Patel Bidish K, Gochhait Debasis, Jinkala Sreerekha, Rangarajan Vidhyalakshmi, Kannan Narasimhapriyan, Durgadevi S, Siddaraju Neelaiah
Senior Resident, Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
Additional Professor, Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
J Cytol. 2022 Apr-Jun;39(2):59-65. doi: 10.4103/joc.joc_204_21. Epub 2022 May 30.
Effusions as part of hematologic neoplasms are rare and as a primary presentation, rarer. In standalone laboratories of developing countries, resorting to techniques such as flow cytometry or immunohisto/cytochemistry may not be possible. A near definitive diagnosis on cytomorphology would, therefore, be an ideal beginning. To that end, we compiled our cases of primary hematolymphoid effusions, devising reproducible reporting categories and looked at their concordance with the final histopathology.
Fifty-four cases of primary hematolymphoid effusions over 10 years with cytology-histopathology correlation were chosen. Post morphology assessment, the cases were organized into six categories: suspicious of hematolymphoid malignancy, non-Hodgkin lymphoma-high-grade (NHL-HG), low-grade NHL (NHL-LG), Burkitt lymphoma, acute leukemias, and plasma cell dyscrasias. Discordance with histology was assigned as major and minor based mainly on therapeutic implications.
Concordance was seen in a good number (81.5%) of cases. The NHL-HG and NHL-LG categories contributed to 33.3% each of major discordance. Tuberculosis and epithelial malignancies comprised the bulk of the major discordance. Overdiagnosis of a high-grade lymphoma for a histologically proven low-grade follicular lymphoma was the only case with minor discordance.
The cytologic categories used are not foolproof for hematologic neoplasms but have a fairly good concordance. A scanty abnormal population should always be viewed with suspicion and definitive labels should be avoided. While morphologic examination is fraught with danger, a good assessment directs the judicious selection of ancillary methods, and hence cannot be supplanted.
作为血液系统肿瘤一部分的积液很少见，而作为主要表现则更为罕见。在发展中国家的独立实验室中，可能无法采用流式细胞术或免疫组织/细胞化学等技术。因此，基于细胞形态学做出近乎明确的诊断将是一个理想的开端。为此，我们汇总了原发性血液淋巴系统积液的病例，设计了可重复的报告类别，并观察了它们与最终组织病理学结果的一致性。
选取了54例10年间具有细胞学 - 组织病理学相关性的原发性血液淋巴系统积液病例。在进行形态学评估后，将病例分为六类：怀疑血液淋巴系统恶性肿瘤、非霍奇金淋巴瘤高级别（NHL - HG）、低级别NHL（NHL - LG）、伯基特淋巴瘤、急性白血病和浆细胞异常。与组织学结果的不一致主要根据治疗意义分为主要和次要两类。
相当数量（81.5%）的病例显示出一致性。NHL - HG和NHL - LG类别在主要不一致中各占33.3%。结核病和上皮性恶性肿瘤构成了主要不一致的大部分。对于组织学证实为低级别滤泡性淋巴瘤而过度诊断为高级别淋巴瘤是唯一一例次要不一致的情况。
所使用的细胞分类对于血液系统肿瘤并非万无一失，但具有相当好的一致性。对于数量稀少的异常细胞群体应始终持怀疑态度，应避免使用确定性标签。虽然形态学检查充满风险，但良好的评估有助于明智地选择辅助方法，因此不能被替代。
