[412] Evaluation of Myeloid Leukemic Effusions in Cytopathology

Marian A Rollins-Raval, Sara E Monaco, Walid E Khalbuss, Liron Pantanowitz. University of Pittsburgh Medical Center, Pittsburgh, PA

Background: Current literature distinguishing primary leukemic effusions (PLE) from peripheral blood (PB) contamination in acute myeloid leukemia (AML) is limited. We attempt to evaluate a series of myeloid effusions, and to determine if true PLE could be distinguished from PB contamination.
Design: In a 10 year archival search, we identified 14 effusions (body fluids excluding CSF) from 9 patients with final diagnosis of atypical, suspicious or positive for leukemic blasts. Effusion preparations were reviewed and correlated with clinicopathologic variables and diagnostic material for primary myeloid neoplasm (2008 WHO Criteria).
Results: Primary myeloid neoplasms included 4 AML with myelodysplasia related changes, 3 therapy related myeloid neoplasms, 1 AML not otherwise specified and 1 AML unclassifiable by available material. Monocytic differentiation was present in 5 cases. At presentation with effusion, median patient age was 60 years with a 1.25:1 male:female ratio. Table 1 includes selected case characteristics and classification of these effusion. 2 cases had follow up tissue biopsy: case 5 showed pleural myeloid sarcoma and case 2 reactive pericarditis.

Table 1. Effusion characteristics
CaseEffusion site% peripheral blood blasts at time of effusionDays from diagnostic specimen to effusionEffusion blast # (1-3)*Effusion maturing granulocytesEffusion red blood cellsApparent Classification of Effusion
1aPeritoneal0 (9% monocytes)4491, but 2-3 immature monocytesYesModerateContamination
1bPeritoneal0 (2% monocytes)4401, but 2-3 immature monocytesRareScantIndeterminate
2cPleural , right511YesModerateContamination
2dPleural, left511YesModerateContamination
3Pleural, right37831YesModerateContamination
4Pleural, left456723RareAbundantContamination
5Pleural, left0-13NoAbundantLeukemic
6aPleural, right2333RareAbundantLeukemic
6bPleural, left2333YesAbundantLeukemic
7Pleural, NOS061YesAbundantIndeterminate
8Pleural, NOS181663YesAbundantContamination
9Pleural, NOS0 (71% monocytes)202YesAbundantContamination
*1=few, 2=moderate number, 3=many

Conclusions: Myeloid neoplasms, particularly with monocytic differentiation, may be detected in PLE or following contamination with blasts in PB. PLE tend to have increased blasts in fluid, but low PB blast counts, and can usually be separated from PB contamination by correlation with PB findings.
Category: Cytopathology

Monday, March 4, 2013 1:00 PM

Poster Session II # 75, Monday Afternoon


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