pg/mL. The good performance of the reported aptasensor indicates that it holds the potential for application in the early diagnosis of, in addition to TB, various diseases associated with IFN-γ release in clinical samples.

Retained hemothorax (RH) is a commonly encountered and potentially severe complication of intrapleural bleeding that can organize with lung restriction. Early surgical intervention and intrapleural fibrinolytic therapy have been advocated. However, the lack of a reliable, cost-effective model amenable to interventional testing has hampered our understanding of the role of pharmacological interventions in RH management. Here, we report the development of a new RH model in rabbits. RH was induced by sequential administration of up to three doses of recalcified citrated homologous rabbit donor blood plus thrombin via a chest tube. RH at 4, 7, and 10 days post-induction (RH4, RH7, and RH10, respectively) was characterized by clot retention, intrapleural organization, and increased pleural rind, similar to that of clinical RH. Clinical imaging techniques such as ultrasonography and computed tomography (CT) revealed the dynamic formation and resorption of intrapleural clots over time and the resulting lung restriction. RH7 and RH10 were evaluated in young (3 mo) animals of both sexes. The RH7 recapitulated the most clinically relevant RH attributes; therefore, we used this model further to evaluate the effect of age on RH development. Sanguineous pleural fluids (PFs) in the model were generally small and variably detected among different models. The rabbit model PFs exhibited a proinflammatory response reminiscent of human hemothorax PFs. Overall, RH7 results in the consistent formation of durable intrapleural clots, pleural adhesions, pleural thickening, and lung restriction. Protracted chest tube placement over 7 d was achieved, enabling direct intrapleural access for sampling and treatment. The model, particularly RH7, is amenable to testing new intrapleural pharmacologic interventions, including iterations of currently used empirically dosed agents or new candidates designed to safely and more effectively clear RH.

Corona virus infects the ciliated cells in the human nasal epithelium. Lung disease and diabetes are enlarged risks of severe breakdown against COVID-19. Cilia are hair-like construction enhanced from the celluloid into the pleural fluid surrounding the cell. Infection is detected in the lungs, a pleural disorder generates a Pleural Effusion. The present paper developed mathematical model intent to analyze the rotational consequence cause of COVID-19 on the human respiratory tract surrounded by the porous medium in the presence of the Soret effect with hall current under the force of the magnetic field. The respiratory tract mechanism of biological flows with the physiological process is observed. The non-dimensional governing equations are solved using the perturbation technique and the numerical computation results are exposed in the form of graphs. The effects of several parameters such as the Hartmann number, Schmidt number, Prandtl number, Soret parameter on the velocity, temperature and concentration fields are determined with their significance.

Abstract Background As promising novel treatments develop for malignant pleural mesothelioma (MPM), early prognostication has become increasingly important. Circulating and local inflammatory cells are known to play a significant role in other tumour types. We assessed the proportion of lymphocyte populations within blood, pleural fluid and tumour stroma to prognosticate patients with MPM at diagnosis. Methods Consecutive patients diagnosed with biopsy-proven MPM were prospectively recruited to an observational cohort study and followed up for a minimum of 7.5 years. Blood and pleural fluid results at presentation were extracted from the medical records. Biopsy specimens were independently reviewed by 2 pathologists who scored the degree of lymphocytic and neutrophilic infiltration. Results Baseline results were available for 184 patients. The predominant pleural fluid cell type was calculable for 84 patients and 118 patients had biopsy specimens available for review. A low blood neutrophil/lymphocyte ratio (NLR

