Flow Cytometry as a Diagnostic Tool in the Early Diagnosis of Aggressive Lymphomas Mimicking Life-Threatening Infection

Abstract

Aggressive lymphomas can present with symptoms mimicking life-threatening infection. Flow cytometry (FC) is usually recommended for the classification and staging of lymphomas in patients with organomegaly and atypical cells in effusions and blood, after the exclusion of other possible diagnoses. FC may also have a place in the initial diagnostic investigation of aggressive lymphoma. Three cases are presented here of highly aggressive lymphomas in young adults, which presented with the clinical picture of fever of unknown origin (FUO) in patients severely ill. All followed a life-threatening clinical course, and two developed the hemophagocytic syndrome (HPS), but microbiological, immunological, and morphological evaluation and immunohistochemistry (IHC) failed to substantiate an early diagnosis. FC was the technique that provided conclusive diagnostic evidence of lymphoma, subsequently verified by IHC. Our experience with these three cases highlights the potential role of FC as an adjunct methodology in the initial assessment of possible highly aggressive lymphoma presenting with the signs and symptoms of life-threatening infection, although the definitive diagnosis should be established by biopsy. In such cases, FC can contribute to the diagnosis of lymphoma, independently of the presence of HPS.

Flow-Cytometry in the Diagnosis of Diffuse Large B-Cell Lymphoma Based on Stomach Tissue Samples: A Case Report

“…Tsagarakis et al proposed the method of combination with IHC and fresh tissue. Flow cytometry was conducted for definitive diagnosis of tumor lymphocyte in three of his patients with clinical manifestations of fever of unknown cause, aggressive clinical course, and hemophagocytic syndrome; this is similar to our patient whose symptoms developed rapidly in 10 days with high fever [9]. In 2013, Demurtas et al released a study on the efficacy of flow cytometry in identifying difficult-to-differentiate B cells by IHC such as follicular lymphoma or reactive lymphoma [12].…”

“…The morphology and immunohistochemistry (IHC) of DLBCL patients' bone marrow and lymph nodes show unusual T-lymphocyte proliferation, making diagnosis challenging. Tsagarakis et al demonstrated tissue flow cytometry (FC) in conjunction with IHC to diagnose earlier lymphoma patients, particularly in the gastrointestinal system [9].…”

Body cavity fluid flowcytometry in the diagnosis of haematolymphoid neoplasms

“…Though immunohistochemistry remains the gold standard of lymphoma diagnosis, it is a tool which may involve difficulties, related to inadequate samples, differential diagnostic problems, or critical delays, before the definitive diagnosis is reached. (10) Through the cases described, we have tried to highlight the potential of Flow cytometry, combined with morphology and immunohistochemistry on cell bock specimens,in select cases, as a valuable, non invasive, informative tool for the early assessment of lymphomas. We recommend that it should be considered as an initial test in all undiagnosed cases of atypical haematolymphoid cells in pleural effusion, in order to assess the possibility of an underlying hematolymphoid neoplasm.…”

Gold Nanoparticles for Diagnostics: Advances towards Points of Care

“…The energy difference between the absorbed and emitted photon is a result of the vibrational relaxation of the excited-state molecule, and it is responsible for the Stokes shift [15]. Fluorescence has been widely used in diagnostics procedures, such as in quantitative real-time polymerase chain reaction (qPCR) for the diagnosis of chronic myeloid leukemia [16], DNA sequencing [17]], flow cytometry [18], fluorescence microscopy [19] and in vivo imaging [20]. …”