Cytomorphology, clinicopathologic, and cytogenetics correlation of myelomatous effusion of serous cavities: A retrospective review

Anaplastic Plasma Cell Myeloma With Peritoneal Involvement

Multiple myeloma (MM) is a B-cell neoplasm that rounds 15% of all hematological malignancies. The typical clinical presentation of MM includes hypercalcemia, renal failure, anemia and bone lesion (CRAB). Effusions due to MM may occur due to secondary involvement of other organs and rarely are present at the initial diagnosis. Anaplastic myeloma (AMM) is rare morphological variant of multiple myeloma with predisposition of extramedullary affection. Herein, we describe a case of malignant plasmacytic ascites at disease onset of anaplastic multiple myeloma.

Identification of evolutionary mechanisms of myelomatous effusion by single-cell RNA sequencing

Myelomatous effusion (ME) is a rare manifestation of extramedullary multiple myeloma (MM) with limited therapeutic options and poor outcomes. The molecular mechanisms underlying ME are incompletely understood. We profiled transcriptomes of bone marrow, peripheral blood (PB), and pleural effusion/ascites from 3 patients with ME using single-cell RNA sequencing analysis. We found that ME contained a higher percentage of cytotoxic T cells, whereas PB contained a higher proportion of naive T cells. Malignant cells varied within and between sites and patients in their expression of signatures. We identified a gene module highly expressed in intramedullary and extramedullary plasma cell clusters and defined cell clusters expressing this gene set as extramedullary-initiating cells (EMICs). This gene set was associated with increased cellular proliferation, involved in p53 signaling, and related to poor prognosis in MM. The transcriptional regulators E2F1, YY1, and SMAD1 were activated in EMICs. Leukocyte immunoglobulin-like receptor subfamily B4 (LILRB4) was upregulated in extramedullary EMICs. We confirmed that LILRB4 promoted MM cell migration in vitro. This study provided insight into the evolutionary mechanisms of ME and defined EMICs and LILRB4 associated with extramedullary development.

Deep Learning-Based Classification and Targeted Gene Alteration Prediction from Pleural Effusion Cell Block Whole-Slide Images

Cytopathological examination is one of the main examinations for pleural effusion, and especially for many patients with advanced cancer, pleural effusion is the only accessible specimen for establishing a pathological diagnosis. The lack of cytopathologists and the high cost of gene detection present opportunities for the application of deep learning. In this retrospective analysis, data representing 1321 consecutive cases of pleural effusion were collected. We trained and evaluated our deep learning model based on several tasks, including the diagnosis of benign and malignant pleural effusion, the identification of the primary location of common metastatic cancer from pleural effusion, and the prediction of genetic alterations associated with targeted therapy. We achieved good results in identifying benign and malignant pleural effusions (0.932 AUC (area under the ROC curve)) and the primary location of common metastatic cancer (0.910 AUC). In addition, we analyzed ten genes related to targeted therapy in specimens and used them to train the model regarding four alteration statuses, which also yielded reasonable results (0.869 AUC for ALK fusion, 0.804 AUC for KRAS mutation, 0.644 AUC for EGFR mutation and 0.774 AUC for NONE alteration). Our research shows the feasibility and benefits of deep learning to assist in cytopathological diagnosis in clinical settings.

Clone Selection Artificial Intelligence Algorithm-Based Positron Emission Tomography-Computed Tomography Image Information Data Analysis for the Qualitative Diagnosis of Serous Cavity Effusion in Patients with Malignant Tumors

This study aimed to investigate the application of positron emission tomography- (PET-) computed tomography (CT) image information data combined with serous cavity effusion based on clone selection artificial intelligence algorithm in the diagnosis of patients with malignant tumors. A total of 97 patients with PET-CT scanning and empirically confirmed as serous cavity effusion were retrospectively analyzed in this study. The clone selection artificial intelligence algorithm was applied to register the PET-CT images, and the patients were rolled into a benign effusion group and a malignant effusion group according to the benign and malignant conditions of the serous cavity effusion. Besides, the causes of patients from the two groups were analyzed, and there was a comparison of their physiological conditions. Subsequently, CT values of different KeV, lipid/water, water/iodine, and water/calcium concentrations were measured, and the differences of the above quantitative parameters between benign and malignant serous cavity effusion were compared, as well as the registration results of the clone algorithm. The results showed that the registration time and misalignment times of clonal selection algorithm (13.88, 0) were lower than those of genetic algorithm (18.72, 8). There were marked differences in CT values of 40-60 keV and 130-140 keV between the two groups. The concentrations of lipid/water, water/iodine, and water/calcium in basal substances of the malignant effusion group were obviously higher than the concentrations of the benign effusion group (P < 0.05). Benign and malignant effusions presented different manifestations in PET-CT, which was conducive to the further diagnosis of malignant tumors. Based on clone selection artificial intelligence algorithm, PET-CT could provide a new multiparameter method for the identification of benign and malignant serous cavity effusions and benign and malignant tumors.

Cytologic and flowcytometric findings in a case of myelomatous pleural effusion: A rare and ominous presentation of multiple myeloma

Plasma cell myeloma is a hematologic malignancy characterized by multifocal clonal proliferation of plasma cells usually associated with M protein secretion in serum and/or urine and evidence of organ damage. Generally, the presenting features are related to anemia, bone lesions, and renal failure. Pleural effusion is rare in multiple myeloma and when present is often due to nonmalignant causes. Myelomatous pleural effusion that is, effusions directly due to pleural infiltration by plasma cells is even rarer. We present a case of a patient presenting with dyspnea due to myelomatous pleural effusion. The fluid in such a case may be subjected to cytology examination, protein electrophoresis, flowcytometric analysis, and cytogenetics. The case highlights the utility of cytomorphology and flowcytometry in the diagnosis of myelomatous pleural effusion and also highlights that this type of presentation portends a poor prognosis to the patient.

