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Background: In the last decade, analysis of malignant cells and flora in gastric lavage (GL) has provided interesting data on pathogenesis of gastric cancer (GC). For this study, combining such two aspects into one cyto-microbiologic category, we tested the prognostic role of the presence/absence of cancer cells (GL1/GL0) and bacterial microbiota (MB1/MB0) in our GC population. Material and Methods: Between April 2012 and August 2019, 79 surgical patients with GC were prospectively investigated with the determination of GL MB. Results: Compared with GL1 MB0, GL1 MB1 strongly correlated with advanced GC, portended poorer overall survival (OS) (45.8 months vs 20.5 months, P = 0.049), and resulted a significant (P = 0.008) and an independent (P = 0.013) prognostic factor unfavorable for OS. Conclusion: In the light of our results, the cyto-microbiologic parameter of GL MB should be used to gain a better prognosis of GC patients. Administration of antimicrobial treatment for MB1 subjects should be entertained because it could reduce the risk of oncogenesis.

Introduction/Objective Merkel cell carcinoma (MCC) is a rare, highly aggressive neuroendocrine carcinoma of the skin, associated with immunosuppression, UV light exposure, and the Merkel cell polyomavirus (MCPyV). Metastatic MCC diagnosed in body fluid cytology is extremely rare. Here, we report on a case of a 65-year-old male presenting with a right pleural effusion and a remote history of MCC, unknown to us during the cytologic evaluation of the effusion. To the best of our knowledge, this is the sixth case of metastatic MCC diagnosed in body fluid cytology reported in English literature, and the first one reported in a patient previously admitted for COVID-19 pneumonia. Methods/Case Report A 65-year-old male presented with dyspnea and acute hypoxic respiratory failure. Past medical history was significant for squamous cell carcinoma of the right forearm excised four months prior and ulcerative colitis. The patient had two recent hospitalizations for COVID-19 pneumonia. Chest x-ray on admission demonstrated an enlarged, loculated right pleural effusion. Emergent thoracentesis was performed and 1500 cc of bloody pleural fluid was sent for cytology. The patient’s respiratory status improved. A ThinPrep and a cell block were prepared. Both displayed clusters of small round blue cells with hyperchromatic nuclei, scant cytoplasm, and fine chromatin in a background of rare mesothelial cells, macrophages, and numerous lymphocytes. Immunohistochemical (IHC) studies showed CK20, AE1/AE3, and CAM 5.2 in a perinuclear dot-like staining pattern. CD56, chromogranin, and synaptophysin were also positive. Ki-67 proliferative index was about 40%. TTF-1 was negative, while CD45 highlighted background lymphocytes. The primary care physician was contacted and the patient’s past medical history was significant for MCC. Subsequent MCPyV and SATB2 demonstrated nuclear positivity in the tumor cells. Diagnosis of MCC was done. Results (if a Case Study enter NA) NA Conclusion MCC is a highly aggressive malignancy rarely reported in body fluids. MCC should be included in the differential diagnosis of malignant pleural effusions, especially in cases of the small blue round cells. Using IHC, like CK20 and neuroendocrine markers including the newer SATB2, can lead to an accurate diagnosis. Additional reporting of such cases may increase awareness, especially where prior history is not readily available, such as in this present instance.

Bronchoalveolar lavage, or BAL, is a minimally invasive procedure frequently used for clinical and non-clinical research, allowing studies of the respiratory system. Macaques are the most widely used non-human primate models in biomedical research. However, very little information is available in the literature concerning BAL cytology in macaques. The purpose of this study was to establish BAL reference values and document an atlas of BAL cytology from healthy cynomolgus macaques. BALs were obtained from 30 macaques and BAL fluid differential cell counts based on 400 nucleated cells/BAL sample were performed by a board-certified clinical pathologist. Results were analyzed using Reference Value Advisor macroinstructions and the effect of blood and oropharyngeal contaminations was investigated. Overall, nucleated cells interval percentages in BAL fluids were 55.8 to 93.7 for macrophages, 1.8 to 37.1 for lymphocytes, 0.4 to 8.7 for neutrophils, and 0.4 to 9.8 for eosinophils. Mild oropharyngeal contamination did not affect BAL differential cell counts, whilst a slight but significant increase of the percentage of lymphocytes was observed in samples with mild blood contamination. Mucus and variable numbers of ciliated epithelial cells were commonly present. Rarely, multinucleated macrophages and mastocytes were also observed. The reference intervals established in this study provide a useful baseline for the assessment of BAL cytological data in cynomolgus macaques.

