1
|
Pereira LJ, Mohrbacher S, Neves PDMDM, Zacchi FFS, Medeiros IUD, Sato VAH, Oliveira ÉS, Pereira LVB, Cuvello-Neto AL, Baiocchi O, Chocair PR. Primary Effusion Lymphoma: A Rare and Challenging Diagnosis for Recurrent Pleural Effusion. Diagnostics (Basel) 2023; 13:diagnostics13030370. [PMID: 36766474 PMCID: PMC9914331 DOI: 10.3390/diagnostics13030370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/11/2023] [Accepted: 01/14/2023] [Indexed: 01/21/2023] Open
Abstract
Primary Effusion Lymphoma is an extremely rare and aggressive subtype of B-cell lymphoma, accounting for only <1% of all cases of this neoplasm. It has a unique clinical presentation because it has a predilection for appearing in body cavities, such as the pleural space, pericardium and peritoneum. It mainly affects immunocompromised individuals and may also affect individuals in the Mediterranean region and in areas endemic for human herpesvirus 8 (HHV-8). Herein, we report the case of an 83-year-old immunocompetent male complaining of coughing, fever and progressive dyspnea for 3 days. His past medical history revealed a recurrent pleural effusion for the last three years, as well as losing weight and malaise. A subsequent investigation revealed a PEL diagnosis of the pleura.
Collapse
Affiliation(s)
| | - Sara Mohrbacher
- Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo 01323-020, Brazil
| | | | | | | | | | - Érico Souza Oliveira
- Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo 01323-020, Brazil
| | | | | | - Otávio Baiocchi
- Oncology Center, Oswaldo Cruz German Hospital, São Paulo 01323-020, Brazil
| | - Pedro Renato Chocair
- Internal Medicine Service, Oswaldo Cruz German Hospital, São Paulo 01323-020, Brazil
| |
Collapse
|
2
|
Zheng JL, Zhou YJ, Yan H. A case report-application of pericardial effusion cytology and next-generation sequencing technology: quick and secure diagnosis of primary effusion lymphoma. Eur Heart J Case Rep 2022; 6:ytac239. [PMID: 35821972 PMCID: PMC9269675 DOI: 10.1093/ehjcr/ytac239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/19/2022] [Accepted: 06/11/2022] [Indexed: 11/14/2022]
Abstract
Background Primary effusion lymphoma (PEL) is an uncommon subtype of non-Hodgkin lymphoma (NHL) that usually involves the pleura, pericardium, and peritoneum without an obvious tumour mass, with multiple plasma effusions as its main clinical feature. We report a case of a massive pericardial effusion in an elderly male with a final diagnosis of PEL. Case summary A 70-year-old male patient was admitted to hospital with symptoms of chest tightness, shortness of breath, fatigue, loss of appetite, and cough with phlegm after a pericardial effusion had been found for 5 months. The next-generation sequencing of pericardial effusion found human herpesvirus type 8 (HHV-8) infection, and further cytomorphological and immunohistochemical examination were done. According to the patient's HHV-8 infection, the pathological features of heterogeneous B cells with plasmablastic differentiation and the immunohistochemical characteristics of PEL, the final diagnosis was made as human immunodeficiency virus-negative PEL. Discussion The diversity and non-specificity of PEL symptoms, as well as its rarity, make it difficult to diagnose. In this case, we used the next-generation sequencing technology to screen the pathogen of the patient's pericardial effusion and carried out morphological and immunohistochemical examination of the cells in the pericardial effusion, which provided a clinically operable diagnosis for an uncommon disease, enabling us to make a clear diagnosis faster and start treatment in time.