O transporte de equinos tem sido um dos fatores de risco mais associados ao desenvolvimento da pleuropneumonia, isso porque há um grande estresse vivido por esses animais durante o embarque, na viagem e no desembarque, levando a uma queda de imunidade. O sistema respiratório de equinos atletas é um dos mais importantes, uma vez que interfere no seu desempenho. O objetivo desse trabalho, foi relatar um caso atendido no Hovet da Universidade Federal do Mato Grosso – Cuiabá. O animal chegou com histórico de pleuropneumonia após ser transportado por longa distância e com recidivas ao tratamento. Para confirmação do diagnóstico e análise do quadro clínico atual, foram realizados exames laboratoriais e de imagem, incluindo hemograma, perfil bioquímico, citologia, cultivo, antibiograma e ultrassonografia torácica, indicando a presença de pleuropneumonia crônica. A terapia foi realizada com antimicrobianos de amplo espectro e baseados no antibiograma, anti-inflamatórios não esteroidais, mucolítico e cuidados de suporte. Após 29 dias de tratamento, apresentou remissão dos sintomas e fluído pleural, apto à alta hospitalar. A pleuropneumonia tem prognóstico reservado, dependendo da gravidade do quadro e rapidez nas tomadas de decisões. O sucesso do caso, deve-se ao diagnóstico correto e condutas terapêuticas assertivas, resultando em bom prognóstico.

Background: The International System for Reporting Serous Fluid Cytopathology (ISRSFC) was published recently to provide standard reporting terminology for serous fluid. To date, several ISRSFC reclassification studies have reported a wide range of diagnostic category frequency and the associated risk of malignancy (ROM). Herein, the authors applied the ISRSFC to report pleural and peritoneal effusions retrospectively in a community hospital setting. Methods: With Internal Review Board approval, 446 peritoneal effusion specimens and 299 pleural fluid specimens from 576 patients in three community hospitals over a 12‐month period were reviewed and reclassified according to the ISRSFC. Results: After reclassification, in pleural effusions, 18 (5.0%) were nondiagnostic (ND), 273 (76.0%) were negative for malignancy (NFM), 18 (5.0%) were atypia of undetermined significance (AUS), 6 (1.7%) were suspicious for malignancy (SFM), and 44 (12.3%) were malignant (MAL). In peritoneal effusions, after reclassification, 11 (5.5%) were ND, 168 (77.1%) were NFM, 9 (4.1%) were AUS, 2 (0.9%) were SFM, and 27 (12.4%) were MAL. The calculated ROM was 0.0% for ND, 1.8% for NFM, 37.5% for AUS, 83.3% for SFM, and 100.0% for MAL in peritoneal effusions; and the ROM was 8.3% for ND, 1.2% for NFM, 44.4% for AUS, and 100.0% for both SFM and MAL in pleural effusions. Further analysis demonstrated notable heterogeneity among published ISRSFC reclassification studies, although the overall ROMs did not differ significantly from the ISRSFC‐determined ROMs (all p values were >.05 for mean ROM comparisons). Conclusions: The findings suggested the necessity for each laboratory to perform its own ROM analysis based on its statistics for ISRSFC‐tiered classification terminology. The International System for Reporting Serous Fluid Cytopathology was used to retrospectively report cytology in pleural and peritoneal effusion specimens in a community hospital setting. Although the system provided consistency of terminology as a tiered classification, the findings suggested the necessity for each laboratory to perform its own risk of malignancy analysis based on its own statistics. [ABSTRACT FROM AUTHOR]

