A rare case of bilateral chylothorax: a diagnostic challenge—follicular lymphoma versus primary effusion lymphoma

Abstract

SUMMARYChylothorax is most common on the left side owing to the position of the thoracic duct. Malignancy-associated chylothorax is not uncommon. However, bilateral chylothorax is rare and malignancy should be a consideration in absence of trauma. We report a case of a patient with follicular lymphoma who presented with bilateral pleural effusion; pleural fluid analysis confirmed chylothorax. The patient did not have any significant peripheral or axial lymphadenopathy, which made the diagnosis difficult in absence of histopathology. Pleural fluid analysis was negative for malignant cells, however, the flow cytometry markers were suggestive of follicular lymphoma. Primary effusion lymphoma, which could have been another possibility, was ruled out by the flow cytometry markers. We conclude that pleural fluid flow cytometry markers play an important role where there is no significant lymphadenopathy and in absence of histopathological diagnosis. This demands further evaluation. BACKGROUND

Flow Cytometry and Effusions in Lymphoproliferative Processes and Other Hematologic Neoplasias

“…PEL is a uncommon hematologic malignancy presenting in fluids of body cavities without forming tumoral masses in immunocompromised patients, mostly with an HIV infection, and it is caused by superinfection with HHV8 [22,31]. PEL accounts for about 4% of all HIV-associated NHL.…”

“…FL is usually diagnosed histologically via demonstration of the typical nodular growth pattern architecture and immunophenotype. Malignant effusions as a first or only presentation of FL are an exception [22], but they belong to the differential diagnosis of an unexplained lymphocytic effusion. Demonstration of a CD19+, CD20+ cell population with a light chain restriction and CD10 positivity, complemented by demonstration of bcl2 and bcl6 expression as well as rearrangement of the bcl2 gene by fluorescence in situ hybridization (FISH), may reliably allow the diagnosis of FL in body fluids.…”

Indonesian female with bilateral chylothorax and mediastinal non-Hodgkin lymphoma: A case report

“…The incidence of chylothorax has been reported in as many as 3 % of cases of pleural effusions [3] and mortality has been reported in as many as 10 % [4] . In addition, the most common cause of chylothorax is lymphoma (70 %) [5] . Bilateral chylothorax is a rare case that is important to report [6] .…”