Collapse
Affiliation(s)
- Jin Lei Zheng
- Master of Medicine, Zhejiang University School of Medicine, Zhejiang, China
| | - Yi Jiang Zhou
- Doctor of Medicine, Department of Cardiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Hui Yan
- Doctor of Medicine, Department of Cardiology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| |
Collapse
|
3
|
Liu CY, Chen BJ, Chuang SS. Primary Effusion Lymphoma: A Timely Review on the Association with HIV, HHV8, and EBV. Diagnostics (Basel) 2022; 12:diagnostics12030713. [PMID: 35328266 PMCID: PMC8947353 DOI: 10.3390/diagnostics12030713] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/10/2022] [Accepted: 03/12/2022] [Indexed: 12/14/2022] Open
Abstract
Primary effusion lymphoma (PEL) is defined by the WHO classification as a large B-cell neoplasm without detectable tumor masses. It is universally associated with HHV8, with most cases occurring in the setting of immunodeficiency such as HIV infection, and a poor prognosis. Morphologically, the neoplastic cells range from immunoblastic, plasmablastic, to anaplastic; and phenotypically, most cases express plasma cell but not B-cell markers, i.e., plasmablastic. During the past decade, primary HHV8-negative effusion lymphoma has been reported. Such cases were considered in the WHO classification scheme as effusion-based lymphoma. We performed a systemic review of 167 HHV8-negative effusion lymphomas from the literature and found that only 42% were associated with a fluid overload state, and with low rates of HIV (6%) or EBV (21%) infection. Furthermore, most patients are old (or immunosenescent) with underlying medical conditions/comorbidities, most neoplasms are of B-cell phenotype, and the outcome is more favorable than that of HHV8-positive PEL. These distinctive findings supported our prior proposal of designating these HHV8-negative cases as type II PEL, in contrast to the classic or type I PEL as defined by the WHO. Furthermore, we propose an algorithmic approach for the diagnosis of PEL and its mimickers.
Collapse
Affiliation(s)
- Chih-Yi Liu
- Division of Pathology, Sijhih Cathay General Hospital, New Taipei City 221, Taiwan;
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 221, Taiwan
| | - Bo-Jung Chen
- Department of Pathology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 221, Taiwan;
- Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Shih-Sung Chuang
- Department of Pathology, Chi-Mei Medical Center, Tainan 710, Taiwan
- Correspondence: ; Tel.: +886-6-2812811 (ext. 53686)
| |
Collapse
|
4
|
Malik P, Khader SN, Asiry S. A rare case of primary effusion lymphoma in HIV negative patient: Diagnostic challenges and literature review. Diagn Cytopathol 2021; 49:785-789. [PMID: 33856127 DOI: 10.1002/dc.24752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 02/04/2021] [Accepted: 04/08/2021] [Indexed: 11/10/2022]
Abstract
We present a rare case of primary effusion lymphoma (PEL) in a 75 year old, HIV-negative male patient with multiple comorbidities. Imaging studies revealed a massive right pleural effusion and a significant lung collapse with multiple plural soft tissue nodules. Immediate thoracentesis was performed. Cytologic evaluation of the pleural fluid showed abnormally large cell with increased nuclear to cytoplasmic ratio, irregular nuclear contours and prominent nucleoli, with phenotypic expression of HHV-8, CD138, CD30, and MUM1 markers and negative staining for epithelial and mesothelial markers. PEL is a rare and aggressive large B-cell lymphoma often affecting immunocompromised adults and is mostly associated with human herpes virus 8/Kaposi sarcoma-associated herpes virus (HHV-8/KSHV). However, cases in immunocompetent elderly patients have been reported. The cytomorphologic features of PEL overlaps with those of aggressive lymphomas such as diffuse large B-cell lymphoma, plasmablastic lymphoma, and anaplastic large-cell lymphoma. Also, mesothelioma, metastatic carcinoma or melanoma should be considered in the differential diagnosis. Hence, PEL should be kept in mind in the diagnostic algorithm of cytological evaluation of serosal fluid not only in HIV positive patients but also HIV-negative elderly patients. In this report, we aim to highlight the cytologic and immunohistochemical staining pattern of this rare entity to increase awareness of this entity among cytopathologists.
Collapse
Affiliation(s)
- Preeti Malik
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Montefiore Hospital and Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| | - Samer N Khader
- Division of Cytopathology, University of Pittsburgh Medical Center (UPMC), Pittsburgh, Pennsylvania, USA
| | - Saeed Asiry
- Department of Pathology, Montefiore Hospital and Medical Center/Albert Einstein College of Medicine, New York, New York, USA
| |
Collapse
|
5
|
Song YF, Liu H, Bai JF, Ke HX, Li JT, Wang T, Yang YZ, Yin JJ, Feng R. [Primary effusion lymphoma in a HIV-negative patient: case report and literatures review]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2021; 41:685-688. [PMID: 32942826 PMCID: PMC7525169 DOI: 10.3760/cma.j.issn.0253-2727.2020.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Y F Song
- Department of Hematology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - H Liu
- Department of Hematology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - J F Bai
- Department of Hematology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - H X Ke
- Department of Respiratory and Critical Care Medicine, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - J T Li
- Department of Hematology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - T Wang
- Department of Hematology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Y Z Yang
- Department of Hematology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - J J Yin
- Department of Hematology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - R Feng
- Department of Hematology, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China
| |
Collapse
|