Cytomorphological analysis of body fluids in tertiary care centre

Introduction: Cytological study of body fluids has become integral part in both diagnostic and management of suspected malignant cases. The meticulous examination of body fluid for there cytomorphological properties throws light on the cause, presence of metastatic cells, typing of unknown cases, staging and prognosis of cancer. Aims and Objectives: 1) To study and evaluate current trends in cytological evaluation of body fluids for various pathological conditions in a tertiary care centre. 2) To analyse their frequency in relation to diagnosis. Materials and Methods: The present study is prospective type of analysis of 311 body fluids received in Department of pathology for duration of one year from Jan 2018 to Dec 2018 in our tertiary care centre. Results: A total of 311 body fluid samples were analyzed in this study. Pleural fluid comprised of the major bulk of the study with 120 cases followed by peritoneal fluid with 100 cases. Non-malignant diagnosis was given in majority of the cases. Slight male preponderance was noted with male to female ration 1.37:1. Conclusion: Cytological analysis of body fluid is routine diagnostic investigation which offers definite aid to the treating physician. Preliminary body fluid analysis in resource limited setups still remains the most simple, convenient and cost effective technique in reaching to a particular diagnosis. © 2020 Published by Innovative Publication. This is an open access article under the CC BY-NC license (https://creativecommons.org/licenses/by-nc/4.0/)


Introduction
Cytology is a study either on exfoliated cells or the cells aspirated by the needle. Normally, all the body cavities are lined by monolayered mesothelial cells with minimal amount of fluid in it and the main function being the lubrication and safe guarding the underlying viscera. Any imbalance between fluid formation and removal leads to effusion, as stated by Starling's law. 1 The peritoneal, pleural, cerebrospinal and pericardial fluids comprise the major chunk of body fluids. 2 And accumulation of fluid in various body cavities can occur in vast range of benign conditions and it also a frequent clinical presentation and complications of Malignant disorder.
Cytological analysis of body cavity fluid is a quite cost effective procedure, rapid and easy to perform with another prime utility of serving both as a diagnostic as well as a therapeutic intervention. It serves as definitive guide in disease progression with monitoring of treatment with good accuracy.

Aims and Objective
Our present study was undertaken with the objective of assessing the incidence and trends of different types of cytological fluid for various pathological diseases received at our tertiary care hospital.

Materials and Methods
The present study was prospective hospital based study of body fluids received in the cytology section of department of Pathology for a duration of one year from Jan 2018 to Dec 2018.All the body fluid samples received for the cytological examination was included in our study. Relevant clinical details such as age, sex, history and accompanying clinical presentation were documented from the requisition.
All the received samples were centrifuged for 2000-3000 rpm for 15 minutes, supernatant was discarded and both wet smears and air dried smears were prepared from the sediments. They were stained with Leishman, H & E and Papanicolau stain. Improved neubauer chamber was used for cell count. All the sample were evaluated for biochemical parameters and cytology, datas were summarized and analyzed.

Results and Observation
A total of 311 body fluid samples were analyzed in this study, with the age range of 12 -81years. Maximum number of cases were encountered in 4 th decade followed by 3 rd decade.
In our study male preponderance was noted with male to female ration of 1.37: 1.
Out of 311 body fluids across both sexes, pleural fluid comprised the major bulk accounting to 120 cases, followed by peritoneal fluid accounting to 100 cases, 20 were synovial fluid, 40 were CSF, 20 were sputum and remaining 11 belonged to miscellaneous body fluids. In our study, a total of 15 cases (4.82%) were found to be malignant, out of which 08 cases (2.57%) were encountered in pleural fluid and 07 cases (2.55%) in peritoneal fluid. None of the other fluids showed malignancy. Among the non neoplastic cases, 181 cases(58.19%) were transudative and 90 cases (28.93%) were exduatives. We also encountered 20 cases(6.43%) of sputum for malignant cells out of which 18 cases were non malignant and no opinion was possible in 2 cases. In our study we received 20 cases(6.43%) of synovial fluid, none of them were malignant.
Out of 40 cases of CSF received, 36 cases were non neoplastic and 04 cases were of scant cellularity with no opinion possible. One case of cryptococcal meningitis was observed in immunocompromised patient.
Among other fluid we received 5 cases of ovarian tumours, 2 cases of cyst, 2 cases from pancreatic fluid and 2 cases from Liver abscess. We encountered 01 cases of Cryptococcus meningitis and Indian ink and Mucicarmine stain was done to confirm the diagnosis.
In our present study 311 body fluid were analyzed. Most common fluid to be encountered was pleural fluid accounting to 120 cases (38.58%), which is in concordance with Bhanvadia et al, 3   Maximum number of cases were seen in 41-50 years (95 cases), which was in comparison with the studies done by Shulbha et al, 7 Pradhan et al. 8 and Joshi et al. 5 Transudative effusions are seen when there is an imbalance of hydrostatic and oncotic pressures and clinically, common causes are congestive heart failure (CHF), cirrhosis and nephrotic syndrome. Exudative effusions are because of injury to the cavity lining and causes for this are malignancy, inflammation or infection, lupus, pulmonary infarction, trauma. 9 Maximum number of cases were transudative nature 181 cases(58.19%), which was in concordance with study done by Kumavat PV et al. 1 In the present study, 15 cases (4.82%) were neoplastic and 275 cases (88.42%)were benign, which was in comparison with various studies. 4,5,7,8 Majority of malignancy was found in pleural fluid 8 cases (2.57%) in our study which in comparison with study done by Pradhan et al 8 and Wong JW et al. 10 Adenocarcinoma was the most common cause of malignant effusions in pleural and peritoneal fluid. This is in concordance with the study done by Jha R et al 11 and Kol PC et al.

Conclusion
This study highlights the significance of cytological examination as a method to categorize them as neoplastic or benign. And presence of malignant cells in the body fluids worsens the prognosis. Cytological analysis although is not an alternate for conventional histopathology, still remains the simple, cost effective, reliable and forms definitive aids in reaching to a particular diagnosis.

Source of Funding
None.

Conflict of Interest
None.