Diagnostic cytopathology · 2026
Cytologic Findings in Esophageal Perforation: An Institutional Experience With Pleural Fluid Specimens.
СтатьяНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Marshall Mason, Khader Samer, Lajara Sigfred, Pantanowitz Liron
Аннотация
INTRODUCTION: Esophageal perforation (EP) is a rare but life-threatening condition, and most cases are due to iatrogenic causes. The rest occur spontaneously, due to malignancies, or trauma. The mortality rates can approach 50%, and delayed diagnosis of EP exacerbates patient outcomes. Cytologic recognition of pleural fluid specimens with oropharyngeal contents (e.g., squamous cells, Candida species) or food/foreign material can expedite the diagnosis of EP. This study presents our institution's experience with cytologic findings in EP patients.
MATERIALS AND METHODS: We reviewed our institutional database over a 25-year period to identify pleural fluid cytology specimens from EP patients. Data on patient demographics, clinical history, and microbiology culture results were collected. Slides were assessed for squamous cells, food/foreign material, and infectious organisms.
RESULTS: Eleven pleural fluid cytology specimens from 10 patients with EP (seven males, three females; mean age 68 years) were retrieved. Three cases were atypical, and eight were negative for malignancy. Mortality occurred in four (40%) patients within a mean of 2.2 months post-EP diagnosis. The majority of EP causes were iatrogenic (82%) or associated with malignancy (55%). Squamous cells were present in 27% of specimens, while food/foreign material and fungi were identified in 36% and 9% of cases, respectively. Cultures were positive in seven (64%) patients, with 46% showing bacterial growth and 55% positive for fungal organisms.
CONCLUSIONS: Our experience corroborates that EP carries a high mortality risk, underscoring the need for prompt diagnosis. Although Candida species were present in only a small subset of pleural fluid samples, the presence of squamous cells or food/foreign material is a helpful diagnostic clue of EP, particularly in patients with a history of recent medical manipulation or malignancy involving the esophagus. Our findings highlight the potential of identifying involved pleural fluid cytology specimens to decrease the time to diagnosis of EP.
MATERIALS AND METHODS: We reviewed our institutional database over a 25-year period to identify pleural fluid cytology specimens from EP patients. Data on patient demographics, clinical history, and microbiology culture results were collected. Slides were assessed for squamous cells, food/foreign material, and infectious organisms.
RESULTS: Eleven pleural fluid cytology specimens from 10 patients with EP (seven males, three females; mean age 68 years) were retrieved. Three cases were atypical, and eight were negative for malignancy. Mortality occurred in four (40%) patients within a mean of 2.2 months post-EP diagnosis. The majority of EP causes were iatrogenic (82%) or associated with malignancy (55%). Squamous cells were present in 27% of specimens, while food/foreign material and fungi were identified in 36% and 9% of cases, respectively. Cultures were positive in seven (64%) patients, with 46% showing bacterial growth and 55% positive for fungal organisms.
CONCLUSIONS: Our experience corroborates that EP carries a high mortality risk, underscoring the need for prompt diagnosis. Although Candida species were present in only a small subset of pleural fluid samples, the presence of squamous cells or food/foreign material is a helpful diagnostic clue of EP, particularly in patients with a history of recent medical manipulation or malignancy involving the esophagus. Our findings highlight the potential of identifying involved pleural fluid cytology specimens to decrease the time to diagnosis of EP.