Background: The cytological analysis of serous effusions helps in diagnostic, therapeutic and prognostic implications especially in malignant effusions.Aims: This study determines the comparison of precision in cytological analysis between conventional smear and cell block in body fluids with clinical correlation.Study Design: The study was conducted in GMERS medical college Junagadh over a period of 2 years (2016-2018) in the department of pathologyon total of 100 fluid cytology samples.Methods and Material: Conventional smears and cell block for the same fluid was performed and cytological analysis done. The cytological data was analyzed for significance in correlation between smear and cell block. Statistical analysis used. The results were tabulated and analyzed using SPSS version 15.0.Results: Cell block was diagnostically superior in 53.11% of cases as compared to conventional smear which was 18.22%. However conventional smear was diagnostically inadequate in 33.98% of cases.Conclusions: Cell block preparations can be combined with conventional smears wherever possible to improve diagnostic accuracy.

Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by the deposition of extracellular lipoproteinaceous material within the air spaces. Although the diagnosis is mainly based on histopathological findings, sometimes, the diagnostic yield of transbronchial and even open lung biopsy can be unsatisfactory. The advantage with bronchoalveolar lavage (BAL) cytology is that apart from being safer for the patient, it can sample a much wider area and help in giving an early diagnosis and treatment to the patient. Herein, we present a case of PAP diagnosed on BAL fluid cytology in an elderly female.

There is a paucity of studies on the yield of Gomori-methenamine-silver (GMS) staining in bronchoalveolar lavage (BAL) fluid cytology and its comparison with fluorescent dye staining for the diagnosis of invasive pulmonary aspergillosis (IPA) in patients with hematologic malignancies. To that end, we analyzed the yield of direct fungal visualization in BAL fluid cytology with GMS staining, in a series of culture-positive IPA cases in 67 patients with hematologic malignancies, and we compared the results with those of direct examination with calcofluor white staining and BAL fluid galactomannan assays, when available. GMS staining in BAL fluid cytology was positive in 42% of the 67 cases and revealed coinfections in 7 cases. In contrast, only 2/67 (3.6%) BAL fluid samples were positive in direct smears stained with the fluorescent dye calcofluor white. Positive GMS staining results were significantly more frequent in IPA cases with cavitary lesions and IPA cases caused by >1 Aspergillus species, but the proportions of positive cytology results among Aspergillus species were not different.

Introduction Malignant pleural effusions (MPE) remain a significant problem with approximately 50% of all cancer patients developing a MPE during their disease process. Our pleural service is one of the largest in the country. This day case service has the potential to accelerate MPE diagnosis, management and thus enhance patient experience. Objectives The aim was to assess the timeline of patients referred to pleural clinic with suspected malignant (unilateral) effusion. Method Retrospective analysis of 178 consecutive patients referred to pleural clinic with suspected MPE from March 2015 to November 2016. Data was collated from electronic patient records, including route of referral, diagnosis methodology, speed of diagnosis (MDT) and procedures performed. Results 126 (70.8%) of the 178 patients had pleural effusion and underwent pleural aspiration. 61 patients (48.4%) had positive malignant fluid cytology. 26 (43%) and 35 (57%) were thoracic and extra thoracic malignancies respectively. Out of the 61 patients, 26 (43%) had systemic treatment and 35 (57%) had palliative management. These patients were diagnosed on average within 17 days from referral to clinic (SD 17.3). Mean time taken from referral to pleural clinic review was 5 days (SD 6.6) and 12.3 days (SD 16.6) elapsed from pleural clinic review to diagnosis. Average time from cytology diagnoses to treatment was 26 days. 20 (16%) patients were referred for VATS (Video Assisted Thoracoscopic Surgery). The average time from VATS diagnosis to treatment was 37 days (for further breakdown see Table 1). The remaining (64%) were benign till to date. Conclusion The data demonstrates that a dedicated pleural service has the ability to rapidly review and diagnose patients with suspected MPE (especially the cytology positive). There is a need for improvement in patient’s timeline for those referred for VATS. Perhaps a dedicated pleural multidisciplinary meeting may help to reduce the delay and improve patient care.

