Pleural Effusions in Hematologic Malignancies

Alexandrakis, Michael G.; Passam, Freda; Kyriakou, Despina; Bouros, Demosthenes

doi:10.1378/chest.125.4.1546

Cited by 194 publications

(170 citation statements)

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“…In the present study, all of the effusions were exudates, with a slight increase in the levels of protein and lactate dehydrogenase. Although increased triglyceride levels in pleural fluid have been reported in cases of lymphoma, (13,14,17) only 4 (≈14%) of the lymphoma patients investigated in the present study showed triglyceride levels higher than 110 mg/dL, which explains the low mean values obtained in that group, as well as the absence of statistical significance when those values were compared with those obtained in the tuberculosis group. Although high levels of cholesterol in pleural fluid are associated with pseudochylous effusions, a condition that is generally associated with chronic fluid collections, (21) cholesterol in pleural fluid can be used in order to classify pleural exudates.…”

Section: Discussioncontrasting

confidence: 77%

“…(14,(16)(17)(18) In addition, ADA levels are commonly increased in the pleural fluid of patients with lymphoma, regardless of the cell subtype (T or B cells). (13) From a clinical standpoint, both tuberculosis and lymphoma predominate in males in the second decade of life, although tuberculosis can also affect younger patients.…”

Section: Discussionmentioning

confidence: 99%

“…Because the morphological features of lymphoma subtypes vary widely, it is often difficult to detect malignant cells in effusions, particularly in cases of low-grade lymphocytic lymphomas. (13,14) In some lymphomas, in addition to lymphocyte predominance, the pleural fluid can show high ADA levels, a finding that is uncommon in solid tumors and that can Differentiating between tuberculosis-related and lymphoma-related lymphocytic pleural effusions by measuring clinical and laboratory variables: Is it possible? J Bras Pneumol.…”

Section: Introductionmentioning

confidence: 99%

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É possível diferenciar derrames pleurais linfocíticos secundários a tuberculose ou linfoma através de variáveis clínicas e laboratoriais?

et al. 2012

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Objective: To describe clinical and laboratory characteristics in patients with tuberculosis-related or lymphomarelated lymphocytic pleural effusions, in order to identify the variables that might contribute to differentiating between these diseases. Methods: This was a retrospective study involving 159 adult HIV-negative patients with tuberculosis-related or lymphoma-related lymphocytic effusions (130 and 29 patients, respectively), treated between October of 2008 and March of 2010 at the Pleural Diseases Outpatient Clinic of the University of São Paulo School of Medicine Hospital das Clínicas Heart Institute, in the city of São Paulo, Brazil. Results: Mean age and the mean duration of symptoms were lower in the tuberculosis group than in the lymphoma group. The levels of proteins, albumin, cholesterol, amylase, and adenosine deaminase (ADA) in pleural fluid, as well as the serum levels of proteins, albumin, and amylase, were higher in the tuberculosis group, whereas serum cholesterol and triglycerides were higher in the lymphoma group. Pleural fluid leukocyte and lymphocyte counts were higher in the tuberculosis group. Of the tuberculosis group patients, none showed malignant cells; however, 4 showed atypical lymphocytes. Among the lymphoma group patients, cytology for neoplastic cells was positive, suspicious, and negative in 51.8%, 24.1%, and 24.1%, respectively. Immunophenotyping of pleural fluid was conclusive in most of the lymphoma patients. Conclusions: Our results demonstrate clinical and laboratory similarities among the patients with tuberculosis or lymphoma. Although protein and ADA levels in pleural fluid tended to be higher in the tuberculosis group than in the lymphoma group, even these variables showed an overlap. However, none of the tuberculosis group patients had pleural fluid ADA levels below the 40-U/L cut-off point.Keywords: Pleural effusion; Tuberculosis; Lymphoma; Adenosine deaminase; Diagnosis, differential. ResumoObjetivo: Descrever características clínicas e laboratoriais em pacientes com derrames pleurais linfocíticos secundários a tuberculose ou linfoma, a fim de identificar as variáveis que possam contribuir no diagnóstico diferencial dessas doenças. Métodos: Estudo retrospectivo com 159 pacientes adultos HIV negativos com derrame pleural linfocítico secundário a tuberculose ou linfoma (130 e 29 pacientes, respectivamente) tratados no Ambulatório da Pleura, Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo (SP), entre outubro de 2008 e março de 2010. Resultados: A média de idade e de duração dos sintomas foi menor no grupo tuberculose que no grupo linfoma. Os níveis pleurais de proteínas, albumina, colesterol, amilase e adenosina desaminase (ADA), assim como os níveis séricos de proteínas, albumina e amilase, foram maiores no grupo tuberculose, enquanto os níveis séricos de colesterol e triglicérides foram maiores no grupo linfoma. As contagens de leucócitos e linfócitos no líquido pleural foram maiores no grupo tub...

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Section: Discussioncontrasting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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É possível diferenciar derrames pleurais linfocíticos secundários a tuberculose ou linfoma através de variáveis clínicas e laboratoriais?

et al. 2012

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“…Nearly all hematologic malignancies can occasionally present with or develop pleural effusions during the clinical course of disease. But acute leukemias are rarely accompanied by pleural involvement [21]. In cases of hematologic pleural effusions, drug toxicity, underlying infectious, secondary malignant or rarely autoimmune causes should be carefully sought.…”

Section: Discussionmentioning

confidence: 99%

Detection of Acute Lymphoblastic Leukemia Involvement in Pleural Fluid in an Adult Patient with Ataxia Telangiectasia by Flow Cytometry Method

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et al. 2013

Indian J Hematol Blood Transfus

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“…Subsequent pleural tap drained off 1200 ml of fluid from each side. Pleural fluid analysis an exudative picture with numerous red cells with leukocyte count of 1900 mm 3 and pleural fluid cytology exhibited malignant plasma cells. (Figure 2).…”

mentioning

confidence: 99%