EFFUSION CYTOLOGY OF ESOPHAGEAL-CARCINOMA

BACKGROUND. Effusions in patients with esophageal carcinoma have only been reported rarely, and the cytologic findings in these specimens ha ve not been well described. METHODS, The authors reviewed 70 effusion specimens from 45 patients with known esophageal carcinoma, 37 of whom underwent resection. RESULTS, Seventeen specimens were from 10 patien ts with squamous cell carcinoma; only 1 specimen contained malignant c ells. Fifty-three specimens were from 35 patients with adenocarcinoma. Twenty-one specimens from 10 patients with adenocarcinoma contained m alignant cells; these included 17 pleural, 2 pericardial, dial, and 2 peritoneal fluids. Lymph node involvement at the time of resection was a significant risk factor for the development of a malignant effusion . The cytologic features were similar to those of other adenocarcinoma s, but >50% of the specimens were hypocellular and neoplastic cells we re rare. Three of 48 negative specimens contained markedly atypical me sothelial cells that were misinterpreted as possibly malignant; in eac h case the findings resolved over time. These cells were smaller and t he chromatin more smudgy than in the neoplastic cells. Patients with p ositive effusions were significantly more likely to die of disease tha n those with a negative effusion, and the average time to death was sh orter (5.3 months vs. 17 months). CONCLUSIONS, Malignant effusions are more common in patients with esophageal adenocarcinoma than those wit h squamous cell carcinoma. Markedly atypical mesothelial cells are a d iagnostic pitfall in patients who undergo resection. (C) 1997 American Cancer Society.