Background: Survival with the epithelioid subtype of malignant mesothelioma (MM) is longer than the biphasic or sarcomatoid subtypes. There is concern that cytology-diagnosed epithelioid MM may underdiagnose the biphasic subtype. This study examines survival differences between patients with epithelioid MM diagnosed by cytology only and other subtypes diagnosed by histology. Methods: Demographics, diagnosis method, MM subtype and survival were extracted from the Western Australia (WA) Mesothelioma Registry, which records details of all MM cases occurring in WA. Results: A total of 2024 MM cases were identified over 42 years. One thousand seven hundred forty-four (86.2%) were male, median (IQR) age was 68.6 (60.4–77.0) years. A total of 1212 (59.9%) cases were identified as epithelioid subtype of which 499 (41.2%) were diagnosed using fluid cytology only. Those with a cytology-only diagnosis were older than the histology group (median 70.2 vs 67.6 years, P

Background & objectives: Data regarding tumor marker usefulness in diagnosing ascites of unknown etiology and determining its malignant nature are conflicting. We aim to assess the diagnostic value of ascitic and serum tumor markers in ascites of unknown etiology and to evaluate their usefulness besides other laboratory tests in a diagnostic work-up in those patients. Design & setting: A prospective case-control study conducted at Assiut University hospital and oncology institute. Patients & Methods: Three groups were included; Group I: 41 patients with ascites of unknown etiology Group II: 7 Patients with TB ascites and Group III:14 patients with cirrhotic ascites. We assessed the CEA, CEA mRNA, CA15-3, CA19.9, CA125, AFP and PSA in serum and ascetic fluid. A diagnostic work-up for group I included: IPD test, ultrasound, CT, ascetic fluid cytology, SAAG, Laparotomy and biopsy. Results: Ascetic fluid and serum levels of CA15-3 and CA125 were significantly increased in group I and were significantly increased in histopathologically proved malignant ascites compared to TB and cirrhotic ascites. In group I, CA 125 was significantly higher in ascites than serum. With the exception of PSA, all tumor markers significantly correlated in serum and ascetic fluid. No significant difference in the level of ascetic CEA messenger RNA was detected between the 3 groups. Cytology had 53% sensitivity, 94% specificity and CA 125 & CA15-3 had 81% sensitivity and 75% specificity in detection of malignant ascites repectively. Laparotomy and biopsy: diagnosed malignnancy in 53.3% and TB in 13.3%. Conclusions: A diagnostic work-up including SAAG, tumor markers in the serum and ascetic fluid may help in adjunct with ascetic fluid cytology, laparotomy and biopsy, imag- ing and other laboratory tests in diagnosing ascites of unknown etiology.

Background: Parasitic infestation is one of the serious health problems in developing countries. Parasitic infestation is usually asymptomatic and does not cause disease as it may eventually lead to the death of both organism and host. Materials and Methods: This was a retrospective study done over a period of 5 years from 2013 to 2018. The study included 26 cases of parasitic infestations diagnosed on fine-needle aspiration cytology (FNAC) as well as fluid cytology. Results: Hydatidosis, cysticercosis, and filariasis were the parasitic infestations observed in this study, of which hydatidosis was the most common infestation. The predominant age group was 20–85 years old, with a mean age of presentation being 55 years. There was male predominance with a male–female of 9:1. Conclusion: FNAC and fluid cytology are rapid diagnostic tools that aid in the early diagnosis of parasitic infestations. In parasitic infestations presenting as visceral cystic lesions, thorough examination with proper clinical correlation aid in early management. In cases with coexistent malignancy, cytology plays a major role in the diagnosis of silent carriers of infection.

Sarcoidosis is an enigmatic multisystem sarcoid disease occurring mainly in the lungs, skin, and eyes. Sarcoidosis of the eyes (intraocular sarcoidosis) has been proposed as one of the causes of uveitis. We carried out a clinicopathological study involving seven patients with intraocular sarcoidosis based on vitreous humor fluid cytology. In the seven patients, the sex ratio was 4:3, and the average age at onset was 65.6-years-old. Vitreous opacity was noted in all patients and snowball-like vitreous opacity in 85.7%. Nerve papilloedema was noted in 42.9%. Diagnostic vitrectomy and adrenocortical hormone therapy were performed in all patients. As a result, the symptoms were improved. Vitreous perfusion fluid cytology revealed multinucleate giant cells in 85.7% and lymphocytes and epithelioid cells in all cases. Cytological diagnosis is not included in the current criteria for sarcoidosis, but its value in the diagnosis of intraocular sarcoidosis was suggested based in present study.

