Diagnostic Significance of Serum Ascites cholesterol to Differentiate Malignant and non Malignant Ascites

Authors

  • Maneesh Sulya Gandhi Medical College, Bhopal, India
  • Ashish Kosthi Gandhi Medical College, Bhopal, India
  • U. R. Singh Shyam Shah Medical College, Rewa, India
  • Reeni Malik Gandhi Medical College, Bhopal, India

Keywords:

Malignant ascitis, Portal hypertension, Serum ascites cholesterol, Serum Ascitic Fluid Albumin Gradient

Abstract

Background: Ascitic fluid usually forms slowly as a result of obstruction of proximal vascular systems (Venous, lymphatic). It may also form directly in response to disease involving the peritoneum. Differentiation between malignancy related and non-malignantascites is a challenge that is not always met satisfactorily. Both malignant and tuberculous ascites are exudative in nature with lymphocytic predominance and low Serum Ascitic Fluid Albumin Gradient values can not be differentiated easily form each other. Studies have shown that parameters like ascitic fluid cholesterol have been superior to the conventional method of ascitic fluid analysis in discriminating ascites caused by malignancy from others.

Method: This study was conducted in the Department of Pathology, Shyam Shah Medical College, Rewa during the period from May 2009 to October 2011. The study comprised of 100 patients with different causes of ascites admitted to wards of S.G.M.H. Rewa.

Result: Cases were divided in to 3 groups. Groups I consists of patents(39 male and 31 female) with ascites due to chronic liver disease and other non tubercular and non neoplastic diseases, Group II consists of 20 patients (4 male and 16 female) with ascites due to tuberculosis, Group III consists of 10 patients (4 male and 6 female) with ascites due to malignant diseases. Ascitic fluid cholesterol level was found to be 32.9571±7.1183mg%,0.05±9.047gm%, 74.1±16.1707mg% in Group I, Group II and Group III respectively. On comparing Group III with I and II values were found to be highly significant (p<0.005) and Group I with II was found to be insignificant (p>0.05). The value of ascitic fluid cholesterol level found in Group III was comparatively higher (>54.5mg%) than Group I and Group II with an exception in one case, where we found a higher level of cholesterol.

Conclusion: In our study we found a significant raised cholesterol level (74.1 ±16.1707mg%) well above the cut off value (54.5mg%) and it has got a good differentiating potential for determining malignant ascites from non-malignant ascites.

 

DOI: 10.21276/APALM.1371

Author Biography

Maneesh Sulya, Gandhi Medical College, Bhopal, India

Assistant professor, Department of pathology,Gandhi medical college bhopal m.p.

References

1. Runyon BA. Management of adult patients with ascites due to cirrhosis. AASLD Practice Guideline. Hepatology 2004;39: 1-16.

2. Moore KP, Aithal GP. Guidelines on the management of ascites in cirrhosis. Gut 2006;55 Suppl 6: vi1-12.

3. Paddock F. The diagnostic signficance of serous fluids in Disease. New England Journal of Medicine 1940; 223: 1010.

4. Gerbes AL, Jüngst D, Xie YN, Permanetter W, Paumgartner G. Ascitic fluid analysis for the differentiation of malignancy-related and nonmalignant ascites. Proposal of a diagnostic sequence. Cancer 1991;68: 1808-1814.

5. Paré P, Talbot J, Hoefs JC. Serum-ascites albumin concentration gradient: a physiologic approach to the differential diagnosis of ascites. Gastroenterology 1983;85: 240-244.

6. Sampliner RE, Iber FL. High protein ascites in patients with uncomplicated hepatic cirrhosis. Am J Med Sci 1974;267: 275-279.

7. Rector WG Jr, Reynolds TB. Superiority of the serum-ascites albumin difference over the ascites total protein concentration in separation of “transudative” and “exudative” ascites. Am J Med 1984;77: 83-85.

8. Rector WG Jr. An improved diagnostic approach to ascites. Arch Intern Med 1987;147: 215.

9. Jain SC, Misra SM, Misra NP, Tandon PL. Diagnostic value of ascitic fluid xamination. J Asso Physic India. 1996;14:59-69.

10. Rana SV, Babu SG, Kocchar R. Usefulness of ascetic fluid cholesterol as a marker for malignant ascites. Med SciMon. 2005;11:136-42.

11. Colli A, Cocciolo M: Ascitic fluid analysis in hepatocellular carcinoma cancer 1993, 72 (3), 677-82.

12. Sood A., Garg R., Kumar R., et al.: Ascitic fluid cholesterol in malignant and tubercular ascites; JAPI, 1995,43, 745-47.

13. Vyakaranam S, Nori S, Sastry GM, Vyakaranam SB, Bhongir AV. Serum - Ascites Albumin and Cholesterol Gradients in Differential Diagnosis of Ascites. NJIRM. 2011;2(3):22-8.

14. Runyon B.A., Montano A.A.: The serum ascites albumin gradient is superior to the exudates-transudate concept in the differential diagnosis of ascites; Ann. Intern. Med. 1992,117(3), 215-20.

15. GoyalA.K., GoyalS.K. et al: Differentail diagnosis of Ascitic fluid, evaluation and comparison of various biochemical criteria with a special reference to serum ascites albumin concentration gradient and its relation to portal pressure; Trop. Gastroenterol 1989,10(1), 515.

16. Alba D., Torres E, V Azquez JJ. Sero-ascitic gradient of albumin, usefulness and diagnostic limitations; An. Med. Interna 1995, 12 (8), 404-7.

17. Prieto M., Gomez-Lechon M.J. et al: Diagnosis of malignant ascites, comparison of ascitic fibronectin, cholesterol, and serum ascites albumin difference; Dig Dis Sci 1988, 33 (7), 833-38.

18. Barbare J.C., Diab G.et al: Concentration of lipids in ascitic fluid and the concentration gradient of albumin in blood and ascites; Diagnostic Significance Ann. Gastroenterol Hepatol (Paris) 1989,25 (6), 251-6.

19. Castaldo G., Oriani G. et al: Total discrimination of peritoneal malignant ascites from cirrhosis and hepatocarcinoma associated ascites by assays of ascitic cholesterol and lactate dehydrogenase; Clin. Chem. 1994, 40 (3), 478-83.

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Published

25-10-2017

How to Cite

1.
Sulya M, Kosthi A, Singh UR, Malik R. Diagnostic Significance of Serum Ascites cholesterol to Differentiate Malignant and non Malignant Ascites. Ann of Pathol and Lab Med [Internet]. 2017 Oct. 25 [cited 2024 Nov. 19];4(5):A482-486. Available from: https://pacificejournals.com/journal/index.php/apalm/article/view/apalm1371

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