CYTOLOGY OF PERICARDIAL-EFFUSIONS IN AIDS PATIENTS

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.