The Prognostic Impact of Pericardial Fluid Cytology in Malignant Pericardial Effusion.

OBJECTIVE: Malignant pericardial effusion may affect almost 15 of the patients with underlying malignancies which deteriorates the prognosis. The prognostic significance of pericardial fluid cytology is under-represented in previous studies. METHODS: A total of 73 patients with symptomatic pericardial effusion treated with pericardiocentesis were included in this retrospective analysis. Macroscopic appearance, biochemical features, and cytological findings were obtained. Patients were divided into 3 groups: (i) without malignancy, (ii) with malignancy and negative cytology, and (iii) with malignancy and positive cytology. Survival data were searched via governmental death notification system. RESULTS: Mean age of the study group was 62 ± 15, and 54% (40) of the patients were female. On the cytological evaluation, 17 patients (23.3%) revealed positive cancer cytology, whereas 56 patients (76.7%) revealed negative cancer cytology. The median follow-up period was 840 days, and 34 patients (46.5%) died during follow-up. The survival rate of Group 3 was found to be significantly worse compared to Groups 1 and 2, no statistical difference was found between Groups 1 and 2 in terms of survival (Group 1 vs. Group 2 P =.078; Group 1 vs. Group 3 P <.001; Group 2 vs. Group 3 P =.041). CONCLUSION: Cytological evaluation is an important step in patients with malignant pericardial effusion. Positive pericardial fluid cytology indicates a poorer prognosis.

Metastatic melanoma: clinicopathologic features and overall survival comparison.

INTRODUCTION: Five-year survival for melanoma with distant metastasis has been reported as 25%. This study evaluates the relationship between known and uncertain clinicopathologic parameters and overall survival (OS) for metastatic melanoma patients. METHODS: Metastatic melanoma cases (n = 122, 45 female, 77 male) that were metastatic at the time of diagnosis or referred for molecular pathological analysis were included. Survival was analyzed using the Kaplan-Meier method with comparisons performed by the log-rank test. RESULTS: The mean age of diagnosis at the time of metastasis was 56 years (range 19-89). The 1-year, 2-year, and 5-year OS rates were 44%, 27%, and 17%, respectively. Cox multiple regression analysis identified the following as independent poor prognostic factors for OS: perivascular pseudorosette formation (hazard ratio [HR]: 12.821, p = 0.045), lung compared to skin and subcutaneous soft tissue and to lymph node, specific cytologic features such as clear cytoplasm (p = 0.043), and hyperchromatic nuclei (HR: 98.605, p = 0.005) compared to vesicular chromatin pattern. At the end of the study, 26 (21%) of the patients were alive, and 96 (79%) were deceased. CONCLUSIONS: In conclusion, perivascular pseudorosette formation, first described as a case report in primary and metastatic melanoma, may represent a new prognostic and diagnostic histopathological finding for metastatic melanoma.