Ascitic fluid analysis in malignancy-related ascites

Hepatology. Sep-Oct 1988;8(5):1104-9. doi: 10.1002/hep.1840080521.

Abstract

A prospective study identified 45 patients with malignancy-related ascites among 448 ascites patients (10% of the total). Patients were categorized into five subgroups based on the pathophysiology of ascites formation. Each subgroup had a distinctive ascitic fluid analysis. Patients with peritoneal carcinomatosis but without massive liver metastases (53.3% of the patients with malignancy-related ascites) had a uniformly positive ascitic fluid cytology, high ascitic fluid protein concentration and low serum-ascites albumin gradient. Patients with massive liver metastases and no other cause for ascites formation (13.3% of the series) had a negative cytology, low ascitic fluid protein concentration, high serum-ascites albumin gradient and markedly elevated serum alkaline phosphatase. Those with peritoneal carcinomatosis and massive liver metastases (13.3% of the series) had a nearly uniformly positive ascitic fluid cytology, variable protein concentration, high serum-ascites albumin gradient and markedly elevated serum alkaline phosphatase. Chylous ascites (6.7%) was characterized by a milky appearance, negative cytology and an elevated ascitic fluid triglyceride concentration. Patients with hepatocellular carcinoma superimposed on cirrhosis (13.3%) had negative ascitic fluid cytology, low ascitic fluid protein concentration, high serum-ascites albumin gradient and elevated serum and ascitic fluid alpha-fetoprotein concentration. Two-thirds of patients with malignancy-related ascites had peritoneal carcinomatosis; 96.7% of patients with peritoneal carcinomatosis had positive ascitic fluid cytology. Ascitic fluid analysis is helpful in identifying and distinguishing the subgroups of malignancy-related ascites.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Alkaline Phosphatase / blood
  • Ascites / classification
  • Ascites / etiology
  • Ascites / physiopathology*
  • Ascitic Fluid / analysis*
  • Ascitic Fluid / cytology
  • Ascitic Fluid / microbiology
  • Chylous Ascites / classification
  • Chylous Ascites / etiology
  • Chylous Ascites / physiopathology
  • Humans
  • Liver Neoplasms / secondary
  • Neoplasm Proteins / analysis
  • Neoplasms / analysis*
  • Neoplasms / complications
  • Peritoneal Neoplasms / secondary
  • Prospective Studies
  • Serum Albumin / analysis

Substances

  • Neoplasm Proteins
  • Serum Albumin
  • Alkaline Phosphatase