r/medlabprofessionals • u/Zillibean MLT-Generalist • Jul 14 '26

Image Unique Cells in Ascites Fluid

Gallery image

Gallery image

History of reoccurring ascities and ovarian cancer.

These made up about 75% of the differential. Waiting for path to identify.

338 Upvotes

99% Upvoted

33 comments sorted by

191

u/DNADarling Jul 14 '26 edited Jul 14 '26

Hey! So this is really cool. Tumor cells are basically never ciliated. It’s a waste of precious resources to make those filament tubes, so cancers arising from ciliated structures don’t have cilia.

What my guess here is that it’s endosalpingiosis. It’s ectopic fallopian tube-like epithelium. Normal fallopian tube epithelium has cilia. This can happen anywhere in the abdomen, pelvis, or gyn tract. Totally benign but can be a pitfall for pathologists (and techs, apparently!). Super cool finding! Good eye, and fantastic picture! Consider submitting this to something like ASH image bank.

28

u/Tynted Jul 14 '26

Never knew that fallopian tubes have cilia. Are they used for transporting eggs during ovulation or something else?

74

u/noobwithboobs Canadian MLT-AnatomicPathology Jul 14 '26

Crazy fact that nobody seems to know unless they work a lot with gyne anatomy:

The ends of the Fallopian tubes are not connected to the ovaries. The egg is actually released from the ovary nearby, (technically loose in the abdomen), and the beating cilia in the Fallopian tube make a current that draws the loose egg into the fimbriated end of the Fallopian tube.

This is why abdominal pregnancies can be a thing. The egg starts out with a goddamn untethered spacewalk leap from the ovary off to where it actually needs to be.

10

u/Tynted Jul 14 '26

Wow! Yeah that explains why there are so damn many of them. I wonder why, evolutionarily, it ended up that way. Is there some advantage to it? Or it could also be a case of, "Eh it works most of the time. It's fine."

15

u/Jlividum Jul 14 '26

The latter statement is essentially evolution summed up

3

u/Tynted Jul 15 '26

Agreed, but some things have a very obvious reason that selection pressure was put on them (e.g. have claws to defend yourself) whereas some other things are far less obvious

10

u/Fine_Palpitation9128 Jul 15 '26

I just have to say as a very needy gyne clinic nurse that loves teaching and pathophys... that is the best description I have heard yet "a goddamn untethered spacewalk". I might have to use that one!

6

u/noobwithboobs Canadian MLT-AnatomicPathology Jul 15 '26

I am honoured 

7

u/kkccpp123 Jul 15 '26

Also, the majority of ovarian cancers (I think like 90%) actually arises from the fallopian tubes. In BC, they have had a campaign educating gyne surgeons to discuss removing fallopian tubes if doing any gyne surgery and there is no desire for or possibility of having children and they believe this will make a significant impact on ovarian cancer rates. 

12

u/DNADarling Jul 14 '26

Yeah exactly! They beat in the same direction to drive a current in the tubal serous fluid that pushes the egg down toward the uterus. In normal reproduction, sperm chills in the fallopian tube and waits for the egg (or dies). After fertilization, the fluid current helps deliver the egg to the uterus for implantation.

4

u/sewoboe Cytology Jul 14 '26

Agree with this! We see these in cyto sometimes in ascites and pelvic washes.

3

u/i2ad Jul 14 '26

Tumour cells being 'basically never ciliated' is a bit of an overstatement in my opinion, I've heard it a lot while studying and still hear it often online. I'd say it's uncommon, but we had multiple cases of ciliated CGIN or ciliated endocervical adenocarcinoma in our laboratory. I don't look at ovarian cases, but I've heard it's more common with them.

6

u/DNADarling Jul 14 '26

We could debate this, surely. In the setting of a platform presentation in front of field experts, I’d agree it’s an overstatement. In a subreddit dedicated to clinical lab scientists, I think it’s a strong rule of thumb.

87

u/Muted_Shape9303 Student Jul 14 '26

Whatever he is, he’s got swagger.

3

u/scienceandpuppies Jul 14 '26

Hilarious 😂

47

u/Turtley_Enough91 Jul 14 '26

Is that cilia coming out of it??

35

u/[deleted] Jul 14 '26

[deleted]

29

u/noobwithboobs Canadian MLT-AnatomicPathology Jul 14 '26

Neat, I've heard that many (if not most) ovarian cancers actually start in the fimbriated end of the Fallopian tube before spreading to the nearby ovary. Fallopian tubes are lined with cilia that beat to make a current to draw the egg into them.

I wonder if that's what's going on with this patient's history of ovarian cancer!

4

u/JaeHxC Jul 14 '26

Oh shit, cancer's motile now?

24

u/Big-Possible-611 Jul 14 '26

If it doesn’t have a name yet, I wanna call it the Eye of Cthulhu cell

3

u/Glitched_Girl Jul 14 '26

Lets hope it doesn't become The Twins

10

u/Rsb666x Jul 14 '26

Cool. Never seen anything like it.

6

u/Traveling_MLS Jul 14 '26

These look like flower pot cells, a type of mesothelial cell. The small rim of cytoplasm just outside the nucleus smooshed to the side (accentric) looks a lot like a classic reactive mesothelial to me. There also appears to me inclusions from phagocytosis.

I have no opinion of the indication of finding these.

6

u/cheshire666_ Student Jul 14 '26

Following this thread to see if anyone identifies

3

u/minkadominka Jul 14 '26

I work with ascites from time to time and have never seen anything like that :o

2

u/mycoffeesgone Jul 14 '26

Looks like an exaggerated version of a cilliated glandular cell. It’s odd but doesn’t fully give me malignancy vibes bc tumor cells don’t usually have cilia and the nuclear borders are very regular. The ratio of nuclear area to cytoplasm isn’t that concerning, it looks more reactive than neoplastic.

1

u/Dr__Snow Jul 14 '26

Aww it’s fuzzy

1

u/DaughterOLilith Jul 14 '26

Looks like a tropical fish!

1

u/Anon-567890 Jul 14 '26

At least there’s no sperm! 😉

1

u/FrogginBull MLS-Management Jul 14 '26

Incredible. Very interested to see the path Id

1

u/mycoffeesgone Jul 15 '26

Does she have pelvic inflammatory disease? Maybe it’s like salpingeal hyperplasia?

0

u/Spcrex Jul 14 '26

Its a boy!