Due to the advances and increased utility of abdominal cross-sectional imaging, the diagnosis of pancreatic cysts continues to increase. Many endosonographers, pancreatologists, and surgeons consider endoscopic ultrasound (EUS) to be an essential tool in the management of pancreatic cystic lesions (PCLs). EUS can help distinguish between mucinous and nonmucinous lesions and may identify the specific cyst type. EUS achieves these goals by delineating the cyst morphology, identifying high risk stigmata and worrisome features, and through image-guided fine-needle aspiration (FNA) and cyst fluid analysis. However, recent consensus statements have called to question the utility and diminished the role of EUS in this setting. The aim of this review is to assess the role and advances of EUS-FNA in pancreatic cyst fluid analysis, specifically in terms of fluid cytology, viscosity, and carcinoembryonic antigen (CEA) analysis.

Seminal fluid was collected by manual ejaculation from 95 dogs. Quantitative aerobic bacterial, qualitative anaerobic bacterial and mycoplasma cultures were performed on the seminal fluid, and their association with presence of inflammatory cells present in the pellet formed after centrifugation of the fluid was investigated. There was a clinically meaningful aerobic bacterial growth in 28.4%, anaerobic bacterial growth in 13.7%, and mycoplasma growth in 57.9% of the seminal fluid samples. Presence of inflammatory cytology was statistically associated with clinically meaningful aerobic bacterial growth. However, of the 78 dogs (82.1%) with clinically meaningful growth of at least one aerobic, anaerobic or mycoplasma organism, 43 (55.1%) had non-inflammatory seminal fluid cytology.

Background and Objectives: With improvements in imaging technologies, pancreatic cystic lesions (PCLs) have been increasingly identified in recent years. However, the imaging modalities used to differentiate the categories of pancreatic cysts remain limited, which may cause confusion when planning treatment. Due to progress in endoscopic ultrasonography-guided fine-needle aspiration (EUS-FNA) technology, auxiliary diagnosis by the detection of cystic fluid has become a recent trend. Methods: From March 2015 to April 2016, 120 patients with PCLs were enrolled in this study. According to the results of EUS, cyst fluid carcinoembryonic antigen (CEA) analysis, and cystic fluid cytology, the patients were divided into two groups: a nonmucinous and a mucinous group. Of those, 61 patients who had undergone surgical resection were included in the analysis. The clinical features, biochemical and tumor markers of cyst fluid as well as the cytological test results of the patients were compared with histopathology results. Results: A cyst size of 4.0 cm was used as the boundary value; a cyst ≤4.0 cm was defined as a small PCL. 87 (72.5%) lesions were ≤4.0 cm, and 33 (27.5%) lesions were >4.0 cm. Regarding the analysis of CEA and carbohydrate antigens 19-9 (CA19-9), significant differences were found between the nonmucinous and mucinous groups (P < 0.05) according to nonparametric independent samples tests. The EUS, cystic fluid CEA, and cystic fluid cytology results were compared with the tissue pathology findings using McNemar's test (P < 0.05) and showed a sensitivity of 90% and a specificity of 84%. Conclusion: A diagnostic combination of EUS, cyst fluid CEA, and cystic fluid cytology could be used to differentiate small pancreatic cystic neoplasms. Cystic fluid cytology analysis is helpful for planning treatment for pancreatic cystic tumors that pose a surgical risk.

