Pleural effusion in hematological pathology

Yerrapotu, Neeraja; Rahman, Abid M.; Gabali, Ali; Shidham, Vinod B.

doi:10.25259/cytojournal_12_2020

Cited by 2 publications

(7 citation statements)

References 8 publications

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“…Pleural effusions due to acute myeloid leukemia of monocyte origin are rarer 7,8 . Most are secondary manifestations of an existing disease, while primary presentations are unusual 2,4–7,9 . Clinically and cytologically, the differential diagnosis is broad 2,6–8 .…”

Section: Discussionmentioning

confidence: 99%

“…7,8 Most are secondary manifestations of an existing disease, while primary presentations are unusual. 2,[4][5][6][7]9 Clinically and cytologically, the differential diagnosis is broad. 2,[6][7][8] Our case showed myeloid leukemic infiltrate of monocyte lineage that morphologically simulated different cell types.…”

Section: Case Reportmentioning

confidence: 99%

“…This is further compounded because some monoblastic and to lesser extent monocyte leukemias often lack expression of other myeloid immunomarkers such as CD10, CD117 and CD34. [1][2][3][4][5][6][7][8][9] Another consideration to explain the unusual findings in the pleural fluid is the cells are more differentiated and more suggestive of histiocytic sarcoma. Even though histiocytic sarcoma has overlapping immunophenotypic features, peripheral blood and bone marrow are usually not involved in histiocytic sarcoma contrary to acute monocytic leukemia.…”

Section: Case Reportmentioning

confidence: 99%

“…Malignant leukemic pleural effusions are sinister signs 4 . The rarity and heterogeneity of the cytomorphologic and immunohistochemical features of acute myeloid leukemias impose diagnostic challenges for cytopathologists 5 . In particular, the variable neoplastic cells of acute myeloid leukemia of monocyte lineage can mimic benign and malignant lymphoid and non‐lymphoid lesions 5 .…”

Section: Introductionmentioning

confidence: 99%

“…The rarity and heterogeneity of the cytomorphologic and immunohistochemical features of acute myeloid leukemias impose diagnostic challenges for cytopathologists 5 . In particular, the variable neoplastic cells of acute myeloid leukemia of monocyte lineage can mimic benign and malignant lymphoid and non‐lymphoid lesions 5 . For prognostic and therapeutic reasons, cytopathologists have an important role in differentiating between benign and malignant effusions in patients with acute myeloid leukemia.…”

Section: Introductionmentioning

confidence: 99%

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Acute monoblastic myeloid leukemic pleural effusion: Pitfalls and clues

AbdullGaffar

Farhan

Dutta

2022

Diagnostic Cytopathology

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Acute myeloid leukemic pleural effusions are uncommon with heterogenous cytomorphology and variable immunoprofiles. This imposes a difficult cytologic diagnosis. In particular, acute myeloid leukemia of monocyte lineage mimicking benign and malignant lymphoid and non-lymphoid lesions is challenging. Few cases of acute myeloid monocyte-lineage leukemia have been reported. Our aim is to report a case of a 54-year-old female patient who presented with pancytopenia and bilateral pleural effusions. We highlight the characteristic cytomorphologic features, diagnostic pitfalls and helpful hints of acute monoblastic leukemia. Initially, the cells were misinterpreted as chronic inflammatory histiocytic infiltrates with reactive mesothelial cells. The presence of frequent mitotic figures, apoptotic bodies and a two-cell population raised the possibility of neoplastic cells. The cellular infiltrate simulated lymphoma, carcinoma and melanoma tumor cells. Cellblock immunocytochemistry however showed negative B-cell, T-cell, myeloid, Langerhans cell, plasma cell and dendritic cell lineage markers. They were positive for LCA, CD68, CD4 and CD117 with a high Ki67 index. The cytologically suggested impression of acute myeloid leukemia of monocyte origin favoring monoblastic variant was confirmed by flow cytometry and bone marrow trephine biopsy. Cytomorphologic clues included agranular amphophilic cytoplasm, occasional grooved indented nuclei, tingible body macrophages, associated plasma cells and absent granulocytes. The cytologic and cellblock findings matched the bone marrow trephine biopsy features. Cytopathologists should be aware of this unusual and challenging cytologic diagnosis in patients with pancytopenia and utilize at least two monocyte markers when formulating their differential diagnosis. Certain cytomorphologic features are helpful hints for their correct recognition.

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Section: Discussionmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute monoblastic myeloid leukemic pleural effusion: Pitfalls and clues

AbdullGaffar

Farhan

Dutta

2022

Diagnostic Cytopathology

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Analysis of CD4, CD8, CD19, CD56-16, CD64, QuantiFERON biomarkers in exudative lymphocyte-dominant pleural effusion

Bakhtiari

Mehraban²,

Pourdowlat³

et al. 2022

Journal of Family Medicine and Primary Care

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A BSTRACT Background: There are two main causes of exudative effusion including malignancy-induced effusion and tuberculosis. Considering that in reactive ejections, such as tuberculosis-induced effusion, the role of B lymphocytes and in the malignant effusion, the role of T lymphocytes are more important, in this study we analyzed the frequency of CD4, CD8, CD19, CD56-16, CD64, QuantiFERON in the pleural and serum samples of patients with exudative lymphocytic-dominant effusion. Methods: In total, 73 patients were enrolled in the study by exudative lymphocyte effusion, and finally, 63 patients had definite diagnoses. The patients were sorted into three groups including malignant, tuberculosis, and none. The sample of blood plasma and pleural effusion were collected and CD markers were analyzed using flow cytometry. Results: The mean age in the malignancy and tuberculous (TB) groups was 63.16 ± 12 and 52.15 ± 22.62, respectively. There was no significant difference in the frequency of CD8, CD4, and CD16-56 cells in blood samples of patients with tuberculosis and malignancy. Compared to those with tuberculosis, the percentage of CD64 cells was significantly higher in patients with tuberculosis than in malignant subjects. Moreover, a comparison of the frequency of cells with CD8, CD4, CD19, CD64, CD16-56, and CD14 markers in pleural samples showed no significant difference between groups. Other inflammatory factors were also investigated. The erythrocyte sedimentation rate (ESR) value for tuberculosis patients was significantly higher than malignancy. Also, QuantiFERON was positive in 14.3% of malignant patients, and 62.5% of patients with TB, which had a significant difference. Conclusion: Considering that there are many confounding variables in the study, such as previous medications, subtypes of Mycobacterium , and race of patients conducting studies in different groups and performing data mining for using a set of parameters can be used to detect the exact diagnosis.

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Pleural effusion in hematological pathology

Cited by 2 publications

References 8 publications

Acute monoblastic myeloid leukemic pleural effusion: Pitfalls and clues

Acute monoblastic myeloid leukemic pleural effusion: Pitfalls and clues

Analysis of CD4, CD8, CD19, CD56-16, CD64, QuantiFERON biomarkers in exudative lymphocyte-dominant pleural effusion

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