Sojung Park,1 Won-Young Kim,2 Moon Seong Baek2 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Republic of Korea; 2Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of KoreaCorrespondence: Moon Seong Baek, Email wido21@cau.ac.krPurpose: Pleural effusions are common in mechanically ventilated patients. However, the risk factors for poor outcomes after pleural drainage are poorly understood. This study aimed to identify factors that were associated with in-hospital mortality among mechanically ventilated patients who underwent pleural drainage.Methods: This retrospective study evaluated 82 consecutive patients who required chest tubes during mechanical ventilation at two university-affiliated hospitals in Korea between January 2015 and June 2020.Results: The median age was 76 years (interquartile range [IQR]: 64– 84 years), and the median SOFA score was 11 (IQR: 7– 13). Intensive care unit admission was most commonly because of pneumonia (n = 44, 53.7%) and 60 patients (77.9%) had exudative pleural effusions. During pleural drainage, the PaO2/FiO2 was 210 (IQR: 153– 253); 45 patients (54.9%) were receiving vasopressors, and 31 patients (37.8%) were receiving continuous renal replacement therapy (CRRT). The multivariable regression analysis revealed that poor overall survival was independently associated with receiving vasopressors (adjusted hazard ratio [aHR]: 3.81, 95% confidence interval [CI]: 1.65– 8.81, p = 0.002) and receiving CRRT (aHR: 5.48, 95% CI: 2.29– 13.12, p < 0.001). The PaO2/FiO2 ratio was relatively stable through the third day of pleural drainage among survivors but decreased among non-survivors. The vasopressor dose decreased among survivors but remained relatively stable among non-survivors.Conclusion: Among mechanically ventilated patients who required pleural drainage, use of vasopressors and CRRT was significantly associated with in-hospital mortality. On the third day of pleural drainage, the changes in PaO2/FiO2 and vasopressor dose were associated with in-hospital mortality.Keywords: pleural fluid, drainage, mechanical ventilation, mortality

Objective: While malignant pleural effusion (MPE) is generally observed in non-small cell lung cancer (SCLC) patients, its prevalence in SCLC has not been reported. Methods: Patients over 18 who were admitted to our hospital between January 2015 and December 2019 and diagnosed with SCLC histologically were retrospectively studied. Demographic data, tumor location, tumor stage, pleural fluid characteristics, radiological findings, and overall survival were recorded from hospital records. Results: Our study included 59 patients (48 [81.4%] men and 11 [18.6%] women), with a median age of 67. Forty-seven (79.7%) patients had a history of smoking. The patients had median tumor standardized uptake values (SUV) max levels of 11.9, a tumor diameter of 6 cm, and a follow-up period of 7 months. Protein levels in pleural fluid of the metastasizing group were significantly higher than in the nonmetastatic group (P = 0.049). In the univariate model, age, N stage, pleural fluid glucose, and pleural fluid protein levels were found significantly efficient in predicting disease-free survival (P = 0.008, P = 0.001, P = 0.001, and P = 0.026, respectively). In the multivariate reduced model, N stage, pleural fluid glucose, and pleural fluid protein levels were found independent predictive factors for disease-free survival (P = 0.000, P = 0.000, and P = 0.009, respectively). Conclusions: MPE is common at presentation (11%) in patients with SCLC and may be associated with reduced survival. Additional studies are needed to assess the treatment-adjusted survival rate in the MPE setting.

Tuberculous pleurisy (TP) is one of the most common forms of extrapulmonary tuberculosis, but its diagnosis is challenging. Lipoarabinomannan (LAM) antigen is a biomarker for Mycobacterium tuberculosis (Mtb) infection. LAM detection has potential as an auxiliary diagnostic method for TP. We have successfully generated five rabbit anti-LAM monoclonal antibodies (BJRbL01, BJRbL03, BJRbL20, BJRbL52, and BJRbL76). Here, anti-LAM antibodies were tested to detect LAM in the pleural fluid and plasma of patients with TP by sandwich enzyme-linked immunosorbent assays (ELISAs). The results revealed that all of the anti-LAM antibodies were successfully used as capture and detection antibodies in sandwich ELISAs. The BJRbL01/BJRbL01-Bio pair showed better performance than the other antibody pairs for detecting mycobacterial clinical isolates and had a limit of detection of 62.5 pg/mL for purified LAM. LAM levels were significantly higher in the pleural fluid and plasma of patients with TP than in those of patients with malignant pleural effusion or the plasma of non-TB, and LAM levels in the pleural fluid and plasma were positively correlated. Moreover, LAM levels in the pleural fluid sample were significantly higher in confirmed TP patients than in clinically diagnosed TP patients. Our studies provide novel LAM detection choices in the pleural fluid and plasma of TP patients and indicate that LAM detection assay has an auxiliary diagnostic value for TP, which may help to improve the diagnosis of TP.

