Epstein-Barr Virus–Positive Pleural Effusion

Dasatinib is currently approved for clinical use as a first-line treatment agent for newly diagnosed chronic myeloid leukemia (CML). However, only a few clinical trials have been performed to evaluate dasatinibinduced PE following first-line therapy. We investigated the incidence and clinical features of dasatinib-induced PE following first-line therapy in Japanese CML patients of real world clinical practice settings. Among 22 patients, the median age of PE-positive patients was higher than that of PE-negative patients. Major molecular response was achieved in 75% of PE-positive patients and 50% of PE-negative patients. Most patients developed PE more than 1 year after treatment. Appearance of PE is associated with better clinical response during dasatinib treatment, however it is developed at any time. Elderly and high-risk patients tend to develop PE. The clinical features of dasatinib-induced PE following first-line therapy might be late onset and might not immediately follow the increasing of large granular lymphocyte.

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“…Furthermore, Epstein-Barr virus (EBV) infection might be associated with PE because some reports have described EBV-associated PE. 17 …”

Section: Discussionmentioning

confidence: 99%

Clinical significance of dasatinib-induced pleural effusion in patients with de novo chronic myeloid leukemia

et al. 2018

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“…Polymorphous lymphocytosis is the most common cytological feature (70%), although they may also exhibit atypical characteristics (both, in lymphocytes and in mesothelial cells). Immunophenotyping by flow cytometry is useful for cases with atypical lymphoid characteristics [151]. PF is generally a one-sided exudate, most frequently appears on the left side, and is lymphocytic, although neutrophilic predominance does not exclude diagnosis [151,152] (Table 2).…”

Section: Other Diseasesmentioning

confidence: 99%

“…Immunophenotyping by flow cytometry is useful for cases with atypical lymphoid characteristics [151]. PF is generally a one-sided exudate, most frequently appears on the left side, and is lymphocytic, although neutrophilic predominance does not exclude diagnosis [151,152] (Table 2).…”

Section: Other Diseasesmentioning

confidence: 99%

“…The prevalence of PE of unknown aetiology depends on the definition employed. In a review of 20 cases of PE secondary to Epstein–Barr infection, T akei and M ody [ 149 ] observed that this infection explained some cases of idiopathic effusion. Polymorphous lymphocytosis is the most common cytological feature (70%), although PEs may also exhibit atypical characteristics (both in lymphocytes and in mesothelial cells).…”

Section: Other Diseasesmentioning

confidence: 99%

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Pleural effusion due to nonmalignant gastrointestinal disease

et al. 2022

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Although pleural effusion is a frequent finding in clinical practice, determining its etiology may be challenging, and up to 20% of cases remain undiagnosed. Pleural effusion may occur secondary to a non-malignant gastrointestinal disease. A gastrointestinal origin is confirmed based on a review of the medical history of the patient, and thorough physical examination and abdominal ultrasonography. In this process, it is crucial to correctly interpret findings on pleural fluid obtained by thoracentesis. In the absence of high clinical suspicion, identifying the etiology of this type of effusion may be difficult. Clinical symptoms will be determined by the gastrointestinal process causing PE. In this setting, correct diagnosis relies on the specialist's ability to associate pleural fluid appearance, test for the appropriate biochemical parameters, and determine whether it is necessary or not to send a specimen for culture. The established diagnosis will determine how pleural effusion is approached. Although this clinical condition is self-limited, many cases will require a multidisciplinary approach, as some effusions only resolved with specific therapies.

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Role of Epstein‐Barr virus status and immunophenotypic studies in the evaluation of exfoliative cytology specimens from patients with post‐transplant lymphoproliferative disorders

Gibson

Picarsic

Swerdlow

et al. 2016

Cancer Cytopathology

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BACKGROUND: Post-transplant lymphoproliferative disorders (PTLDs) are well characterized in tissue sections, but their evaluation in exfoliative cytology specimens is limited. This study reports a 25-year experience with PTLDs in exfoliative cytology specimens. METHODS: All solid organ or allogeneic stem cell transplant recipients with PTLDs and exfoliative cytology specimens from 1987 to 2011 were identified. The cytomorphology, Epstein-Barr virus (EBV) status, flow cytometry, immunohistochemistry, and molecular studies were reviewed from all exfoliative cytology specimens previously diagnosed as atypical lymphoid proliferations or PTLDs. RESULTS: A total of 55 patients (age range, 1-72 years) with PTLDs had 434 exfoliative cytology specimens. Thirty-six of the 55 patients (65%) had 54 specimens with abnormal lymphoid proliferations (12% of the specimens), and 26 of these patients had 37 specimens available for review (15 cerebrospinal fluid specimens, 12 peritoneal fluid specimens, 9 pleural fluid specimens, and 1 bronchoalveolar lavage fluid specimen).Thirty percent of the reviewed cytology specimens were diagnostic of PTLDs, including 8 cases of monomorphic posttransplant lymphoproliferative disorder (M-PTLD) with abnormal B/T-cell populations identified with flow cytometry/ immunohistochemistry and 3 EBV-positive specimens with a differential diagnosis of polymorphic PTLD versus M-PTLD.All cases diagnostic of a PTLD had 1 to 3 ancillary studies performed. Forty percent of the cytology specimens (15 of 37) were suspicious for a PTLD, but ancillary studies were performed for only a third of them, and they did not support a definitive diagnosis of a PTLD. Thirty percent of the cytology specimens (11 of 37) appeared reactive, but they lacked sufficient ancillary studies to exclude a PTLD. CONCLUSIONS: Atypical lymphoid proliferations are common in exfoliative cytology specimens from patients with PTLDs, and they require ancillary studies at least including immunophenotyping and EBV evaluations for a definitive diagnosis. Cancer Cytopathol 2016;124:425-35.

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Epstein-Barr Virus–Positive Pleural Effusion

Abstract: EBV infection/reactivation can account for certain proportions of "idiopathic" PEs. Polymorphous lymphocytosis is the most common cytologic feature, but atypical features (in both lymphocytes and mesothelial cells) can be seen.

Cited by 8 publications

References 9 publications

Clinical significance of dasatinib-induced pleural effusion in patients with de novo chronic myeloid leukemia

Clinical significance of dasatinib-induced pleural effusion in patients with de novo chronic myeloid leukemia

Pleural effusion due to nonmalignant gastrointestinal disease

Role of Epstein‐Barr virus status and immunophenotypic studies in the evaluation of exfoliative cytology specimens from patients with post‐transplant lymphoproliferative disorders

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