Cytology of pleural, peritoneal and pericardial fluids in children. A 40-year summary

To determine the applicability of the cytologic examination of serous fluids in the management of malignant neoplasms in children.

A review of the reports of all cytologic specimens of pleural, peritoneal and pericardial fluids from children examined in our laboratory during a 40-year period. A total of 226 specimens from 146 patients under 18 years old with a documented neoplasm were analyzed by diagnosis and fluid type. The data were tabulated and analyzed in a format that allowed comparison with the results of earlier studies.

Eighty-eight specimens (39%) from 66 patients (45%) were suspicious or positive for malignancy. The positive specimens included lymphoma and leukemia (52%), neuroblastoma (14%), Wilms' tumor (9%), gonadal and extragonadal germ cell neoplasms (8%), bone and soft tissue sarcomas (7%), epithelial neoplasms (5%), Ewing's sarcoma (2%) and other neoplasms (3%). Positive results were obtained in 47% (66/139) of pleural fluids, 23% (15/65) of ascitic fluids, 27% (4/15) of peritoneal washings and 43% (3/7) of pericardial fluids.

Cytologic examination of serous fluids is a simple and useful procedure in the management of pediatric neoplasms. This study showed a higher proportion of positive effusion cytology with lymphoma/leukemia and a lower proportion with sarcoma as compared with earlier reports. Pleural fluids were the most common specimen type and showed the highest proportion of positivity.