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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]

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]

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]

Primary mediastinal large B‐cell lymphoma (PMBCL) is an uncommon non‐Hodgkin lymphoma that is rarely described in cytology samples. The present study highlights the importance of flowcytometric immunophenotyping and immunocytochemistry in an effusion sample of an uncommon case of PMBCL. [ABSTRACT FROM AUTHOR]

Mesothelioma has always been a challenging diagnosis to render in body cavity cytology samples. This review is a timely update on pleural fluid cytology and ancillary studies that should be considered in the diagnosis of mesothelial proliferations, specifically mesotheliomas. Information about new diagnostic approaches and ancillary studies in mesothelioma was obtained from the peer‐reviewed literature and the authors' experiences. Although the morphological diagnosis of mesothelioma is fraught with numerous challenges given the overlap with other diagnostic entities, there are a variety of immunohistochemical and fluorescence in situ hybridization studies available to help in determining mesothelial origin and in distinguishing malignant proliferations from the more common benign or reactive mesothelial proliferations. Although ancillary studies can be helpful, there are important pitfalls to be aware of when interpreting these cases, and this review highlights some of the challenges that require caution. [ABSTRACT FROM AUTHOR]

Respiratory cytology continues to play a central role in the diagnosis and staging of thoracic malignancy, although over time indications have changed. Historically, sputum cytology and endobronchial brushings and washings figured prominently, but with the advent of endobronchial and endoscopic ultrasound much greater emphasis is placed on fine needle aspirates from lymph nodes. The advent of targeted sequencing panels for genomic profiling to identify driver mutations and PD‐L1 directed immunotherapy means that there is a need to extract increasing amounts of diagnostic and predictive information from ever smaller amounts of diagnostic material. Recent work has demonstrated that cytology samples are well suited to delivering the information required, but in order to understand the limitations of clinical and laboratory techniques, a close working relationship between pathologist and thoracic oncologist is needed to optimise sample procurement and utilisation. Respiratory cytology plays a central role in diagnosis of thoracic malignancy but indications have changed with the development of endobronchial ultrasound. The advent of genomic profiling to identify actionable driver mutations means that increasing amounts of diagnostic and predictive information are required from ever smaller amounts of diagnostic material. In this article we reflect on the relationship between thoracic oncologist and Cytopathologist to optimize diagnostic algorithms. [ABSTRACT FROM AUTHOR]

S. C. Thomas, L. R. R. Davidson and M. E. McKean The cytological examination of pleural effusions is an important investigation in the diagnosis of malignancy. Maximizing the chances of identifying malignant effusions is therefore desirable. Recent Royal College of Pathologists guidelines, based on the British Society for Clinical Cytology codes of practice, have suggested that a minimum of 20 ml of pleural fluid is required for diagnostic purposes. We examined 2155 pleural fluids received over a 6-year period in order to define a minimum required volume for adequacy. By examining the plateau phase of a graph of threshold volumes for initial samples received for each patient ( n = 1584) we determine that a minimum fluid volume of 25 ml is required and that more than 50 ml does not improve sensitivity. Between 25 and 50 ml of fluid are required for the adequate assessment of pleural effusions for malignancy. [ABSTRACT FROM AUTHOR]