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Lymphoproliferative disorder involving body fluid: diagnostic approaches and roles of ancillary studies

전윤경|이지애|신선아|고지원
대한병리학회|2022.07|Journal of Pathology and Translational Medicine|제56권 제4호|pp. 173-186|DOI 10.4132/jptm.2022.05.16

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키워드

Polymerase chain reactionImmunocytochemistryNext-generation sequencingCytologyBody fluidLymphoproliferative disorderMalignant lymphoma
주제분류병리학

초록

Lymphocyte-rich effusions represent benign reactive process or neoplastic condition. Involvement of lymphoproliferative disease in body cavity is not uncommon, and it often causes diagnostic challenge. In this review, we suggest a practical diagnostic approach toward lymphocyte-rich effusions, share representative cases, and discuss the utility of ancillary tests. Cytomorphologic features favoring neoplastic condition include high cellularity, cellular atypia/pleomorphism, monomorphic cell population, and frequent apoptosis, whereas lack of atypia, polymorphic cell population, and predominance of small T cells usually represent benign reactive process. Involvement of non-hematolymphoid malignant cells in body fluid should be ruled out first, followed by categorization of the samples into either small/medium-sized cell dominant or large-sized cell dominant fluid. Small/medium-sized cell dominant effusions require ancillary tests when either cellular atypia or history/clinical suspicion of lymphoproliferative disease is present. Large-sized cell dominant effusions usually suggest neoplastic condition, however, in the settings of initial presentation or low overall cellularity, ancillary studies are helpful for more clarification. Ancillary tests including immunocytochemistry, in situ hybridization, clonality test, and next-generation sequencing can be performed using cytologic preparations. Throughout the diagnostic process, proper review of clinical history, cytomorphologic examination, and application of adequate ancillary tests are key elements for successful diagnosis.

Abstract

Lymphocyte-rich effusions represent benign reactive process or neoplastic condition. Involvement of lymphoproliferative disease in body cavity is not uncommon, and it often causes diagnostic challenge. In this review, we suggest a practical diagnostic approach toward lymphocyte-rich effusions, share representative cases, and discuss the utility of ancillary tests. Cytomorphologic features favoring neoplastic condition include high cellularity, cellular atypia/pleomorphism, monomorphic cell population, and frequent apoptosis, whereas lack of atypia, polymorphic cell population, and predominance of small T cells usually represent benign reactive process. Involvement of non-hematolymphoid malignant cells in body fluid should be ruled out first, followed by categorization of the samples into either small/medium-sized cell dominant or large-sized cell dominant fluid. Small/medium-sized cell dominant effusions require ancillary tests when either cellular atypia or history/clinical suspicion of lymphoproliferative disease is present. Large-sized cell dominant effusions usually suggest neoplastic condition, however, in the settings of initial presentation or low overall cellularity, ancillary studies are helpful for more clarification. Ancillary tests including immunocytochemistry, in situ hybridization, clonality test, and next-generation sequencing can be performed using cytologic preparations. Throughout the diagnostic process, proper review of clinical history, cytomorphologic examination, and application of adequate ancillary tests are key elements for successful diagnosis.

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관련 논문AI추천

Molecular Testing of Lymphoproliferative Disorders: Current Status and Perspectives고영혜, 김영아, 김지은, 김현정, 백진호, 신봉경, 윤선옥, 전윤경, 차희정, 허주령대한병리학회 · Journal of Pathology and Translational Medicine2017 · 제51권 제3호Fine-Needle Aspiration Cytology of the Nodal Marginal Zone Lymphoma고영혜, 권지은, 최승규대한병리학회 · Journal of Pathology and Translational Medicine2011 · 제45권 제4호A stepwise approach to fine needle aspiration cytology of lymph nodes강창석, 김현정, 박경신, 이승숙, 정요셉, 차희정, Jamshid Abdul-Ghafar대한병리학회 · Journal of Pathology and Translational Medicine2023 · 제57권 제4호Bone Marrow Flow Cytometry in Staging of Patients With B-cell Non-Hodgkin Lymphoma김보람, 김선희, 김희진, 이승태대한진단검사의학회 · Annals of Laboratory Medicine2015 · 제35권 제2호체액 세포검사에서 고식적 세포도말검사와 CellprepPlus􀋓 액상세포검사의 세포학적 평가 비교구지혜, 송형근, 이기만, 이기형, 이옥준, 이호창, 최강현, 한혜숙대한병리학회 · Journal of Pathology and Translational Medicine2009 · 제43권 제5호Current Concepts in Primary Effusion Lymphoma and Other Effusion-Based Lymphomas노진, 김윤정, 박찬정, 허주령대한병리학회 · Journal of Pathology and Translational Medicine2014 · 제48권 제2호

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