T-Cell Lymphoma Is a Rare Entity in Body Fluid Cytology: Findings from a Large Case Series
Vlada Alexeeva, Silvat Sheikh-Fayyaz, Judith Brody, Minoti Magotra, Junaid Seikh, Robina Atta, Morris Edelman, Mohamed Aziz, Melissa Klein, Filiz Sen. North Shore LIJ Health System, Lake Success, NY
Background: Malignant lymphomas may cause effusion fluids during the course of the disease. Moreover, lymphomas may initially be diagnosed in body fluid samples. Cytomorphology in conjunction with flow cytometric immunophenotyping is essential in evaluation of these specimens. Both B and T cell lymphomas (TCL) are reported in association with effusions. The incidence of body fluid specimens involved by T cell lymphomas is unclear. Only a handful of case reports and case series describing various T cell lymphomas in the body fluids are identified in the literature, without an up-to-date immunophenotypic and genotypic characterization of the (TCL) subtype.
Design: We are reporting a large series of body fluids to identify and characterize TCL using the current WHO Classification, 2008. We identified 9,969 body fluid specimens in the database of two major academic centers over a period of 2005 -2010. The cytologic, flow cytometric, immunohistochemical, cytogenetic and molecular genetic studies of these cases were reviewed.
Results: 53 of 9,969 body fluid specimens were involved by lymphoma; 41 B cell lymphoma (0.4%) and 12 T cell lymphoma (0.1%). The 12 samples with TCL belonged to 8 patients and included; pleural effusion (n = 7), ascitic fluid (n = 2), bronchoalveolar lavage fluid (n = 2) and pericardial effusion (n = 1). The patients were predominantly male (6 males, 2 females), age range 9-71 yrs. Flow cytometric immunophenotyping was performed in 6 out of 12 samples (50%). In 3/8 patients, primary diagnosis of lymphoma was established in the body fluid specimen. The rest of the patients (5) were diagnosed with TCL previously from biopsies of: gastric mass (n = 1), lymph node (n = 1), abdominal mass (n = 1), lung (n = 1) and bone marrow (n = 1). The diagnoses were Adult T-cell leukemia/lymphoma (3), ALK+ Anaplastic Large Cell lymphoma (2), Angioimmunoblastic T cell lymphoma (1), Peripheral T cell lymphoma, Not Otherwise specified (1) and T lymphoblastic lymphoma/leukemia (1). Cytogenetic and molecular genetic studies were performed in 3 patients. Serologic studies were positive for HTLV-1 antibodies in three patients.
Conclusions: In our series, body fluids involved by TCL represented only 0.1% of the specimens. Most common type of TCL was HTLV-1 positive ATLL followed by ALK+ ALCL. In spite of rarity and variable cytomorphologic presentation of the TCL, primary as well as the secondary diagnosis can be made with confidence using cytomorphologic and flow cytometric evaluation. Cytogenetic, molecular genetics and serologic studies are a critical part of the evaluation of body fluids for TCL.
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 47, Monday Morning