Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

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Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2012 | Month : September | Volume : 6 | Issue : 7 | Page : 1280 - 1283 Full Version

The Role of the Cell Block Method in the Diagnosis of Malignant Ascitic Fluid Effusions


Published: September 1, 2012 | DOI: https://doi.org/10.7860/JCDR/2012/.2429
Shivakumarswamy Udasimath, Surekha U. Arakeril, Mahesh H. Karigowdar, B.R. Yelikar

1. Assistant Professor, Department of Pathology, HIMS, Hassan, India - 573201. 2. Professor, Department of Pathology, BLDEA’s Shri BM Patil Medical College, Bijapur, India. 3. Professor, Department of Pathology, BLDEA’s Shri BM Patil Medical College, Bijapur, India. 4. Head and Professor, Department of Pathology, BLDEA’s Shri BM Patil Medical College, Bijapur, India.

Correspondence Address :
Dr. Shivakumarswamy Udasimath, MD, DNB, (Pathology)
Assistant Professor, Department of Pathology,
HIMS, Hassan, India - 573201.
Phone: +91-9481730220
E-mail: udasimath@gmail.com

Abstract

Background:
The Cell Block (CB) technique is one of the oldest methods which is used for the evaluation of body cavity fluids. The accurate identification of the cells as either malignant or reactive mesothelial cells is a diagnostic problem in cytological conventional Smears (CS). As compared to the older methods, a new method of cell block preparation which is being used, which uses 10% alcohol-formalin as a fixative, increases the cellularity, gives better morphological details and helps in improving the sensitivity of the diagnosis. Multiple sections can be obtained by the CB method for the special stains and immunohistochemistry studies.
Aims:
To know the role, utility and the sensitivity of the cell block method in the diagnosis of malignant ascitic fluid effusions.
Materials and Methods:
This study was conducted in the Cytology Section of the Department of Pathology. 44 peritoneal fluid samples were subjected to a diagnostic evaluation for over a period of 20 months. The cell blocks were prepared by using 10% alcohol-formalin as a fixing agent along with the CS. The cellularity, architectural patterns, morphological details and the cytoplasmic and the nuclear details were studied both in the CS and the CB methods. Mc. Naemer’s χ2 test was used to identify the additional yield for malignancy which was obtained by the CB method.
Results:
The additional yield for malignancy was 13.63% more as was obtained by the CB method.
Conclusions:
The CB method provides high cellularity, better architectural patterns, morphological details and an additional yield for malignant cells. Therefore, the CB technique could be considered as a useful adjuvant in evaluating the fluid cytology for a final cytodiagnosis, along with the routine CS method.

Keywords

Cell block, Conventional smear, Ascitic fluid, Cytodiagnosis

Introduction
The cytological examination of serous fluids is important in the diagnosis, staging and the prognosis of malignant lesions. The cytodiagnosis which is made by conventional smears has got a lower sensitivity due to the overcrowding of the cells, cell loss and also due to the different laboratory processing methods. The accurate identification of the malignant or reactive mesothelial cells is a diagnostic problem in conventional cytological smears (1). The cell block technique is one of the oldest methods which is used for the evaluation of the body cavity fluids (2). The routine use of CB by agar or plasma thrombin is not cost effective, as it needs additional material. A new method of the CB preparation which uses 10% alcohol-formalin as a fixative, which is being used, is a simple, inexpensive method, and it does not require any special training or instrument. This method increases the cellularity, gives better morphological details and it also improves the sensitivity of the diagnosis (1). Therefore, the CB technique can be considered as a useful adjuvant in evaluating the fluid cytology for a final cytodiagnosis, along with the routine CS method.

