Hyaline Globules In Ascitic Fluid In Primary Hepatic Undifferentiated Embryonal Sarcoma

Undifferentiated Embryonal Sarcoma (UES) of the liver is a rare predominantly pediatric malignancy. Only one brief report of cytologic findings in ascitic fluid of a recurrent tumor is available. The characteristic eosinophilic hyaline globules (HG) with immunohistochemistry on fluid cytology, has not previously been documented. A 20-year-old male presented with ascites. Cytology revealed a sparse number of pleomorphic malignant cells. Sections of the cell-block preparation revealed a loose myxomatous background and numerous atypical cells with marked pleomorphism, multinucleation and many intraand extracytoplsmic eosinophilic HG that were periodic acid-Schiff (PAS) positive and diastase-resistant. They displayed a positive reaction to alpha-1-antitrypsin on immunoperoxidase staining. A needle biopsy of a liver mass detected by CT scan confirmed the diagnosis of UES. Detection of sarcoma cells on fluid cytology is not often difficult. But an accurate diagnosis can be achieved only by detailed immunohistochemistry. Preparation of cell-blocks is of value in the work-up and management of patients presenting with malignant effusion.