2024 Volume 63 Issue 2 Pages 91-96
Background : Invasive lobular carcinoma (ILC) is the most common cause of malignant ascites caused by metastatic breast carcinoma in women. When cell blocks of aspirates are unobtainable, immunohistochemistry of specimens of the malignant ascites fluid obtained by the cell transfer technique is expected to be valuable for establishing a prompt histopathological diagnosis.
Case : A woman in her fifties was referred by a local physician to the emergency unit of our hospital with suspected carcinomatous peritonitis. She complained of gastrointestinal symptoms, with a several days’ history of recurrent diarrhea and lower abdominal pain, and abdominal ultrasonography revealed an intraabdominal mass. Her past medical history was unremarkable. Abdominal computed tomography at her first presentation to this hospital revealed ascites and adhesions between the mesentery and the small intestine, and multiple bone metastases. Ascites cytology was positive for malignancy. A breast ultrasound examination performed after admission revealed a solid mass in the right breast, and a tumor biopsy revealed the diagnosis of ILC. Subsequent gastric biopsy under gastrointestinal endoscopic guidance also revealed metastatic lesions. Considering the severity of her illness, in order to avoid the extra burden to the patient of a repeat peritoneal aspiration for preparing cell blocks, we conducted immunostaining of cell transfer specimens, which revealed findings consistent with the diagnosis of metastatic ILC. The patient was immediately transferred to a specialized cancer hospital for targeted treatment.
Conclusion : Immunohistochemical assessment of a specimen of ascites fluid prepared by the cell transfer technique established a prompt histopathological diagnosis, to the patient’s benefit.
