The value of cytology in diagnosis of serous effusions in malignant lymphomas: An experience of a tertiary care center

Abstract

Background: Malignant lymphomas (ML) are often complicated by serous effusions.The present study is an attempt to cytologically assess a large series of serous effusions associated with ML, identify the immunoreactivity of cells and to evaluate the role of various ancillary methods in confirming and subtyping these cases. Methods: A cross-sectional study of 4612 serous effusions was undertaken at the Department of Cytology, Gujarat Cancer and Research Institute by retrieving data from the year 2015 to 2017. Total 169 cases of ML, clinically suspicious, were included. All cerebrospinal fluids, serous effusions involved by myeloid neoplasms, and cases of primary effusion lymphomas were excluded from our study. Pap stained smears of all these serous effusions were examined. Ancillary methods such as immunohistochemistry were used to further subtype the positive cases using the WHO classification of hematopoietic and lymphoid neoplasms (2016). Results: Out of total 169 clinically suspicious cases, 109 cases were cytologically positive for ML which included 73 (66.9%) pleural effusions, 34 (31.1%) ascitic fluids, and 2 (1.8%) pericardial effusions. T-lymphoblastic lymphoma (36.9%) and Burkitt's lymphoma (38.2%) were the most common ML involving the pleural and ascitic fluids respectively. Non-Hodgkin's lymphoma (NHL) more frequently involved the serous cavities than Hodgkin's lymphoma. (P value <.0001). Among the NHL, T-cell lymphomas more commonly lead to serous effusions than B-cell lymphomas (P value <.0048). Conclusion: Cytological examination of serous effusions is an accurate, prompt, affordable technique having diagnostic and therapeutic implications. With the help of ancillary methods, we can identify the phenotype of cells, classify as well as confirm our diagnosis. K E Y W O R D S immunohistochemistry, malignant lymphomas, serous effusions

The cytopathological spectrum of lymphomas in effusions in a tertiary center in Taiwan

“…Malignant effusion is usually caused by carcinoma such as lung cancer in the pleural effusion (PE) and gastrointestinal cancer in the ascites. Among samples with serous PE, about 1.6% to 3% cases are caused by hematologic malignancies 1,2 . Lymphomas in effusions could be either primary or secondary.…”

“…Around 10% to 15% cases of malignant PE are caused by hematologic malignancy 5‐7 . Both Hodgkin and non‐Hodgkin lymphoma may cause malignant effusion, either as initial presentation or at disease progression/relapse 2,8‐13 . The relative frequencies of lymphoma types in malignant effusion differ in various studies.…”

Clinical and cytopathologic characteristics of lymphoid neoplasms involved with serous effusions: a single center experience

“…Cytologic analysis of pleural effusion (PE), ascites, or pericardial effusion was often the first-line diagnostic test performed after an effusion was detected [1][2][3]. It was simple, safe, fast and cost effective.…”

“…Cytopathologic diagnoses could determine whether or not neoplastic cells were present in SEs [2][3][4][5][6], but sometimes it was difficult to determine by cytomorphology alone. For example, indolent 3 lymphoma often mimics a reactive lymphocytosis consisting predominantly of small cells, and plasma cells may present cytomorphologic features nearly identical to mesothelial cells in some effusions.…”

Clinical and laboratory characteristics of lymphoid neoplasms in serous effusions: a single centre experience in China

“…Cytologic analysis of serous effusions can be used to determine whether or not neoplastic cells are present, [2][3][4][5][6] sometimes this is difficult to determine by cytomorphology alone. For example, indolent lymphoma often mimics reactive lymphocytosis consisting predominantly of small cells, and plasma cells may present cytomorphologic features nearly identical to those of mesothelial cells in some effusions.…”