Hematolymphoid Neoplasms in Serous Effusions: Morphological Spectrum, Distribution, and Role of Ancillary Techniques—A Retrospective Analysis of 75 cases

Abstract

Introduction Involvement of body fluids can occur at the time of diagnosis or during the disease course of hematolymphoid neoplasms. Cytodiagnosis of malignant effusion is important in effective clinical management.

Objectives (1) The aims of the study were to determine the frequency of distribution of various hematolymphoid neoplasms involving body fluids, (2) to study the morphology of hematolymphoid neoplasms in fluids, and (3) to assess the role of ancillary techniques in the diagnosis.

Materials and Methods In this retrospective study, all cases of hematolymphoid neoplasms involving body fluids diagnosed from January 2016 to December 2018 were evaluated.

Results During the 3-year period, there were 75 cases of hematological malignancies involving body fluids. These included 48 male patients and 27 female patients. Pleural fluid was involved in majority of cases (56 cases; 74.67%), followed by ascitic fluid (17 cases; 22.67%), and pericardial fluid (2 cases; 2.67%). High cellularity, monotonous population of cells, high nuclear-cytoplasmic (N/C) ratio, indentation/irregularity of nuclear membrane, immature chromatin/irregular clumping of chromatin, increased mitosis, and karyorrhexis were the key features which helped to differentiate between reactive and neoplastic processes. There were 35 cases of B-cell neoplasms, 33 cases of T-cell neoplasms, and seven cases of myeloid neoplasms involving body cavity fluids. T-lymphoblastic lymphoma was the most common subtype (29 cases; 38.7%), followed by diffuse large B-cell lymphoma (DLBCL) (12 cases; 16%). In 53 cases, effusion was present in the initial presentation itself. Initial diagnosis was made in effusion cytology in 25 cases (33.33% of the total), with the help of flow cytometry in 20 cases, and immunohistochemistry (IHC) in cell blocks in five cases.

Conclusion Diagnosis of hematolymphoid neoplasms in body fluids based on correlation with clinical details, critical evaluation of cytology findings, and comparison with previous diagnosis along with the judicious use of ancillary techniques helps in deciding an early treatment plan.

Keywords

Effusion cytology - hematolymphoid neoplasm - peritoneal fluid - pleural fluid

• References

• 1 Elis A, Blickstein D, Mulchanov I. et al. Pleural effusion in patients with non-Hodgkin’s lymphoma: a case-controlled study. Cancer 1998; 83 (08) 1607-1611
• 2 Alexandrakis MG, Passam FH, Kyriakou DS, Bouros D. Pleural effusions in hematologic malignancies. Chest 2004; 125 (04) 1546-1555
• 3 Vakil E, Jimenez CA, Faiz SA. Pleural effusions in hematologic malignancies and their management with indwelling pleural catheters. Curr Opin Pulm Med 2018; 24 (04) 384-391
• 4 Bode-Lesniewska B. Flow cytometry and effusions in lymphoproliferative processes and other hematologic neoplasias. Acta Cytol 2016; 60 (04) 354-364
• 5 Gilbert CR, Lee HJ, Skalski JH. et al. The use of indwelling tunnelled pleural catheters for recurrent pleural effusions in patients with hematologic malignancies: A multicentre study. Chest 2015; 148 (03) 752-758
• 6 Bangerter M, Hildebrand A, Griesshammer M. Combined cytomorphologic and immunophenotypic analysis in the diagnostic workup of lymphomatous effusions. Acta Cytol 2001; 45 (03) 307-312
• 7 Chen L, Zhang JS, Cui D, Liu DG. Cytological diagnosis of T lymphoblastic leukemia/lymphoma in patients with pleural effusion as an initial clinical presentation: Two case reports of an algorithmic approach using complete immunohistochemical phenotyping. Acta Cytol 2015; 59 (06) 485-492
• 8 Palmer HE, Wilson CS, Bardales RH. Cytology and flow cytometry of malignant effusions of multiple myeloma. Diagn Cytopathol 2000; 22 (03) 147-151
• 9 Yu GH, Vergara N, Moore EM, King RL. Use of flow cytometry in the diagnosis of lymphoproliferative disorders in fluid specimens. Diagn Cytopathol 2014; 42 (08) 664-670
• 10 Das DK. Serous effusions in malignant lymphomas: a review. Diagn Cytopathol 2006; 34 (05) 335-347
• 11 Monappa V, Reddy SM, Kudva R. Hematolymphoid neoplasms in effusion cytology. Cytojournal 2018; 15: 15
• 12 Chen YP, Huang HY, Lin KP, Medeiros LJ, Chen TY, Chang KC. Malignant effusions correlate with poorer prognosis in patients with diffuse large B-cell lymphoma. Am J Clin Pathol 2015; 143 (05) 707-715
• 13 Deshpande AH, Munshi MM. Pleural effusion as an initial manifestation of multiple myeloma. Acta Cytol 2000; 44 (01) 103-104
• 14 Faiz SA, Bashoura L, Lei X. et al. Pleural effusions in patients with acute leukemia and myelodysplastic syndrome. Leuk Lymphoma 2013; 54 (02) 329-335
• 15 Nuwal P, Dixit R, Dargar P, George J. Pleural effusion as the initial manifestation of chronic myeloid leukemia: Report of a case with clinical and cytologic correlation. J Cytol 2012; 29 (02) 152-154