A Pleural effusion cytology is vital for treating metastatic breast cancer; however, concerns have arisen regarding the low accuracy and inter-observer variability in cytologic diagnosis. Although artificial intelligence-based image analysis has shown promise in cytopathology research, its application in diagnosing breast cancer in pleural fluid remains unexplored. To overcome these limitations, we evaluate the diagnostic accuracy of an artificial intelligence-based model using a large collection of cytopathological slides, to detect the malignant pleural effusion cytology associated with breast cancer. This study includes a total of 569 cytological slides of malignant pleural effusion of metastatic breast cancer from various institutions. We extracted 34,221 augmented image patches from whole-slide images and trained and validated a deep convolutional neural network model (DCNN) (Inception-ResNet-V2) with the images. Using this model, we classified 845 randomly selected patches, which were reviewed by three pathologists to compare their accuracy. The DCNN model outperforms the pathologists by demonstrating higher accuracy, sensitivity, and specificity compared to the pathologists (81.1% vs. 68.7%, 95.0% vs. 72.5%, and 98.6% vs. 88.9%, respectively). The pathologists reviewed the discordant cases of DCNN. After re-examination, the average accuracy, sensitivity, and specificity of the pathologists improved to 87.9, 80.2, and 95.7%, respectively. This study shows that DCNN can accurately diagnose malignant pleural effusion cytology in breast cancer and has the potential to support pathologists.

Abstract Background Eosinophilic pleural effusion (EPE) is a distinct entity among pleural effusions, but its diagnostic and prognostic significance is still controversial. This study aimed to evaluate the incidence and aetiological distribution of EPE in our institution and to assess the relationship between EPE and malignancy and other underlying diseases and the relevance of the percentage of eosinophils and other laboratory parameters. Methods A retrospective study was conducted by reviewing the medical records of 252 patients with PE from September 2017 to January 2021. Results EPE was found in 34 (13.49%) out of 252 patients. There were 20 (58.82%) males and 14 (41.18%) females in the EPE group. The mean percentage of eosinophils in EPE (21.7%, range (10.0–67.5%)) was significantly higher than the percentage of eosinophils in peripheral blood (5.65%, range (0–34.60%); p

ABSTRACT The diagnosis of pleural tuberculosis (TB) remains difficult due to the paucity of Mycobacterium tuberculosis in pleural fluid (PF). This study aimed to improve pleural TB diagnosis using highly sensitive digital PCR (dPCR) technique. A total of 310 patients with evidence of PF were consecutively enrolled, 183 of whom suffered from pleural TB and 127 from non-TB. PF samples were prospectively collected and total DNA was extracted. The copy numbers of M. tuberculosis insertion sequence (IS) 6110 and IS1081 in DNA were quantified using dPCR. The overall area under the curve of IS6110-dPCR was greater than that of IS1081-dPCR (0.85 versus 0.79). PF IS6110 OR IS1081-dPCR (according to their cut-off values, “positive” was defined as either of them was positive, while “negative” was defined as both of them were negative) had higher sensitivity and equal specificity compared with single target-dPCR. The sensitivity of PF IS6110 OR IS1081-dPCR for total, definite, and probable pleural TB was 59.0% (95% CI = 51.5% to 66.2%), 72.8% (95% CI = 62.6% to 81.6%), and 45.1% (95% CI = 34.6% to 55.8%), respectively. Its specificity was 100% (95% CI = 97.1% to 100.0%). PF IS6110 OR IS1081-dPCR showed a higher sensitivity than smear microscopy (57.4% versus 7.1%), mycobacterial culture (55.3% versus 31.8%), and Xpert MTB/RIF (57.6% versus 23.0%). Long antituberculosis treatment time (>1 month) was found to be associated with negative dPCR results in pleural TB patients. This study indicates that PF IS6110 OR IS1081-dPCR is an accurate molecular assay, which is more sensitive than routine etiological tests and has the potential to enhance the definite diagnosis of pleural TB. IMPORTANCE Pleural TB is one of the most frequent causes of pleural effusion, especially in areas with high burden of TB. Due to the paucibacillary nature of the disease, the diagnostic sensitivities of all available bacteriological and molecular tests remain poor. There is an urgent need to develop new efficient methods. Digital PCR (dPCR) is the third generation of PCR that enables the exact quantification of trace nucleic acids in samples. This study evaluates the diagnostic performance of pleural fluid (PF) dPCR analysis for pleural TB, and shows that PF IS6110 OR IS1081-dPCR has a higher sensitivity than routine etiological tests such as smear microscopy, mycobacterial culture, and Xpert MTB/RIF. This work provides a new choice for improving the definite diagnosis of pleural TB.

