Malignant Hematolymphoid Plasmacytic Effusions: A Cytopathologic Study of Six Cases

IF 1 4区 医学 Q4 MEDICAL LABORATORY TECHNOLOGY
Badr AbdullGaffar
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引用次数: 0

Abstract

Compared to myelomatous effusions, there is a lack of studies that specifically address hematolymphoid plasmacytic effusions (HPEs). We conducted a retrospective review study over 15 years to investigate the prevalence, cytologic patterns, potential interpretation pitfalls, and clinical associations of HPEs. Serous effusion fluids in which plasmacytoid and plasma cells represented more than 10% of effusion cells were classified as HPEs. We extracted relevant clinical, laboratory, and follow-up data for each patient. We found six patients [age range: 60–88, average age: 73, male to female ratio 1:1] with HPEs that constituted 0.2% of serous effusions. Relevant clinical history prompted us to consider HPEs and include plasma cell immunomarkers in cellblock sections. Light chain-restricted plasmacytic cellular infiltrates confirmed the cytologic diagnosis in the absence of fluid flow cytometry. We have recognized three cytomorphologic patterns: pure plasmacytic infiltrates, lymphoplasmacytic infiltrates, and plasma cells intermixed with other cellular constituents. Four patients had multiple myeloma (two patients with pure high-grade large pleomorphic myeloma cells, two patients with mature plasma cells intermixed with inflammatory cells), one patient had marginal zone lymphoma, and another patient had lymphoplasmacytic lymphoma. The patients had similar clinical features with even kappa (3 cases) and lambda (3 cases) light chain distribution. HPEs are uncommon malignant effusions that occur in elderly patients with multiple myeloma and low-grade B-cell lymphomas. High-grade myeloma cells can be confused with hematolymphoid and non-hematolymphoid malignancies, whereas mature plasma cells in multiple myeloma and low-grade lymphomas can be misinterpreted as reactive plasmacytosis. Cellblock immunocytochemistry is a valuable diagnostic tool.

Abstract Image

恶性血淋巴浆细胞积液6例病理分析。
与骨髓瘤积液相比,缺乏专门针对血淋巴浆细胞积液(HPEs)的研究。我们进行了一项超过15年的回顾性研究,以调查hpv的患病率、细胞学模式、潜在的解释缺陷和临床关联。浆液性渗出液中浆细胞样细胞和浆细胞占渗出细胞的10%以上被归类为HPEs。我们提取了每位患者的相关临床、实验室和随访数据。我们发现6例患者[年龄范围:60-88岁,平均年龄:73岁,男女比例1:1]HPEs占浆液积液的0.2%。相关的临床病史促使我们考虑HPEs,并在细胞块切片中加入浆细胞免疫标记物。在没有流式细胞术的情况下,轻链限制性浆细胞浸润证实了细胞学诊断。我们已经认识到三种细胞形态模式:纯浆细胞浸润、淋巴浆细胞浸润和与其他细胞成分混合的浆细胞。4例多发性骨髓瘤(2例为纯高级别大多形性骨髓瘤细胞,2例为成熟浆细胞混杂炎性细胞),1例为边缘带淋巴瘤,1例为淋巴浆细胞性淋巴瘤。患者临床特征相似,kappa(3例)和lambda(3例)轻链分布均匀。HPEs是罕见的恶性积液,发生在老年多发性骨髓瘤和低级别b细胞淋巴瘤患者中。高级别骨髓瘤细胞可与血淋巴和非血淋巴恶性肿瘤混淆,而多发性骨髓瘤和低级别淋巴瘤中的成熟浆细胞可被误解为反应性浆细胞增多症。细胞块免疫细胞化学是一种有价值的诊断工具。
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来源期刊
Diagnostic Cytopathology
Diagnostic Cytopathology 医学-病理学
CiteScore
2.60
自引率
7.70%
发文量
163
审稿时长
3-6 weeks
期刊介绍: Diagnostic Cytopathology is intended to provide a forum for the exchange of information in the field of cytopathology, with special emphasis on the practical, clinical aspects of the discipline. The editors invite original scientific articles, as well as special review articles, feature articles, and letters to the editor, from laboratory professionals engaged in the practice of cytopathology. Manuscripts are accepted for publication on the basis of scientific merit, practical significance, and suitability for publication in a journal dedicated to this discipline. Original articles can be considered only with the understanding that they have never been published before and that they have not been submitted for simultaneous review to another publication.
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