Pomalidomide and dexamethasone in myelomatous pleural effusion

Myelomatous pleural effusion (MPE) is an uncommon clinical entity and occurs in less than 1% of all patients with multiple myeloma. MPE indicates a progression of disease, therefore is associated with a poor prognosis and estimated median survival of <3 months. Treatment of MPE is challenging, and the data regarding the role of novel agents lack in the literature. Herein, we report a relapsed IgA myeloma case of a patient presenting with MPE, who was treated with pomalidomide with a very good partial response.

Clinical and laboratory characteristics of lymphoid neoplasms in serous effusions: a single centre experience in China

BACKGROUND

Lymphoid neoplasms in serous effusions are uncommon, and the details of lymphoid neoplasms in serous effusions from China are still unclear.

METHODS

Between January 2004 and December 2019, all patients with lymphoid neoplasms in pleural effusions, ascites, and pericardial effusions in our hospital, were reviewed.

RESULTS

A total of 65 patients with lymphoid neoplasms were collected during this period. The top three neoplasms were diffuse large B-cell lymphoma (DLBCL) (n = 20, 30.7%), myeloma (n = 13, 20.0%), and T-lymphoblastic lymphoma (n = 7, 10.8%). In pleural effusions involving DLBCL, the cytomorphology of DLBCL cells was diverse; most pleural effusions were present during the tumor course (92.9%); bilateral pleural effusions were predominant (57.2%); and the median survival time was only 1.23 months after the effusion. In pleural effusions involving myeloma, 90.9% of cases (10/11) had a high ratio (> 1.0) of immature to mature plasma cells; paraprotein types of IgA (36.4%) and light chain λ (36.4%) were the most frequently found; bilateral pleural effusions were easily found (n = 10, 90.9%); and the median survival time was only 1.4 months after the effusion.

CONCLUSION

In pleural effusions involving DLBCL, most of our patients with effusions are present during the tumor course, and bilateral pleural effusions are predominant. In pleural effusions involving myeloma, the paraprotein types of IgA and light chain λ are the most frequently found, and it has a high ratio of immature to mature plasma cells in pleural effusions.

Diagnosis and categorization of malignant effusions: A 6-year review from a single academic institution

BACKGROUND

Cytologic detection of malignant cells in pleural, peritoneal, or pericardial effusion most likely indicates advanced stage of malignant disease. There are a few studies updating the categorization of malignant effusions.

METHODS

The electronic pathology database was searched to identify consecutive cases of malignant effusion during a 6-year period. Patient age and gender, origins of known malignancy, and cytologic diagnoses were recorded and summarized.

RESULTS

A total of 1059 specimens included 561 (53%) pleural, 441 (41.6%) peritoneal, and 57 (5.4%) pericardial fluids. Most of the pleural (516, 92.0%), peritoneal (418, 94.8%), and pericardial (53, 93.0%) specimens were derived from patients with a single known malignancy. More common origins involving pleural fluid were lung (152, 27.1%) followed by breast (103, 18.4%) and gastrointestinal tract (76, 13.5%). The most common etiology for women and men was breast (102, 30.8%) and lung (67, 36.2%), respectively. More common origins involving peritoneal fluid were gastrointestinal (158, 35.8%) and gynecologic (156, 35.4%) tracts, and breast (46, 10.4%). The most common etiology for women and men was Mullerian (156, 55.5%) and gastrointestinal tract (94, 68.6%), respectively. Most common origins involving the pericardial fluid were breast (20, 37.7%) and lung (17, 29.8%). Breast and lung were the most common etiology for women (20, 57.1%) and men (8, 44.4%), respectively.

CONCLUSIONS

Breast and lung remain to be the most common origin of both malignant pleural and pericardial effusion for women and men, respectively. The most common origin involving peritoneal effusion is Mullerian for women and gastrointestinal tract for men.

Pleural effusion as first extra-medullary clinical presentation of an occult multiple myeloma: The role of medical thoracoscopy

Multiple myeloma is a malignant neoplasm of plasma cells that usually invades the bone marrow replacing normal bone marrow and producing large amounts of light chains of immunoglobulins (Ig) [1]. Clinical manifestations are related to the accumulation of these proteins in vital organs such as kidney and heart. Pleural effusion may be a sign of chest involvement that occurs in approximately 6% of patients with Known multiple myeloma [2,3]. We present the case of an 80-year- old man with pleural effusion as first extra-medullary clinical presentation of an occult multiple myeloma.

Cytology and clinical features of myelomatous pleural effusion: Three case reports and a review of the literature

The purpose of this study was to report the clinical features, laboratory findings, and cytomorphology, and prognosis of three patients with myelomatous pleural effusion (MPE). The literature pertaining to MPE was reviewed. The three cases and literature review suggest that MPE is rare and often associated with a poor prognosis. The correct diagnosis depends on the aggressive clinical characteristics, laboratory findings, and chromosomal abnormalities, but routine pathological examination of the pleural effusion has low sensitivity. Cell blocks stained with hematoxylin & eosin and by immunohistochemistry revealed that abnormal proliferation of plasma cells and light chain restrictive expression in MPE may be helpful for improving the detection rate of MPE.