Material and Methods

Peritoneal fluids were collected for cytological evaluation in the Cytology Section for a period of 20 months. Ten milliliters of fresh peritoneal fluid sample was divided into two equal parts of five milliliters each. One part was subjected to the conventional smear cytology technique and the other part for the cell block technique. Thus, the same sample was evaluated for a comparative study.
The Conventional Smear Technique
The 5 milliliter sample was centrifuged at 2500 rpm for 15 minutes. A minimum of 2 thin smears were prepared from the sediment. One smear was prepared after air drying and it was stained with the May-GrĂĽnwald-Giemsa stain. The other smear was immediately fixed in 95% alcohol and it was stained with the Papanicolaou stain.
The Cell Block Technique
The remaining 5ml sample was subjected to fixation for one hour by mixing it with 5ml of 10% alcohol–formalin (i.e., 9 parts of 90% alcohol and one part of 7.5% formalin). This 10 ml fluid was centrifuged at 2500 rpm for 15 minutes after one hour. A further 3ml of fresh 10% alcohol–formalin was once again added to the sediment after discarding the supernatant and it was kept for 24 hours. On the next day, the sediment which contained the cell button of the peritoneal fluid sample was scooped out on to a filter paper. This cell button was processed along with other routine biopsy specimens. After paraffin embedding 4–6 μ thickness sections were prepared from this cell button (Table/Fig 1) (Cell block), and they were stained with the hematoxylin and eosin stain. Special stains like the Periodic Acid Schiff (PAS) and Mucicarmine were performed wherever they were necessary.
The Interpretation of CS versus CB
The samples were studied in detail, taking into account the available clinical data, various investigation reports and microscopic details. The samples were categorized as benign, suspicious for malignancy, or malignant lesions. The morphological criteria that were taken into account, included the cellularity, the arrangement of the cells (acini, papillae and cell balls) and the cytoplasmic and the nuclear details. All these criteria were put together and they were used for the categorization of the sample. The cytomorphological characters were studied in detail to identify the malignancy and the most probable primary site. A comparative evaluation of the CS versus the CB techniques was conducted.

Results

44 peritoneal fluid samples were subjected to the CS and the CB techniques. The ages of the patients ranged from 21 to 80 years. The maximum number of samples were from the 51–60 years age group. The female patient’s samples (23) outnumbered the male patient’s samples. The cellular yield which was obtained by the CB method was more when it was compared to that which was obtained by the CS method. Architectural patterns such as, glands, three-dimensional cell clusters, cell balls and sheets, were commonly observed in the CB method as compared to the singly scattered cells, glands and cell clusters which were found in the CS findings. After the analysis of the above samples, they were categorized as benign, suspicious for malignancy, (Table/Fig 2) or malignant samples (Table/Fig 3). By the CB method, an additional 6 cases were detected as malignant, that is, a 14% more diagnostic yield for malignancy. These samples were reported as either suspicious for malignancy or benign samples. Further analysis showed a discrepancy in 08 cases (Table/Fig 4). In the CS method, out of 4 reported benign samples, one case was reported as florid mesothelial hyperplasia, and the other 3 samples were misdiagnosed, as the morphology was obscured by a haemorrhagic background, plenty of inflammatory cells and reactive mesothelial cells. However, these four samples were reported as malignant by the CB method. Out of the 4 samples that were reported as suspicious for malignancy by the CS method, 2 samples were diagnosed as malignant effusions and the other 2 as benign lesions by the CB method. The malignant effusions were more common in females than in males. The female-to-male ratio was 2:1 for the malignant effusions. The most common primary malignancy, identified was from the ovary. Out of 13 cases of malignant peritoneal effusions, the primary was known in nine cases, which included 5 cases of carcinoma of the ovary and one case each of carcinoma of the colon, liver, cervix, and the urinary bladder. In the remaining 4 cases, the primary malignancy could not be detected, as the patients were lost to follow-up. The statistical analysis of these 44 samples showed a high cellular yield by the CB method than by the CS method. Mc. Naemer’s χ2 test was used for analyzing the benign and the malignant lesions by the CB and the CS methods in which the P value was found to be highly significant. The results showed 100% sensitivity by the CB method in the diagnosis of malignancy. Therefore, in this study, the utility of the CB method in the cytodiagnosis of malignant effusions was found to be highly significant as compared to the CS method.

