Flow Cytometry and Effusions in Lymphoproliferative Processes and Other Hematologic Neoplasias

Abstract

Cytopathologists are regularly confronted with lymphocyte-rich effusions, and the definite decision of whether the lymphocytosis is of a purely reactive nature or a presentation of an indolent lymphoma may be an extremely difficult one based on microscopy alone. Flow cytometry (FC) offers many advantages in terms of its application in body cavity fluids, and it has proven to be very useful both in the setting of a known disease and for new lymphoma diagnoses. In this paper, the studies published in recent years dealing with the applications of FC in body cavity effusions in the context of hematologic neoplasia are reviewed, stressing the integrative diagnostic approach. The incorporation of microscopical, immunophenotypical, and molecular findings from examinations of the cellular content of effusions and the interpretation of results in relation to the current WHO classification of hematolymphoid malignancies give cytopathologists new perspectives on advanced and clinically highly relevant diagnostics.

Cytological diagnostic features of late breast implant seromas: From reactive to anaplastic large cell lymphoma

“…The observation of Piccinni and Colleagues that Progesterone promotes both IL-4 production and membrane CD30 expression in established human Thl cell clones is an intriguing link to this hypothesis [33]. Furthermore, in this case TRG clonality analysis showed a prominent peak over a polyclonal background, consistent with an exaggerated reactive expansion of a restricted T-cell population, likely selected by an unknown antigen [11], [12]. Similarly, Kadin ME and collaborators have recently described a late seroma surrounding a breast implant in which flow cytometry detected an expanded population of CD30 + /CD3 + T cells expressing TCRVβ13.2 in a polyclonal background [34].…”

“…However, in the routine diagnostic testing of late peri-implant breast seromas flow cytometry is restricted to adequately equipped institutions and to effusions with sufficient viable events. Moreover, as for the diagnosis of other large-cell lymphomas [11], flow cytometry studies on BI-ALCL highlighted several issues related to lymphomatous cells falling outside the typical lymphocyte region, to the marked loss of T cell antigens, and to the variable expression of myeloid markers [9], [10]. These aspects, altogether, may pose a diagnostic challenge and may give false-negative results when not integrated with the morphologic evaluation of the cells and clinical data, particularly in cases containing a low percentage of neoplastic cells.…”

Diagnostic role of cytology in serous effusions of patients with hematologic malignancies

“…However, hematologic malignancies, present less commonly with serous effusions (10%‐15%), than other malignancies . According to recent studies, the frequency of lymphomatous involvement of serous cavities in hematologic patients ranges from 20% to 48%, depending on the specific entity . Pleural effusions are more common, whereas ascitic and pericardial effusions occur less often .…”

“…[1][2][3] According to recent studies, the frequency of lymphomatous involvement of serous cavities in hematologic patients ranges from 20% to 48%, depending on the specific entity. [4][5][6] Pleural effusions are more common, whereas ascitic and pericardial effusions occur less often. 7 Lymphomas, predominantly non-Hodgkin lymphomas (NHL), are the most frequently encountered subtypes, followed by leukemias and multiple myelomas.…”

‘Six Memos' for Lymph Node Fine-Needle Cytology and Flow Cytometry

“…FC may be helpful in these cases, especially in the differentiation between low-grade NHL and reactive processes, which are a main diagnostic problem in CSF and effusions. FC applications on cytological samples are described by Bode-Lesniewska [17]. As reported above, effusions may also be caused by nonlymphomatous neoplasms and FC also contributes, to a lesser extent, to the diagnosis of these tumors.…”