Cystic fibrosis (CF) is associated with a neutrophil dominated airway inflammation. So far bronchoalveolar lavage (BAL) studies in CF have used pooled BAL samples which may be more representative of the alveolar compartment rather than the airways. To assess whether the first sample of a BAL is more sensitive in the evaluation of airway inflammation, the authors have studied 105 stable CF patients aged 5-37 yrs with a mean forced expiratory volume in one second (FEV1) of 96+/-15% (mean+/-SD). BAL cytology of the first and pooled samples were compared to reference values obtained in children without respiratory disease. Absolute cell counts and the percentage of neutrophils were significantly increased in CF patients. If the 95% confidence interval was used as a cut-off point, 17/105 CF patients had a normal percentage of neutrophils in pooled BAL samples, but only three also had a normal percentage of neutrophils in the first BAL aliquot. Therefore, neutrophil dominated airway inflammation is more pronounced in the first, mainly bronchial, bronchoalveolar lavage sample suggesting that sequential analysis of bronchoalveolar lavage fluid may have a higher sensitivity to detect early inflammatory changes in CF patients.

PURPOSE To determine the diagnostic value of pleural fluid telomerase activity in distinguishing a malignant from a nonmalignant pleurol effusion in a cohort of patients undergoing thoracentesis. PATIENTS AND METHODS Using a polymerase chain reaction (PCR)-based assay, telomerase activity was examined in the pleural fluid cells obtained from 144 consecutive, unselected patients. According to the final diagnosis achieved, these patients were classified into three groups: group I consisted of 70 malignant pleural effusions diagnosed by either fluid cytology or pleural biopsy, group II consisted of 52 nonmalignant pleural effusions, and another 22 samples were categorized to be suspicious malignant pleural effusions (group III) due to inconclusive results in effusion cytology and percutaneous pleural biopsy, but were strongly suspicious in clinical settings. RESULTS The presence of telomerase activity was observed in 64 of 70 samples in group I (91.4%), three of 52 samples in group II (5.8%), and 20 of 22 samples in group III. All three nonmalignant, telomerase-positive pleural effusion samples in group II were obtained from patients with tuberculosis. As a diagnostic criterion for malignant pleural effusion in group I and group II patients, positive telomerase activity had a sensitivity of 91.4%, a specificity of 94.2%, and a positive and negative predictive value of 0.96 and 0.89, respectively. CONCLUSION Our results indicate that the detection of telomerase activity may be a useful adjunct to cytopathologic methods in the diagnosis of malignant pleural effusions.

The Cyto-Shuttle® (Cancer Diagnostics, Inc., Fairfax, VA) monolayer preparation method was compared to our routine cytocentrifuge method in 129 fluid cytology cases. A single sample from each case was split and prepared by each method. The Cyto-Shuttle preparation was superior to the cytocentrifuge preparation in 51% of cases, equal to it in 38%, and inferior to it in 11%: bronchial wash/lavage (45 cases), 38%, 49%, 13%; body cavity fluid (39 cases), 72%, 15%, 13%; urine (18 cases), 56%, 44%, 0%; peritoneal washing (16 cases), 44%, 44%, 12%; and miscellaneous (11 cases), 36%, 55%, 9%. Cyto-Shuttle preparations were superior due to decreased background and increased number of cells per slide; fixation and morphology were generally equivalent to cytocentrifuge preparations. Diagn Cytopathol 1996;14:305–309. © 1996 Wiley-Liss, Inc.

Cytology as a diagnostic tool has played a major role in the management of diseases affecting domestic mammals for over 20 years. It has also become a valuable diagnostic tool in the evaluation of nondomestic or the so-called "exotic" animal patients, such as small mammals and the lower vertebrates. Common cytologic specimens used to evaluate the exotic animal patient include aspirates of masses and organs, imprints of biopsy material, tracheal wash samples, aspiration of abdominal or coelomic fluid, and fecal smears. In general, the same cytologic sample collection and preparation techniques used for domestic mammals also apply to exotic animal patients. The interpretation of the cytology specimen is generally the same as that of domestic mammals.

With increasing emphasis on public awareness of breast cancer and screening mammography, more women seek consultation for breast symptoms, including nipple discharge. The presence of nipple discharge is distressing for the patient; however, its origin is fortunately most often benign. Nipple discharge associated with a recognizable mass requires sampling and surgical excision. Currently, clinical breast examination, cytology, ductography, mammogram, and ultrasound are commonly used to evaluate patients who have nipple discharge. Ductal lavage and ductoscopy, in association with emerging new technology, may be of help in increasing the sensitivity of nipple fluid cytology. In addition, nipple fluid cytology may offer a new way to study the spectrum of premalignant breast lesions, and to identify women at risk for breast cancer.

