Pericardial effusions in patients with the acquired immunodeficiency s
yndrome (AIDS) can be due to a variety of causes and are often large e
nough to be sampled for cytologic examination. Over a period of 46 mon
ths, 15 cytologic specimens from 14 patients with AIDS were examined T
hirteen patients were male, one was female; the age range was 26 to 43
years. All male patients were homosexual or intravenous drug abusers,
and the female patient was the spouse of an intravenous drug abuser.
In general, the cytology specimens were moderately cellular with infla
mmatory cells seen in all cases. Atypical or reactive mesothelial cell
s were found in 12 cases (80%), and the atypia in one of these 12 was
so marked that carcinoma was suspected; cells suspicious for malignant
lymphoma were found in 2 cases (13%); degenerated mesothelial cells w
ere present in one case. No infections were identified in this series.
Ten patients (66%) had subsequent pericardial biopsies. Marked cellul
arity and nuclear pleomorphism in lymphoid cells with an altered nucle
ar cytoplasmic ratio were the dominant findings in the two suspected l
ymphoma cases. Both patients had known lymphoma elsewhere; in one, inv
olvement by lymphoma was also found on pericardial biopsy. Mesothelial
proliferations showing papillary formations with psammoma bodies were
seen in three cases; in one of these, histoplasmosis was later diagno
sed by pericardial biopsy. To our knowledge this is the first series t
o describe cytologically the marked mesothelial atypia seen in pericar
dial fluid in AIDS patients. We contrast this atypia with that seen in
malignant effusions and caution against overinterpretation of pericar
dial fluids from AIDS patients.