Medicine CPC

1
Medicine CPC
CWM Hospital / Fiji School of Medicine Depts. of
Medicine Pathology

• March 27, 2003
• Recurrent Tense Ascitis

2
Clinical Details

• 42 Year Fijian Male
• Recurrent tense Ascitis, 3rd admission.
• Liver function tests normal
• Mildly elevated ESR 40mm/hr
• Hepatitis screen normal
• FBC, Biochem normal
• ? Irregular Mass felt below umbilicus
• CT Scan abdomen no mass lesion.
• Ascitis tap done exudate, RBC , cytology done

3
Ascitic Fluid cytology

• Moderately cellular
• Mucin background
• RBC in background
• Clusters of hyperchromatic cells.

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Ascitic Fluid cytology

• Moderately cellular
• Mucin background
• RBC in background
• Clusters of hyperchromatic cells.

5
Ascitic Fluid cytology

• Moderately cellular
• Mucin background
• RBC in background
• Clusters of hyperchromatic cells.

6
Ascitic Fluid cytology

• Moderately cellular
• Mucin background
• RBC in background
• Clusters of hyperchromatic cells.

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Ascitic Fluid cytology

• Hyperchromatic and Pleomorphic cells forming
  glands

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Ascitic Fluid cytology

• Some clusters show well formed glands with mucin
  secretion.

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Ascitic Fluid cytology

• Some clusters show Signet ring cells with
  intracellular mucin.
• (A feature of Adenocarcinoma)

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Discussion

• Secondary spread of mucin secreting
  adenocarcinoma usually appendix, ovary etc.
• Well differentiated, mucin secreting.
• Spreads over the peritoneal surface with mucinous
  nodules on serosal surface.
• Complications include adhesions, frozen abdomen.