When Should We Send a Cellular Lymphoid Effusion for Lymphoma Work-Up
Michael Chaump, Dariusz Stachurski, Gengsheng Yu. Rhode Island Hospital, Providence, RI; Warren Alpert Medical School, Providence, RI
Background: Many malignant effusions caused by hematopoietic malignancies often emerge as the initial presentation, especially low-grade lymphomas, such as chronic lymphocytic leukemia/lymphoma, mantle cell lymphoma, marginal zone cell lymphoma and low-grade follicular lymphoma in elderly patients. These low-grade lymphomas consist of relatively small lymphocytes, cytologically difficult to distinguish from benign lymphocytes. Definitive diagnosis of lymphoma in body fluids is inevitably based on further ancillary immunohistochemical studies, flow cytometric analyses and sometimes molecular tests to detect clonality. Triage of effusion specimens with atypical lymphoid populations for further lymphoma work-up will not only render a definitive diagnosis but may also reduce unnecessary procedures and initiate prompt and appropriate treatment. In this study, we review 40 lymphoma cases with neoplastic effusions and summarize the cytologic features that potentially trigger further work-up to diagnose non-Hodgkin's lymphoma.
Design: Thin-prep slides from10 cases of CLL, 4 cases of mantle cell/marginal zone lymphoma, 4 cases of low grade follicular lymphoma, 3 cases of T cell lymphoma, 10 cases of large cell lymphoma, 3 cases of T cell lymphoma and 9 cases of benign inflammatory effusion were reviewed. The following nuclear features were evaluated as abnormal if seen in >30% of lesional cells: enlarged nuclei (>medium size), cleaved nuclei, clumped chromatin pattern, prominent nuclear membrane, nuclear lobulation, distinct nucleoli (any size), and mitoses.
Results: On Thin-prep slides, distinct nucleoli, of any size, were the most frequently encountered features in all lymphomas. Cleaved nuclei and clumped chromatin pattern were also very common in lymphomatous effusions (as shown in Table).
|Enlarged nuclei||Cleaved nuclei||Clumped chromatin||Prominent nuclear membrane||Distinct nucleoli||Nuclear lobulation||mitosis|
|Chronic lymphocytic lymphoma (10)||4/10||7/10||8/10||8/10||2/10||0/10||4/10|
|Mantel cell/marginal zone cell lymphoma(4)||2/4||3/4||3/4||3/4||4/4||2/4||0/4|
|Follicular lymphoma (4)||3/4||3/4||3/4||3/4||4/4||1/4||3/4|
|Large cell lymphoma(10)||10/10||10/10||4/10||5/10||10/10||5/10||3/10|
|T cell lymphoma(3)||3/3||3/3||1/3||1/3||3/3||0/3||0/3|
|Benign lymphoid effusion (9)||0/9||0/9||0/9||0/9||0/9||0/9||1/9|