Subclassification of lymphoproliferative disorders in serous effusions

Abstract

BACKGROUND: Rare studies have reported the application of multiple ancillary tests to the diagnosis of lymphoproliferative disorder in serous effusions. In the current study, the authors evaluated the effectiveness of using an algorithm for the triage of serous effusions and the contribution of ancillary studies to achieve a specific subtype of lymphoproliferative disorder. METHODS: Serous effusion samples that had a final diagnosis of lymphoproliferative disorder or suspicious for lymphoma were selected from cases that were diagnosed between 2001 and 2010. Data were collected on patient and sample characteristics as well as results from immunophenotype and molecular studies. RESULTS: In total, 168 serous effusions were identified from 110 patients. The most common site of involvement was the pleural cavity (n ¼ 133) followed by the peritoneal cavity (n ¼ 30) and pericardial cavity (n ¼ 5). The volume of serous effusions ranged from 2 mL to 1000 mL (mean, 238 mL). In 42 patients (38.2%), serous effusions were the primary source of diagnosis. In 129 patients who had a diagnosis of LPD, either generic (n ¼ 82) or specific (n ¼ 47) ancillary tests were performed as a single test in 58 samples (67.4%) or as a combination of multiple studies in 19 samples (23.2%). Immunophenotyping was successful in almost all samples that had a specific subtype with 16 B-cell and 4 T-cell lymphomas being diagnosed. More samples with a specific subtype of lymphoma underwent molecular tests compared with those who had a generic diagnosis (19.1% vs 13.4%). CONCLUSIONS: Successful, specific subtyping of lymphoproliferative disorders was achieved in approximately 33% of cases that were tested for ancillary studies following an approach for the triage and aliquoting of serous effusion samples.

Flow Cytometry and Effusions in Lymphoproliferative Processes and Other Hematologic Neoplasias

“…Among the negative cases, 6 showed atypical morphologic features and were studied further, similarly to the cases with atypical, but nondiagnostic, findings on FC, yielding a final definitive diagnosis in an additional 29 and 17% of cases, respectively. The study of Tong et al [9] describes an algorithmic approach, including the application of FC and other auxiliary studies [immunohistochemistry, polymerase chain reaction for B- and T-cell clonality, human herpes virus type 8 (HHV8) status, and EBER], to the diagnosis of lymphoproliferative disease in effusion samples based on 10 years of experience. A diagnosis of a lymphoproliferative disease was made in 133 pleural effusions, 30 ascites, and 5 pericardial effusions.…”

“…After consideration of the differential diagnosis, the proper indication should lead to selection of the antibody panel for the FC study. Since the frequency of malignant effusions is significantly higher in patients with known lymphomas than in those without a hematologic malignancy, the history of any such neoplasia, particularly of an indolent lymphoma, is the most important indication for performance of an FC analysis [6,8,9]. However, if the etiology of the microscopically nonneoplastic effusion remains unexplained, and especially if it is recurrent or accompanied by a striking lymphadenopathy, FC should be performed to rule out or prove the presence of an indolent lymphoma.…”

“…The application of FC to large-cell lymphomas generally carries a substantial risk of false-negative results due to the potential destruction of the fragile cytoplasm of the neoplastic cells with a subsequent artificial loss of surface antigens during cell sorting, with an FC failure rate of 28% mostly for large-cell lymphoma [9,12,27]. Since blastic large-cell lymphomas tend to develop a sometimes extensive necrotic change, FC may not be applicable to such samples (fig.…”

“…PEL show expression of CD45 but lack B-cell and T-cell markers, with a variable presence of activation markers (CD30, CD38, and CD71) and plasma cell differentiation (CD138). As aggressive, blastic lymphomas, they are difficult to characterize by FC and are mostly diagnosed by immunocytochemistry preferably on cell blocks [9]. …”

Extraoral Plasmablastic Lymphoma Detected Using Ascitic Fluid Cytology and Flow Cytometry: A Case Report with a Review of the Literature

“…The newer ancillary techniques used by cytologists, like flow cytometry (FC), help validate his/her morphological diagnosis with an immunological validation. The combined use of cytology and FC has been known to provide nearly 100% sensitivity and specificity, alleviating the need for an invasive procedure to obtain a tissue biopsy [1,2,3]. Fine-needle aspiration cytology (FNAC) along with FC has been shown to be a fundamental tool in the diagnosis and classification of non-Hodgkin's lymphoma [4].…”