Department of Oncopathology, Gujarat Cancer and Research Institute, Ahmedabad, India.
Pathology, PDCC Oncopathology, Associate Professor, Department of Oncopathology, Gujarat Cancer and Research Institute, Ahmedabad, India.
Diagn Cytopathol. 2021 Aug;49(8):948-958. doi: 10.1002/dc.24772. Epub 2021 May 11.
Serous effusions (SE) in leukemic patients can be due to infections, therapy, volume overload, lymphatic obstruction or malignancy having implications on treatment and mortality. The objective of the present study is to highlight the spectrum of cytomorphology, immunophenotype, and cytogenetics in leukemic serous effusions (LSE).
Present study is retrospective and descriptive. We reviewed all the SE, which were reported as suspicious or positive of leukemic infiltration from 2016 to 2019 for cytomorphological features. CSF and effusions involved by lymphomas were excluded. Cyto-diagnosis was compared with primary proven diagnosis (by ancillary techniques) and disconcordant cases were analyzed.
Out of total 9723 effusions, only 0.4% (n = 40) showed leukemic involvement and included nine cases of AML, three of B-ALL, 13 T-ALL, 2 MPAL, 6 CML, 5CLL, one each of chronic myelomonocytic leukemia and AML with myelodysplasia. The most common site of involvement was the pleural cavity (n = 30), followed by the peritoneal cavity (n = 7) and the pericardial cavity (n = 3). T -ALL (41.9%) was the most common leukemia involving pleural fluid followed by AML (23.3%). CML (42.8%) was the most common leukemia involving the ascitic fluid followed by B-ALL (28.6%). Accurate diagnosis was given on cytomorphology in 72.5% (29/40) cases and 15.0% (6/40) were reported as non-Hodgkin lymphoma.
Cytology is an effective tool available to make a diagnosis of LSE. Nuclear indentations in large atypical cells and cells with eosinophilic granular cytoplasm with sparse or abundant eosinophils in the background are an important clue in favor of leukemia over lymphoma.
白血病患者的浆膜腔积液（SE）可能由感染、治疗、容量超负荷、淋巴阻塞或恶性肿瘤引起，这对治疗和死亡率有影响。本研究的目的是强调白血病浆膜腔积液（LSE）的细胞形态学、免疫表型和细胞遗传学特征。
本研究为回顾性和描述性研究。我们回顾了 2016 年至 2019 年所有报告为可疑或阳性的浆膜腔积液的 SE，以进行细胞形态学特征分析。排除了累及淋巴瘤的脑脊液和积液。细胞诊断与主要确诊诊断（通过辅助技术）进行比较，并对不一致的病例进行分析。
在总共 9723 例积液中，仅有 0.4%（n=40）显示有白血病浸润，包括 9 例急性髓系白血病（AML）、3 例 B 细胞急性淋巴细胞白血病（B-ALL）、13 例 T 细胞急性淋巴细胞白血病（T-ALL）、2 例混合表型急性白血病（MPAL）、6 例慢性髓系白血病（CML）、5 例慢性淋巴细胞白血病（CLL）、1 例慢性粒单核细胞白血病和 1 例伴骨髓增生异常的 AML。最常见的受累部位是胸腔（n=30），其次是腹腔（n=7）和心包腔（n=3）。T-ALL（41.9%）是最常见的累及胸腔积液的白血病，其次是 AML（23.3%）。CML（42.8%）是最常见的累及腹水的白血病，其次是 B-ALL（28.6%）。在 72.5%（29/40）的病例中，细胞形态学可做出准确诊断，15.0%（6/40）报告为非霍奇金淋巴瘤。
细胞学是诊断 LSE 的有效工具。大异型细胞的核切迹和背景中具有嗜酸性颗粒细胞质的细胞，伴有稀疏或丰富的嗜酸性粒细胞，是支持白血病而非淋巴瘤的重要线索。