Discussion

The cytological examination of serous effusions is of paramount importance in diagnostic, therapeutic and prognostic implications. It is important not only in the diagnosis of malignant lesions, but it also helps in the staging and the prognosis of these lesions (3).The malignant cells in the pleural or the ascitic fluids were almost always indicative of metastatic tumours, as primary malignancies which arose from the mesothelial cell lining were rare. When a primary malignancy was present, the tumour cells were usually found to be numerous and they were seen in clusters. A positive effusion for malignant cells is an important prognostic indicator in oncologic patients. The development of a malignant pleural effusion is a common complication of cancers like pulmonary and gastric carcinomas (4). Malignant neoplasms, especially lymphoid neoplasms, represent a major cause of death in children and in these cases, a cytological examination is very useful for their management (5). Hence, presently, the examination of body fluids for the presence of malignant cells has been accepted as a routine laboratory procedure, not only for the detection of unsuspected cancers, but also for the detection of metastasis of an unknown primary origin (1),(3),(5). Beale introduced the paraffin-block method for serous effusions in 1895 (6). In 1896, Bahrenberg first described the cell block technique and it was commonly used after Mandlebaum reported the finding of actinomyces in a cell block (7). In the CS method, reactive mesothelial cells, an abundance of inflammatory cells and a paucity of representative cells contribute to the considerable difficulties which are faced in making conclusive diagnosis. The reactive mesothelial cells which are common in hepatic cirrhosis, allergic pleurisy, polyarteritis, pulmonary infarcts and in long standing effusions, of cardiovascular diseases, may show reactive changes such as cytomegaly, nucleomegly, multinucleation, mitotic figures and a high N/C ratio. Another limitation of the conventional cytological examination of effusions is that it has a sensitivity of only 40–70% for detecting the presence of malignant diseases, due to the overcrowding of the cells, cell loss and also due to the different laboratory processing methods (8). The difficulty is either secondary to the marked atypia of the mesothelial cells which is caused by the microbiological, chemical, physical, immunological, or the metabolic insults to the serous membranes or due to the subtle cytomorphological features of some malignant neoplasms (9). The problem may become compounded due to the artifacts which are caused by poor fixation, preparation, or staining techniques (8),(9). For this reason, in this study, an attempt was made to prepare and to analyze both the CS and the CB which were prepared by using 10% alcohol- formalin as a fixative, from the same specimen. Although the preparation of CS is a much simpler procedure than that of paraffin sections, it has limitations, that is, a lack of the tissue architecture. In some cases, the appreciation of the tissue architecture could make the diagnosis easier (10). The storage of the CS slides is also a practical problem (10),(11). The CBs which are prepared from the residual tissue and fluids can be particularly useful for the identification of the tumours that cause diagnostic difficulties on smears. This technique is simple, reproducible and safe. Further, the effectiveness of the cellblock lies in the availability of the diagnostic material for the further histological examination, histochemistry and IHC studies for a better classification of the tumour and for the identification of infectious causes by using microbiologic stains (3),(6),(9),(10). In this study, the paraffin block gave a concentrated material in smaller fields, a more frequent appearance of the organoid pattern and cells in the same focal plane.(10),(11),(12) The serial sections which were made from even a minute amount of cellular material from various types of the sample showed a high cellularity with an excellent morphologic preservation (13). The diagnosis of carcinoma which is more reliable when it is based upon the cell clusters rather than on the individual cells (7),(14). The paraffin block effectively puts the morphological features in their proper perspective, i.e., the presence of the nucleoli and the pseudoacinar or the acinar structures. It is a valuable tool which can be used for the identification of the acinar structures in a majority of adenocarcinomas and the papillary nature in some cases. The glandular forms can be more reliably diagnosed on CBs. The demonstration of mucin in the tumour cells is an evidence that they originate from a glandular epithelium (2),(11),(13). More important still, this CB is a valuable tool which can be used for the evaluation of well‑differentiated adenocarcinomas such as tumours of the breast, lung, or the gastrointestinal tract. These tumours have few malignant characters in CS, while the presence of the true acini is seen in the CB, together with mucin, when it is stained for mucin, and these are are indicative of a malignancy (2),(7),(14).
