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2018 ; 15
(ä): 15
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Hematolymphoid neoplasms in effusion cytology
#MMPMID30034505
Monappa V
; Reddy SM
; Kudva R
Cytojournal
2018[]; 15
(ä): 15
PMID30034505
show ga
BACKGROUND: Hematolymphoid neoplasms (HLNs) presenting as body cavity effusions
are not a common finding. They may be the first manifestation of the disease. A
diagnosis on effusion cytology may provide an early breakthrough for effective
clinical management. AIMS: Study the cytomorphology of HLNs in effusion cytology,
determine common types, sites involved and uncover useful cytomorphologic clues
to subclassify them. MATERIALS AND METHODS: Twenty-four biopsy-proven HLN cases
with malignant body cavity effusions and 8 cases suspicious for HLN on cytology
but negative on biopsy are included in this study. Effusion cytology smears were
reviewed for cytomorphological features: cellularity, cell size, nuclear
features, accompanying cells, karyorrhexis, and mitoses. RESULTS: Diffuse large
B-cell lymphoma (37%) was the most common lymphoma type presenting as effusion
followed by peripheral T-cell lymphoma (25%). Pleural effusion (75%) was most
frequent presentation followed by peritoneal effusion (20.8%). Pericardial
effusion was rare (4.1%). The common cytologic features of HLNs in effusions:
high cellularity, lymphoid looking cells with nuclear enlargement, dyscohesive
nature, and accompanying small lymphocytes. Mitosis and karyorrhexis were higher
in high-grade HLNs when compared to low-grade HLNs. Myelomatous effusion showed
plasmacytoid cells. Very large, blastoid looking cells with folded nuclei, high
N: C ratio, and prominent nucleoli were seen in leukemic effusion. CONCLUSION:
HLNs have characteristic cytomorphology and an attempt to subclassify them should
be made on effusion cytology. Reactive lymphocyte-rich effusions cannot be
distinguished from low-grade lymphomas based on cytomorphology alone. Ancillary
tests such as immunocytochemistry, flow cytometry, and/or molecular techniques
may prove more useful in this regard.