Indian Journal of Pathology and Oncology 2023;10(1):44–51 Content available at: https://www.ipinnovative.com/open-access-journals Indian Journal of Pathology and Oncology Journal homepage: www.ijpo.co.in Original Research Article Sarcomas in fluid cytology: Experience from a tertiary care centre in India Shilpa Kapoor 1 , Kanwalpreet Kaur 1 , Satarupa Samanta 1, *, Paheli Maru 1 , Priti Trivedi 1 1 Dept. of Oncopathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India ARTICLE INFO Article history: Received 30-01-2023 Accepted 21-02-2023 Available online 16-03-2023 Keywords: Sarcomas Fluid cytology Cytomorphology Differentials ABSTRACT Background: Cytological evaluation of fluids for sarcomatous exfoliation is extremely rare. However, recently studies have come up describing characteristics of sarcomatous malignancies exfoliating into fluids but study from an Indian experience is still lacking. Objective: Description of clinico-pathological landscape in known cases of sarcomas, involving body fluid with emphasis on cytomorphologic details. Material and Methods: Study includes cases reported as positive for involvement by sarcoma on fluid cytology including pleural, ascitic and cerebrospinal fluid (CSF) specimens between Jan 2016 to June 2022. Cases were retrieved and reviewed for cytomorphologic features which were subsequently correlated with its parent histology and IHC. IHC was applied on cell blocks for two cases where involvement was doubtful. Results: In total, 21 fluid samples/cases including 4 CSF, 6 ascitic and 11 pleural fluid specimens were incorporated. Case spectrum comprised of 6 cases of Ewing Sarcoma (ES), 3 cases of rhabdomyosarcoma (RMS), 3 cases of osteosarcoma (OS), 2 cases of malignant peripheral nerve sheath tumor (MPNST), 2 cases of synovial sarcoma (SS), a case each of chondrosarcoma (CS), leiomyosarcoma (LMS) angiosarcoma (AS) and two cases of other malignancies with exfoliation of their sarcomatous component. Two cases presented as isolated latent metastasis so an IHC panel was applied to exclude involvement by secondary malignancy and prove involvement by primary diagnosed sarcoma. Conclusion: Majority of exfoliated sarcomas presented with epithelioid to pleomorphic morphology where at times it becomes obligatory to rule out occurrence of a secondary malignancy. It’s the first study from an Indian institute’s perspective that reflects upon such diversity of sarcomas with variability in morphology on exfoliation which can be overwhelming for a cytopathologist at times. IHC panel might be used when clinical background is unknown or when involvement is uncertain. More studies are needed that can help come up with recommendations that address such problems. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. For reprints contact: reprint@ipinnovative.com 1. Introduction Adenocarcinomas are among the tumors that exfoliate into body cavities most commonly, while sarcomas are among the rare malignancies that do so. Treatment must be modified if malignant cells are discovered in body * Corresponding author. E-mail address: samanta.satarupa@gcriindia.org (S. Samanta). fluids which indicates advanced disease and poor prognosis. Studies have shown that fine needle aspiration cytology (FNAC) has good sensitivity and specificity in identification of bone and soft tissue tumors, 1 but the approach in exfoliative fluid cytology is still not well understood. This is not only due to its rarity but also due to the morphologic alterations that tumor cells may undergo in fluids. 2 In addition, paucity of pertinent literature describing https://doi.org/10.18231/j.ijpo.2023.008 2394-6784/© 2023 Innovative Publication, All rights reserved. 44