Lymphoreticular malignancies in serous effusions: Cytomorphologic, flow cytometric and immunocytochemical analysis

Abstract

Introduction Involvement of body fluids by lymphoreticular malignancies (LRM) is rare and often associated with poor prognosis and decreased overall survival. The present study was conducted to analyze the characteristic cytomorphologic, flow cytometric and immunocytochemical features of LRMs in serous effusions. Materials and methods This was a three‐year retrospective study. A total of 218 effusion samples, reported as involved by lymphoreticular malignancies, on cytology, were reviewed. All the cases wherein the cytological diagnosis was confirmed by flow cytometric (FCM) and/or immunocytochemical (ICC) studies were retrieved and studied in detail. FCM and/or ICC were performed in a total of 51/218(23.4%) samples, including 30 pleural (58.8%), 18 peritoneal (35.3%), and 3 pericardial fluid (5.9%) samples. Results The cytomorphologic diagnoses included infiltration by non‐Hodgkin lymphoma (NHL;n = 27), infiltration by LRM (n = 19), infiltration by chronic lymphocytic leukemia (CLL;n = 2), Hodgkin's lymphoma (HL;n = 1) and suggestive of infiltration by LRM (n = 2). FCM and/or ICC confirmed the diagnoses as infiltration by T‐cell lymphoblastic lymphoma in 18; mature B‐cell NHL in 10; Burkitt lymphoma in 7; diffuse large B‐cell lymphoma in 4; follicular lymphoma, T‐ cell NHL and CLL in 2 samples each and hairy cell leukemia, plasmablastic lymphoma and HL in 1 sample each. 94.1% concordance was noted between the initial and final cytologic diagnosis. Conclusions Involvement of body fluids and effusions by LRMs, though rare, carries an immense prognostic significance and hence the prompt detection is crucial. Detection of these malignancies by cytologic examination of effusions is challenging yet potentially useful and the least invasive method available to establish an early diagnosis.

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

“…In addition, BL cases expressed germinal centre markers like CD10 and BCL6 and almost always showed strong positivity for cMYC. 10 In our study, three cases that tested negative for CD10 in cytology exhibited CD10 positivity in histopathology. This observation could be attributed to the loss of CD10 antigenicity in the cytology smear, possibly due to preservation issues.…”

Flow cytometric immunophenotyping in a liquid‐based cytology sample of pleural fluid: Connecting the dots

“…There have been previous series of diagnoses of lymphoma on effusion cytology, especially with application of flowcytometric immunophenotyping. However, to the best of our knowledge, a diagnosis of PMBCL has not been offered on effusion cytology 4 …”

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

“…Body fluid effusions are often suitable samples for flow cytometry (FC), given the samples are not fixed by alcohol or formalin. FC-based analysis is an extremely useful method when dealing with differential diagnosis of effusion-based hematolymphoid malignancy, because this technology provides a reproducible, quantitative and sensitive immunophenotyping of cells, using fluorescent-tagged antibodies targeting surface markers [5,[41][42][43][44]. Similar to ICC, FC analysis using a panel of antibodies can provide diagnostic clues in lymphoid malignancies.…”

“…Similar to ICC, FC analysis using a panel of antibodies can provide diagnostic clues in lymphoid malignancies. One important consideration should be noted; since the reactive lymphocyte-rich effusions are often T-cell predominant, T-cell abundancy shown by FC does not guarantee the diagnosis of T-cell lymphoma [5,41].…”

“…Though rarer than lymphoid diseases, FC also serves important roles in leukemic conditions [41,43]. For instance, involvement of chronic lymphocytic leukemia (CLL) on body fluid can be very difficult to distinguish from reactive lymphocytosis.…”