Flow cytometric surface light chain analysis of lymphocyte-rich effusions. A useful adjunct to cytologic diagnosis

Abstract

The cytologic diagnoses in 49 body cavity fluids from 46 patients, of whom 30 had a clinical diagnosis of lymphoma or lymphatic leukemia, and 16 patients with benign inflammatory or reactive conditions, were compared to flow cytometric surface immunoglobulin light chain analysis (kappa-lambda analysis [KLA]). The results of both tests were correlated with clinical outcome and all available information from biopsy, autopsy, and additional cell marker studies. When the diagnoses by both cytologic analysis and KLA were in agreement (57.1% of cases), there were no false-negative or false-positive results. Overall, false-positive and false-negative rates were, respectively, 6.1% and 12.2% with cytologic study, and 4.1% and 4.1% with KLA. Sixteen samples were from patients with small lymphocytic lymphoma (CLL) and small cleaved lymphoma, which had a false-negative rate of 37.5% by cytologic study, and only 6.2% by KLA. There was one false-positive result by KLA among the benign effusions. These findings indicate that KLA is a powerful adjunct to the cytologic evaluation of lymphocyte-rich effusions, especially in cases of lymphoproliferative disorders characterized by small lymphocytes, in which the cytologic diagnosis is frequently difficult.

Primary-Effusion Lymphoma and Kaposi's Sarcoma in a Cardiac-Transplant Recipient

“…Analysis of cell-surface markers was performed by flow cytometry on fresh samples of pleural fluid, as previously described, with monoclonal antibodies directed against CD3, CD5, CD10, CD13, CD14, CD19, CD20, CD33, CD38, and CD45 (all from Becton Dickinson, San Jose, Calif.) and CDIIb (Immunotech, Marseilles, France). 28 For ultrastructural analysis, cells from fresh samples of pleural fluid were fixed first in paraformaldehyde-glutaraldehyde and then in osmium tetroxide, embedded in Epon, sectioned, and stained with uranyl acetate. Structural features were compared with those of primary-effusion-lymphoma-derived cells that have been shown to support the replication of HHV-8.…”

Pleural, Pericardial, and Peritoneal Fluids

“…The differential diagnosis of secondary involvement by a lymphoma composed predominantly of small cells (e.g., lymphoblastic lym-phoma) includes a benign lymphocytic effusion like that resulting from tuberculosis. 14 In the case of the less common T-cell lymphoma, a T-cell phenotype with aberrant markers can be demonstrated by immunocytochemistry or flow cytometry, confirming a malignant diagnosis. The cells of small lymphocytic lymphoma are virtually impossible to distinguish from small, mature lymphocytes with Papanicolaou-stained preparations, even with the help of computer-assisted morphometry.…”

The utility of ancillary techniques in effusion cytology

“…28,31,32 The technique can be quite useful in the workup of lymphocytic effusions, espe-cially when the lymphocytic effusion is composed of small lymphoid cells and differentiation from reactive processes, such as tuberculosis, is difficult. The diagnostic utility of immunophenotyping of obviously malignant lymphoid cells is less certain, although classification as to whether a B-or T-cell lymphomatous effusion is present may be useful in selective cases.…”