Cytologic Aspects of T-Cell Acute Lymphoblastic Leukemia Presenting as a Massive Pericardial Effusion

Basu, Debdatta; Siddaraju, Neelaiah; Murugan, Paari; Badhe, Bhawana Ashok; Akkarappatty, Cherian; Dutta, Tarun Kumar

doi:10.1159/000325321

Cited by 5 publications

(13 citation statements)

References 12 publications

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“…Among 3 case reports of pericardial effusion, there was only 1 case of T-LBL diagnosed based on cytology and IHC on a cell block [8]. In the other 2 cases, the diagnosis was confirmed by flow cytometry of pericardial fluid in 1 case [10] and by clinical workup and BM biopsy in the other [9]. Our cases presented the first reported diagnoses of T-ALL/LBL in pleural fluid.…”

Section: Discussionmentioning

confidence: 79%

“…Despite a high frequency of effusion accompanied by the disease, there was a very limited number of case reports on the morphologic diagnosis in effusion, except 3 case reports from pericardial effusion and 1 from pleural effusion [8,9,10,11]. The latter article dated back to 1980, when there were neither uniform terminologies nor panels of IHC markers for accurate diagnosis of T cell lymphoma [11].…”

Section: Discussionmentioning

confidence: 99%

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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

Chen

Zhang²,

Cui³

et al. 2015

Acta Cytologica

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Background: T cell lymphoblastic leukemia/lymphoma with the initial symptom of effusion is an uncommon condition. It may present a diagnostic challenge as lymphoblastic cells mimic normal lymphocytes under a low-power microscopic view. Cases: Two cases are presented, both male, with the first aged 31 years and the second aged 54 years. Both initially presented with chest pain and shortness of breath, and CT scans found an anterior mediastinal mass and left pleural effusion in both subjects. Cytological smears of pleural fluid in each case showed monotonous small-to-medium-sized lymphoid cells with moderate chromatin condensation and round-to-convoluted nuclei. There were prominent apoptotic bodies and mitosis in both cases. Immunohistochemistry of cell blocks demonstrated their T cell lineage and lymphoblastic nature. Diagnosis of T cell lymphoblastic leukemia/lymphoma was determined by a 3-step algorithmic approach using complete panels of immunohistochemical markers (CD3, CD20, Ki-67, CD10, CD5, CD99, CD1a, CD34, CD4, CD8, TDT, CD7, CD2 and CD68). Conclusion: An algorithmic approach based on cytological morphology and immunophenotyping is an effective way to diagnose T cell lymphoblastic leukemia/lymphoma in patients with an initial symptom of pleural effusion and insidious cytological morphology.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

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

Chen

Zhang²,

Cui³

et al. 2015

Acta Cytologica

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“…Dear Editor, Malignant serous effusions are relatively common complications of lymphomas and leukaemias in the paediatric population. [1][2][3][4][5] Secondary pleural and peritoneal effusion predominates, while isolated pericardial effusion is the least common. 3,6 Primary serous effusions are uncommon clinical manifestations of lymphoblastic lymphoma (LBL), which usually presents as a mediastinal mass with secondary pleural effusions.…”

mentioning

confidence: 99%

“…[1][2][3][4][5] Secondary pleural and peritoneal effusion predominates, while isolated pericardial effusion is the least common. 3,6 Primary serous effusions are uncommon clinical manifestations of lymphoblastic lymphoma (LBL), which usually presents as a mediastinal mass with secondary pleural effusions. 1 We report a case of clinically unsuspected LBL, which was first diagnosed by pericardial effusion fluid cytology.…”

mentioning

confidence: 99%

“…2 Even though isolated pericardial effusion is rare in acute leukaemias and lymphoblastic lymphomas, doctors, paediatric surgeons, radiologists and cytopathologists should be aware of this manifestation in order to reach the right diagnosis. 1,3,4,6 Lymphoma cells usually do not form clusters in cytological material. 7 The cells of other small blue cell tumours of childhood, for example neuroblastoma, Wilms tumour, EwingÕs sarcoma ⁄ PNET and rhabdomyosarcoma, usually form specific clusters that aid in their differential diagnosis.…”

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confidence: 99%

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Lymphoblastic lymphoma with unusual cytological features in pericardial effusion fluid

AbdullGaffar

AlAbsi

2011

Cytopathology

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T‐cell prolymphocytic leukemia (T‐PLL) with overlapping cytomorphological features with T‐CLL and T‐ALL: A Case Initially Diagnosed by Fine‐Needle Aspiration Cytology and Immunocytochemistry

Das

Pathan

Joneja

et al. 2011

Diagnostic Cytopathology

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T-cell prolymphocytic leukemia (T-PLL) is a very unusual form of chronic lymphoproliferative disorder, which has rarely been diagnosed by fine needle aspiration (FNA) cytology. We report one such case with some overlapping cytomorphological features with chronic lymphocytic leukemia and acute lymphoblastic leukemia. A 91-year-old man presented with generalized lymphadenopathy, pleural effusion, ascites, and an ulcerated growth in rectum. FNA smears from the left cervical lymph node showed a monotonous population of small lymphoid cells having small but distinct nucleoli that was initially diagnosed as chronic lymphocytic leukemia (CLL). Smears from the left axillary lymph node contained both small and medium-sized lymphoid cells with frequent hand-mirror cell appearance, which has been described in acute lymphoblatic leukemia (ALL). Immunocyto/histochemical stainings on smears and cell block preparations of the aspirate showed the following immunophenotype: CD3+, CD4+, CD5+, CD7+, CD8-, CD20-, CD23-, and Tdt-. Total peripheral blood leukocyte count was 26.4 × 10(9) /L and total lymphocyte count, 8.3 × 10(9) /L with predominance of small lymphocytes. T-cell nature of the neoplasm was confirmed by biopsies from the cervical lymph node (T-cell lymphoma), bone marrow (T-cell lymphoid neoplasm/chronic lymphocytic leukemia), and the ulcerated rectal lesion (atypical T-cell lymphoproliferative disorder). The patient developed deep vein thrombosis, heparin-induced thrombocytopenia and bleeding from duodenal ulcer. By the time the reports of all the investigations were ready, the patient succumbed to bronchopneumonia. To the best of our knowledge, this T-CLL/T-PLL which was diagnosed initially by FNA cytology with immunocytochemical support is first of its kind to be reported.

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Cytologic Aspects of T-Cell Acute Lymphoblastic Leukemia Presenting as a Massive Pericardial Effusion

Cited by 5 publications

References 12 publications

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

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

Lymphoblastic lymphoma with unusual cytological features in pericardial effusion fluid

T‐cell prolymphocytic leukemia (T‐PLL) with overlapping cytomorphological features with T‐CLL and T‐ALL: A Case Initially Diagnosed by Fine‐Needle Aspiration Cytology and Immunocytochemistry

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