Extra‐nodal (NK/T) cell lymphoma (NKTCL) of nasal type (ENKL) presents with extranodal involvement and is associated with EBV. They are localized primarily to nasal and upper airway region but can rarely involve skin, testis, intestine, muscle, or present as a disseminated disease. We present a case of a 65‐year‐old male presented with bilateral orbital swelling, right parotid swelling, fever, mediastinal nodes, pleural effusion and hepatomegaly. Cytology of pleural fluid showed monomorphic lymphoid cells with folded nuclei, vesicular chromatin, inconspicuous nucleoli and granular cytoplasm. Few histiocytes showing hemophagocytosis were also noted in a background of inflammatory cells. Flow cytometric immunophenotyping of pleural fluid showed abnormal lymphoid cells which were positive for CD45, CD2 and CD56. Histopathological examination of the right eye swelling showed many atypical lymphoid cells which were positive for CD56 and negative for B and T cell markers. Based on morphological and immunophenotypic features a diagnosis of NKTCL, extra‐nasal type was suggested. Patient succumbed to the disease despite aggressive therapy. Extranasal type of NKTCL is an aggressive disease with some characteristic morphological and immunophenotypic features and a poor overall outcome. Pathologists and clinicians must be aware of this entity to ensure a prompt diagnosis and adequate management. [ABSTRACT FROM AUTHOR]

Background: Cytological evaluation of body fluids is an important diagnostic test for various malignant and benign conditions. Objectives: Our study aims to analyse the various body fluids received in our department over a ten-year period. It also seeks to determine the accuracy and significance of specimen volumes of fluid cytology specimens in diagnosing malignancy in a resource-poor setting. Methodology: This is a retrospective study carried out in the Department of Anatomic Pathology of a teaching hospital in SouthEast, Nigeria. Histopathologic tissue results, if available were also retrieved from the archives as gold standard. Results: Within the period under review, 358 pleural fluid specimens, 358 ascitic fluid specimens and 2 pericardial effusion specimens were retrieved. Of all effusion cytology specimens, 126 (17.5%) were cytologically malignant. More specifically, 48 (13.4%) of pleural effusion specimens, and 78 (21.8%) of ascitic fluid specimens were malignant. The most common histologically diagnosed cancer observed in patients with malignant pleural effusion was breast cancer, while for ascitic fluid, it was ovarian cancer. For all cytologic diagnoses, the sensitivity was 37.0%, specificity 87.2%, PPV 84.4%, NPV 42.5% and accuracy 54.5%. With respect to the specimen volume of the histologically confirmed malignant cases received for cytological examination, 114 (52.1%) of the specimen were <10mls, only 36 (16.4%) were ≥20mls. Those cytologically positive for malignant cells had a median volume of 10.0ml, while those cytologically negative for malignant cells had a median volume of 8.8ml. In addition, there was an incremental increase in the percentage of cytologically malignant effusions with increased volume of specimen used for the analysis from 34.2% for specimens <10mls to 50% for specimen volumes ≥20mls. However, a Chi-squared test showed there is no statistically significant difference between these (P = 0.213). Conclusion: The sensitivity of effusion cytology in this study is at the lower end of the spectrum. This may be related amongst other factors to the suboptimal specimen volume received for evaluation and lack of resources for cell block and immunocytochemistry. [ABSTRACT FROM AUTHOR]