Results of cytological analysis of bronchoalveolar lavage (BAL) fluid were compared with clinical diagnoses in dogs that presented with signs of respiratory disease to referral hospitals. Of 68 dogs in which a clinical diagnosis was possible, BAL cytological findings were considered definitive for the diagnosis in 17 cases (25%), supportive of the diagnosis in 34 cases (50%), and not helpful in 17 cases (25%). Findings were most often considered supportive of or definitive for the clinical diagnosis in dogs with alveolar or bronchial radiographic patterns, or the presence of pulmonary masses. BAL results among lung lobes differed in 23 of 63 dogs (37%) with diffuse radiographic patterns. Tracheal wash cytology differed from BAL fluid cytology in 45 of 66 dogs (68%). Bronchoalveolar lavage was a clinically useful procedure for the diagnostic evaluation of dogs with signs of respiratory disease.

Introduction: Nipple discharge is common. It is the presenting symptom in 5–7.4% of referrals to breast clinics. 1. Nipple fluid cytology is not useful in discriminating malignant from benign causes of nipple discharge in women of all ages. 2. There is no published data on the role of nipple smear cytology specifically in younger women and its predictive value for breast cancer. Methods: We reviewed all women who attended our unit with symptoms of nipple discharge from 2010–11 and reviewed the cytology and final diagnosis to ascertain the role of nipple fluid cytology in women under 40. Results: During the two year study period there were 195 smears taken from 161 women. 33% (53/161) of the women were under 40 years of age (range 13–93). One woman in the under 40’s group had a malignant diagnosis (1/53, 2%) compared with 11 in the over 40’s group. (11/108, 10%) (Fishers exact test p = 0.05) Discussion: The rate of malignancy in those presenting with nipple discharge is small. In women under 40, the rate is very small, and nipple discharge cytology does not add to the assessment of these women.

A technique for quantitative cytology of tear fluid collected by a micropipette from the tear meniscus is presented. This technique has been compared with that using the standardized Norn-pipette collecting fluid from the lateral part of the inferior fornix. The two methods show the same magnitude of sensitivity and specificity, the same coefficient of variation, as regards neutrophilic leucocytes and erythrocytes (200 samples). The normal tear meniscus contains less than 40 leucocytes or erythrocytes per microliter. The tear cell concentration is about 200 times lower in the meniscus than in the fornix inferior in normal eyes. This observation supports the compartment-theory of a rapid flow in the tear meniscus and a slow flow with insignificant admixture in the conjunctival fluid in the fornices. The tear meniscus cytology is of use in association with testing of other parameters in the tears, for instance. The conjunctival fluid cytology is quicker and more convenient for the patient. In addition, it is necessary in connection with observation for pathological epithelial desquamation, because the tear meniscus cytology brings about an artificial increase of the epithelial cell concentration.

Ventilator-associated pneumonia (VAP) is a common nosocomial infection in intensive care patients. The most accurate diagnosis relies on the quantitative culture results of broncho-alveolar lavage (BAL) fluid. In our hospital, BAL fluid quantitative culture and cytology analysis are performed routinely in patients suspected of VAP. In this study, we assessed the value of the combination of various BAL fluid cytology findings for the diagnosis of VAP.

Summary. The clinical usefulness of a newly devised, simple apparatus, the Nishimura fluid sedimentation chamber, is described. The latter consists of an open-ended plastic tube, an absorbent paper with a central hole, and a glass slide which are stuck to each other with double-sided plastic adhesive tape with a central hole of equal size. The chamber is set to allow 0.5 ml of cerebrospinal fluid (CSF) to be absorbed in 15–20 min. The principle of the sedimentation relies on the absorption of the fluid portion into the absorbent paper with the cellular elements sedi mented onto the glass slide. Thin stationery paper is used as the absorbent material which controls sedimentation speed and minimizes cellular loss. 190 CSF specimens obtained from 28 patients with acute leukaemia were processed by this method. The results obtained showed that sedimentation using this simple chamber is quite reliable for the recognition of small number of abnormal cells in the CSF producing little or no noticeable cellular damage. This technique may be applied to other clinical situations in which fluid cytology is useful in establishing a diagnosis or in evaluating clinical progress.

