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Lamellar Inclusions within Hyperplastic Endoplasmic Reticulum in Benign Mesothelial Cells
Simon Haefliger1, Deepali Jain2, Thomas Menter1
1Department of Pathology, Institute of Pathology and Medical Genetics, University Hospital of Basel, Basel, Switzerland.
Insights
Cytoplasmic lamellar inclusions (LIs) in mesothelial cells are found in benign effusions, aiding differentiation from malignant cells. Electron microscopy revealed these inclusions within the rough endoplasmic reticulum.
Area of Science:
- Cytopathology
- Cell Biology
- Electron Microscopy
Background:
- Mesothelial cells in effusion cytology can exhibit cytoplasmic lamellar inclusions (LIs).
- The nature, function, and diagnostic significance of these LIs are not well understood.
Purpose of the Study:
- To investigate the characteristics of LIs in mesothelial cells.
- To determine the prevalence and diagnostic utility of LIs in routine cytological practice.
Main Methods:
- Review of 102 reactive and 90 malignant effusions (including 63 mesotheliomas and 27 carcinomas).
- Electron microscopy analysis of LIs in one effusion specimen.
Main Results:
- LIs were identified in 14% of benign mesothelial cells in reactive effusions and 4% in malignant effusions with carcinomatosis.
- LIs were absent in malignant mesothelioma effusions.
- Electron microscopy showed LIs as lamellar and tubular structures within hyperplastic rough endoplasmic reticulum (rER).
Conclusions:
- Cytoplasmic LIs within hyperplastic rER occur in up to 14% of effusions, exclusively in benign mesothelial cells.
- These inclusions serve as an indirect morphological marker for benign effusions.
- LIs can assist cytologists in distinguishing between reactive and malignant mesothelial cells.
Introduction:
In effusion cytology, mesothelial cells can occasionally present with striking intracytoplasmic accumulation of rod- and crystal-like cytoplasmic lamellar inclusions (LIs). Their nature and function are poorly understood, and their diagnostic relevance is unknown.
Objective:
The aim of this study was to explore the nature of LIs in mesothelial cells and determine their prevalence and diagnostic utility in routine practice.
Material And Method:
We reviewed a consecutive series of cytological specimens of reactive (n = 102) and malignant effusions (n = 90), respectively. Malignant effusions included malignant mesotheliomas (n = 63) and carcinomas (n = 27). LIs of one effusion were analyzed by electron microscopy (EM).
Results:
LIs were found exclusively in benign mesothelial cells in 14% (14/102) of reactive and in 4% (1/27) of malignant effusions with carcinomatosis. They were absent in effusions of malignant mesothelioma. EM revealed mainly straight lamellar, less tubular, structures in cisternae of the hyperplasic rough endoplasmic reticulum (rER).
Conclusion:
Cytoplasmic LIs located within hyperplastic rER can be found in up to 14% of effusions restricted to benign mesothelial cells. They can be used as an indirect morphological clue favoring the diagnosis of benign effusion and helping the cytologist to differentiate between reactive and malignant mesothelial cells in daily practice.
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