title: Laparoscopic aspiration cytology in rheumatoid ascites: a case report.
abstract: BACKGROUND
  To the best of our knowledge, there are currently no recorded cytologic features of any effusion from rheumatoid peritonitis showing cytologic findings linked to rheumatoid pleural disease, although rheumatoid nodules have been described in the peritoneum.
  
  
  METHODS
  A 75-year-old man with longstanding, poorly controlled rheumatoid arthritis was seen in our hospital after a motor vehicle collision. Computed tomography showed free fluid in the abdominal cavity. Laparoscopic examination revealed a large amount of nonhemorrhagic ascitic fluid and no traumatic intraabdominal injuries. Abdominal and peritoneal surfaces appeared completely normal. The ascitic fluid was aspirated through the laparoscope and sent for cytologic examination. Cytospin preparations revealed histiocytes and loosely cohesive clusters of small cytologically bland epithelioid cells amid acute inflammatory cells and granular necrotic debris. Cell block material displayed transected fibroconnective tissue fragments lined by hyperplastic mesothelium with squamous metaplasia. Immunohistochemical studies revealed that the mesothelial cells were positive for calretinin, cytokeratin 5/6, and p63.
  
  
  CONCLUSIONS
  The ascites was attributed to peritoneal disease from rheumatoid arthritis, based on the cytologic findings, immuno-profile, exclusion of other possible causes (i.e., cirrhosis, nephrotic syndrome, protein-losing enteropathy, or drugs), and patient's clinical setting.
authors.affiliation: Department of Pathology, University of Toledo Medical Center, Ohio 43614, USA. luis.delascasas@utoledo.edu
authors.forename: Luis E
authors.initials: LE
authors.lastname: De las Casas
authors.forename: Angel M
authors.initials: AM
authors.lastname: Morales
authors.forename: Darius A
authors.initials: DA
authors.lastname: Boman
authors.forename: Alan H
authors.initials: AH
authors.lastname: Tyroch
authors.forename: Jesus E
authors.initials: JE
authors.lastname: Calleros-Macias
authors.forename: Roberto N
authors.initials: RN
authors.lastname: Miranda
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D001201:Ascites / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D064032:Calbindin 2; D006644:Histiocytes / Q000473:pathology; D006801:Humans; D033162:Incidental Findings; D053555:Keratin-5 / Q000378:metabolism; D053553:Keratin-6 / Q000378:metabolism; D010535:Laparoscopy; D008297:Male; D008565:Membrane Proteins / Q000378:metabolism; D010532:Peritoneal Diseases / Q000150:complications / Q000378:metabolism / Q000473:pathology*; D064030:S100 Calcium Binding Protein G / Q000378:metabolism
chemical_list: C576764:CALB2 protein, human; C081876:CKAP4 protein, human; D064032:Calbindin 2; D053555:Keratin-5; D053553:Keratin-6; D008565:Membrane Proteins; D064030:S100 Calcium Binding Protein G