Lymphoproliferative disorder involving body fluid: diagnostic approaches and roles of ancillary studies

Abstract

Lymphocyte-rich effusions represent benign reactive process or neoplastic condition. Involvement of lymphoproliferative disease in body cavity is not uncommon, and it often causes diagnostic challenge. In this review, we suggest a practical diagnostic approach toward lymphocyte-rich effusions, share representative cases, and discuss the utility of ancillary tests. Cytomorphologic features favoring neoplastic condition include high cellularity, cellular atypia/pleomorphism, monomorphic cell population, and frequent apoptosis, whereas lack of atypia, polymorphic cell population, and predominance of small T cells usually represent benign reactive process. Involvement of non-hematolymphoid malignant cells in body fluid should be ruled out first, followed by categorization of the samples into either small/medium-sized cell dominant or large-sized cell dominant fluid. Small/medium-sized cell dominant effusions require ancillary tests when either cellular atypia or history/clinical suspicion of lymphoproliferative disease is present. Large-sized cell dominant effusions usually suggest neoplastic condition, however, in the settings of initial presentation or low overall cellularity, ancillary studies are helpful for more clarification. Ancillary tests including immunocytochemistry, in situ hybridization, clonality test, and next-generation sequencing can be performed using cytologic preparations. Throughout the diagnostic process, proper review of clinical history, cytomorphologic examination, and application of adequate ancillary tests are key elements for successful diagnosis.

The urgency of Burkitt lymphoma diagnosis in fluid cytology—A tertiary care experience

“…Among all the lymphomas, body fluids are more commonly involved by NHL than Hodgkin lymphoma (HL). Many studies have reported that fluid involvement by B‐cell NHL was more commonly observed than T‐cell NHL 6 . Diagnosis of fluid involvement by lymphoma is straight forward in already diagnosed/biopsy proven cases of lymphoma.…”

“…Some studies have recommended diagnostic algorithms to systematically approach lymphoid cell‐rich effusions/fluids 6,8 . Fluids involved by BL show uniform population of medium to large‐sized lymphoid cells.…”

“…Moreover, BL patients have a high risk of developing tumour lysis syndrome, which is considered as a potentially lethal complication. Cytological examination of body fluids with adjunct ancillary studies can provide a prompt and precise diagnosis of BL, thus avoiding a catastrophic event for the patient.Some studies have recommended diagnostic algorithms to systematically approach lymphoid cell-rich effusions/fluids 6,8. Fluids involved by BL show uniform population of medium to large-sized lymphoid cells.…”

Lymphoma presenting as the first finding in pleural fluid cytology: A rare cytologic presentation

“…Infiltration of the lining of serous cavities in the body results in effusion which can be due to either benign or malignant causes. 1,2 Among malignant pleural effusions, ascites lymphoma accounts for 10.0-15.0% followed by lung, breast, and ovary carcinoma. 1 Patients with pleural effusions present with respiratory distress and require immediate therapeutic intervention.…”

“…1,2 Among malignant pleural effusions, ascites lymphoma accounts for 10.0-15.0% followed by lung, breast, and ovary carcinoma. 1 Patients with pleural effusions present with respiratory distress and require immediate therapeutic intervention. [2][3][4] Pleural fluid analysis along with cytological examination is the readily available and cost-effective method of investigation for unilateral pleural effusions.…”