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Case History:
An 82 year old female with end-stage renal failure presented with bilateral pleural effusions following a missed haemodialysis session. Her stay was complicated by hospital-acquired pneumonia. A pleural tap was performed and fluid was submitted for cytological analysis. Representative Papanicolaou-stained smears are shown (Figures 1-3). Diff-Quik-stained smears were largely acellular; an attempt to produce a cell block for further investigations was unsuccessful.

Fig. 1

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What is the most likely diagnosis?