The cytology of the spinal fluid in poliomyelitis is of great diagnostic importance and is by many authors also credited with prognostic significance. In the differential diagnosis between poliomyelitis and other diseases of the central nervous system, tuberculous meningitis has a fluid resembling closely that of poliomyelitis. A graphic study, therefore, of the cell counts and the range of polymorphonuclears and a comparison of these curves with similar curves for tuberculous meningitis seem timely. Chart 1 shows the curves for the cell counts in 122 cases of poliomyelitis and in 147 of tuberculous meningitis, the abscissa representing the number of cells and the ordinate the number of cases, reduced to a percentage basis in order that the two curves might be comparable. Most of the cases of poliomyelitis show a cell count between 50 and 200, but a fair proportion (19.7 per cent) are below 50, and the curve drops

Pneumocystis carinii pneumonia (PCP) is a major infectious complication of immunodeficiency states, including the acquired immunodeficiency syndrome (AIDS). Bronchoalveolar lavage (BAL) is a safe and effective procedure for making this diagnosis. In addition to the characteristic organisms, both histologic and cytologic material often reveals exudate in the form of foamy alveolar casts (FACs). To test the diagnostic utility of FACs in BAL fluids, we compared 20 PCP-positive and 28 PCP-negative fluids as assessed by silver stains. All PCP-positive fluids contained FACs on Papanicolaou-stained material. Only one PCP-negative lavage contained FACs, and transbronchial biopsy in this case revealed PCP. We suggest that FACs in BAL fluids are highly sensitive and specific for the diagnosis of PCP.

In a retrospective study of 44 cases of suspected primary pulmonary cancer with pleural involvement, the diagnostic value of pleural biopsy a.m. Abrams was evaluated. Biopsy specimens in 20 patients showed malignancy, which in 16 cases provided an adequate diagnosis, while 4 patients needed pleural biopsy by means of operation. In a total of 24 cases showing biopsy specimens without malignancy there were 4 false-negative ones. Among the patients under study, closed pleural biopsy combined with pleural fluid cytology proved malignancy in 96% of the cases in which neoplastic disease of the lungs and pleura was otherwise diagnosed. These findings indicate the value of using both fluid cytology and closed pleural biopsy at an early stage of the diagnostic procedure in cases of suspected pulmonary cancer with pleural involvement.

Introduction Bronchoalveolar lavage (BAL) fluid cytology is a major diagnostic method for detecting exercise-induced pulmonary haemorrhage (EIPH) and inflammatory airway disease (IAD) in racehorses. Our hypothesis was that training and racing would increase the incidence of IAD and EIPH. Methods On three different occasions (day-1, −30 and −60), BAL fluid was obtained from both lungs of 14 Standardbred trotters with similar age and training level. Cytological inclusion criteria were neutrophils >10%, and/or mast cells ≥5%, and/or eosinophils ≥5% for IAD, and haemosiderophage/macrophage (H/M) ratio >20% for EIPH. Since previously found not to be equivalent, both samples from each horse were independently investigated. Horse status (‘IAD’,‘EIPH’, ‘mixed’, or ‘control’) at each time point was based on cytological profiles from both lungs. Cell proportions were compared by repeated measures ANOVA. Results Haemosiderophage proportions and H/M were significantly higher on day-60 compared to day-1. No significant difference was observed for other cell proportions. On day-1, 5 horses were ‘control’, 2 ‘IAD’, 2 ‘EIPH, and 5 were ‘mixed’. On day-30, 3 horses were ‘control’, 4 ‘IAD’, 2 ‘EIPH’, and 5 were ‘mixed’. On day-60, 3 horses were ‘control’, 0 ‘IAD’, 3 ‘EIPH’, and 8 ‘mixed’. Despite the different horses′ distribution within each category, an overall increase in EIPH was observed. Five of the 7 horses classified ‘control’ or ‘IAD’ on day-1 presented EIPH on day-30 and/or −60. EIPH was detected in 11/14 horses (78.6%) on day-60, versus 7/14 horses (50%) on day-1. Conclusions The incidence of EIPH, but not IAD, significantly increased during a racing season. This evolution should be considered when assessing BAL fluid cytology in racehorses. Ethical Animal Research The study was approved by the regional Animal Ethics Committee (n°CEEA.2012.179) and all owners signed a consent form. Sources of funding: IFCE (National Studs) and SECF (French Trotters Racing Association). Competing interests: none.