Cytological detection of lymphoma in Douglas aspirate

Abstract

Except in primary effusion lymphoma (PEL), serous effusions with lymphomatous cells in non-Hodgkin lymphoma (NHL) are not frequently seen as first manifestation of disease. In NHL lymphoplasmacytic lymphoma (LPL) the spleen, lymph nodes, and bone marrow are frequently sites of disease and this type of NHL is usually associated with a serum paraprotein of IgM type accompanied by the clinical syndrome of Waldenström macroglobulinemia. Our patient with NHL LPL type presented in this report had less frequently seen involvement of gastrointestinal tract and clinically was first manifested as effusion in Douglas space. Cytological evaluation as well immunoanalyses of effusion in such cases is essential, and various ancillary studies, because of differential diagnostic problems of lymphomas in serous effusions, first include reactive lymphocytoses and small round-cell tumors (SRCT). In our patient, cytology of effusion revealed cytomorphologically atypical lymphomatous cells with plasmocytoid differentiation. Immunocytochemical and flow cytometry analysis confirmed lymphoid cell differentiation and pathohistological diagnosis of CD20(+) LPL was set after pathohistological analysis of resected ileum.

MYD88 L265P mutation analysis is a useful diagnostic adjunct for lymphoplasmacytic lymphoma with pleural effusion

“…Malignant PE in patients with LPL/WM is a rare extramedullary manifestation. [13][14][15] Cytologically, the lymphomatous PE by LPL may comprise small lymphocytes, plasmacytoid lymphocytes and plasma cells as in the marrow. 13 However, in rare cases, the predominant cells were small lymphocytes, such as our Cases no.…”

“…Malignant PE in patients with LPL/WM is a rare extramedullary manifestation . Cytologically, the lymphomatous PE by LPL may comprise small lymphocytes, plasmacytoid lymphocytes and plasma cells as in the marrow .…”

“…2 and 3; and these cases would easily be misdiagnosed as negative should the (cyto)pathologists were unaware of the prior history of lymphoma. Although flow cytometry and clonality studies are helpful in the diagnosis of effusions of body cavities in patients with LPL/WM, some cases are still problematic when tumor cells are few and plasma cells are scarce or absent . Gustine et al reported that 78% (7/9) of their cases of WM with PE were initially diagnosed as negative as the effusion was lymphocyte‐rich.…”

“…Non‐Hodgkin lymphomas may secondarily involve body cavities, while LPL/WM rarely involves extramedullary sites, with only sporadic reports involving body cavities as pleural effusion (PE) or ascites . In our index case (Case no.…”

“…[5][6][7][8][9][10][11][12] Non-Hodgkin lymphomas may secondarily involve body cavities, while LPL/WM rarely involves extramedullary sites, 2 with only sporadic reports involving body cavities as pleural effusion (PE) or ascites. [13][14][15] In our index case (Case no. 2), the effusion fluid was composed almost entirely of small lymphocytes.…”