The main advantages of the CB procedure include: recognition of the histological patterns of diseases, the possibility of studying multiple sections by routine staining, special staining and by IHC studies, lesser cellular dispersal, less difficulty on microscopic observation and the possibility of storing the slides for retrospective studies (1),(3),(6),(11),(13). The disadvantage with the cellblock technique is a delay in the diagnosis when it is compared to the conventional smears and sometimes, the risk of losing material during the processing (14). Some mesothelial cells, because of centrifugation artefacts, may form rosettes or pseudoacini which can be the sources of a misdiagnosis (15). The CBs from serous effusions can be prepared by various methods. They can be prepared by adding a few drops of old plasma and thrombin solution to the centrifuged button and by fixing it in 95% alcohol and 5% formalin. Fixatives such as 2% agar with 10% formalin can also be used for the cellblock preparation (15). These techniques have received not much attention, probably due to the lack of standardized cost effective methods that can achieve better diagnostic results. The routine use of cell block by the agar or the plasma thrombin methods is not cost effective, as it requires additional materials and the consumption of extra time as compared to the earlier conventional methods (16). The CB technique which uses 10% alcohol–formalin as a fixative, was found to be simple and inexpensive and it did not require special training or special instruments. By using formalin, the proteins would become cross linked and a gel would be formed, which could not be dissolved in any material during sample processing, thus minimizing the cell loss (3). To achieve the maximum usefulness of CB, the fixation and the processing of the samples had to be modified. By using 5-10% formalin, results which were comparable to those of the biopsy reports were obtained (16).The use of an alcohol based fixative provides a better preservation of the antigenicity and also cytomorphological features which are comparable to those of the conventional smears (10). Histochemical staining methods can easily be performed on the sections which are prepared from CB. For the histochemical studies, various special stains such as PAS, PAS-Diastase, Ziehl- Neelsen and Gomori-Methenamine Silvernitrate can be done (10). The CB technique is a valuable method, particularly when the IHC staining is required for a battery of markers. The IHC staining,when it is applied to the cellblock preparations, provides the same accuracy as do the histological specimens (3),(6),(11). By using a combination of the CS and the CB methods for the reporting of malignant effusions, the primary site could be determined with 81% accuracy (14),(17). On correlating the clinical, radiological and the cytological features, the primary site could be determined with 90% accuracy (17). In this study, the additional yield for the malignancy was found to be 14% more by CB as compared to that which was obtained by the CS findings. Our results correlated with those of a study which was done by Khan et al. (14),(17) According to various studies, an additional diagnostic yield for malignancy was noted if the conventional smear technique was supplemented by the cellblock method (1),(6). Among the peritoneal effusions in our study, ovarian carcinoma (69%) was the commonest primary, followed by one case each of carcinoma of the GIT, liver, cervix and the urinary bladder (8%). Bonito et al., (18) study, reported a similar pattern of primary lesions. The CB study provided additional information for a definitive diagnosis, as it allowed the recovery of even minute cellular materials and it was valuable for the histochemical and the immunohistochemical methods (2),(13). To conclude, the present study results showed that the CB technique which used 10% alcohol–formalin as a fixative, was a simple, safe, reproducible and inexpensive method, which did not require any special training or instrument. This method yielded more cellularity with better architectural patterns and it improved the cytodiagnosis of additional malignancies by 14%. Hence, the CB technique can be recommended as a useful adjuvant in evaluating the fluid cytology for a final cytodiagnosis, along with the routine CS method.

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DOI and Others

ID: JCDR/2012/4411:2429

Financial OR OTHER COMPETING INTERESTS:
None.


Date of Submission: Apr 18, 2012
Date of Peer Review: Jun 19, 2012
Date of Acceptance: Jul 30, 2012
Date of Publishing: Sep 30, 2012

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