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Wauye VM, Njiru E, Amadi AK, Hagembe MN, Kigen G. Chronic myelomonocytic leukemia primarily presenting as life-threatening pericardial effusion, Eldoret, Kenya: A case report. Clin Case Rep 2024; 12:e9048. [PMID: 38855083 PMCID: PMC11157417 DOI: 10.1002/ccr3.9048] [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: 01/20/2024] [Revised: 05/11/2024] [Accepted: 05/25/2024] [Indexed: 06/11/2024] Open
Abstract
Key Clinical Message Chronic myelomonocytic leukemia, a rare case of hematological malignancy mainly affects the elderly and may present with life threatening pericardial effusion as an initial manifestation. High index of suspicion is hence key for early management. Abstract We present a case of an 81-year-old African male who presented with progressive cough, respiratory distress and bilateral lower limb swelling, and was diagnosed with life-threatening pericardial effusion resulting from chronic myelomonocytic leukemia following complete blood count, peripheral blood film, bone marrow aspirate with trephine biopsy, and flow cytometry studies.
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Affiliation(s)
- Victor M. Wauye
- Department of Internal Medicine, School of MedicineCollege of Health Sciences, Moi UniversityEldoretKenya
| | - Evangeline Njiru
- Department of Internal Medicine, School of MedicineCollege of Health Sciences, Moi UniversityEldoretKenya
| | - Angela K. Amadi
- Department of Internal Medicine, School of MedicineCollege of Health Sciences, Moi UniversityEldoretKenya
| | - Mildred N. Hagembe
- Department of Internal MedicineMoi Teaching and Referral HospitalEldoretKenya
| | - Gabriel Kigen
- Department of Pharmacology and Toxicology, School of MedicineCollege of Health Sciences, Moi UniversityEldoretKenya
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Zhang Y, Li K, Li X, Wang H, Li T, Long F. Concurrent Pleural and Pericardial Involvement in a Patient With De Novo Pure Erythroid Leukemia. Ann Lab Med 2024; 44:179-182. [PMID: 37840313 PMCID: PMC10628751 DOI: 10.3343/alm.2023.0252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/12/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Affiliation(s)
- Yun Zhang
- Department of Clinical Laboratory, The District People’s Hospital of Zhangqiu, Jinan, Shandong, China
| | - Kechao Li
- Department of Clinical Laboratory, The District People’s Hospital of Zhangqiu, Jinan, Shandong, China
| | - Xue Li
- Department of Health Ward, The District People’s Hospital of Zhangqiu, Jinan, Shandong, China
| | - Hui Wang
- Department of Laboratory Medicine, Hebei Yanda Ludaopei Hospital, Langfang, China
| | - Ting Li
- Department of Laboratory Medicine, Beijing Ludaopei Hospital, Beijing, China
| | - Fang Long
- Department of Clinical Laboratory, Sichuan Provincial Maternity and Child Health Care Hospital, The Affiliated Women’s and Children’s Hospital of Chengdu Medical College, Chengdu, Sichuan, China
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AbdullGaffar B, Farhan R, Dutta P. Acute monoblastic myeloid leukemic pleural effusion: Pitfalls and clues. Diagn Cytopathol 2023; 51:E59-E64. [PMID: 36308418 DOI: 10.1002/dc.25068] [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: 06/23/2022] [Revised: 10/02/2022] [Accepted: 10/19/2022] [Indexed: 01/04/2023]
Abstract
Acute myeloid leukemic pleural effusions are uncommon with heterogenous cytomorphology and variable immunoprofiles. This imposes a difficult cytologic diagnosis. In particular, acute myeloid leukemia of monocyte lineage mimicking benign and malignant lymphoid and non-lymphoid lesions is challenging. Few cases of acute myeloid monocyte-lineage leukemia have been reported. Our aim is to report a case of a 54-year-old female patient who presented with pancytopenia and bilateral pleural effusions. We highlight the characteristic cytomorphologic features, diagnostic pitfalls and helpful hints of acute monoblastic leukemia. Initially, the cells were misinterpreted as chronic inflammatory histiocytic infiltrates with reactive mesothelial cells. The presence of frequent mitotic figures, apoptotic bodies and a two-cell population raised the possibility of neoplastic cells. The cellular infiltrate simulated lymphoma, carcinoma and melanoma tumor cells. Cellblock immunocytochemistry however showed negative B-cell, T-cell, myeloid, Langerhans cell, plasma cell and dendritic cell lineage markers. They were positive for LCA, CD68, CD4 and CD117 with a high Ki67 index. The cytologically suggested impression of acute myeloid leukemia of monocyte origin favoring monoblastic variant was confirmed by flow cytometry and bone marrow trephine biopsy. Cytomorphologic clues included agranular amphophilic cytoplasm, occasional grooved indented nuclei, tingible body macrophages, associated plasma cells and absent granulocytes. The cytologic and cellblock findings matched the bone marrow trephine biopsy features. Cytopathologists should be aware of this unusual and challenging cytologic diagnosis in patients with pancytopenia and utilize at least two monocyte markers when formulating their differential diagnosis. Certain cytomorphologic features are helpful hints for their correct recognition.
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Affiliation(s)
| | - Rabiah Farhan
- Cytology Unit, Dubai Hospital, Dubai, United Arab Emirates
| | - Pankhi Dutta
- Hematology Unit, Dubai Hospital, Dubai, United Arab Emirates
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Frankel D, Kaspi E, Grosdidier C, Arpin M, Costello R, Roll P. Enigma portal: Peritoneal effusion in a patient with a myeloproliferative neoplasm. Cytopathology 2023; 34:84-86. [PMID: 36226841 PMCID: PMC10099779 DOI: 10.1111/cyt.13186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/28/2022] [Accepted: 10/08/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Diane Frankel
- INSERM, MMG, APHM, Hôpital la Timone, Service de Biologie Cellulaire, Aix-Marseille University, Marseille, France
| | - Elise Kaspi
- INSERM, MMG, APHM, Hôpital la Timone, Service de Biologie Cellulaire, Aix-Marseille University, Marseille, France
| | | | - Maud Arpin
- Laboratoire d''Hématologie, APHM, Hôpital la Timone, Marseille, France
| | - Regis Costello
- Service d'Hématologie et Thérapie Cellulaire, APHM, Hôpital La Conception, Marseille, France
| | - Patrice Roll
- INSERM, MMG, APHM, Hôpital la Timone, Service de Biologie Cellulaire, Aix-Marseille University, Marseille, France
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Koh J, Shin SA, Lee JA, Jeon YK. Lymphoproliferative disorder involving body fluid: diagnostic approaches and roles of ancillary studies. J Pathol Transl Med 2022; 56:173-186. [PMID: 35843627 PMCID: PMC9288893 DOI: 10.4132/jptm.2022.05.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/16/2022] [Indexed: 11/17/2022] Open
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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Affiliation(s)
- Jiwon Koh
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sun Ah Shin
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Pathology, National Cancer Center, Goyang, Korea
| | - Ji Ae Lee
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Kyung Jeon
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University, Seoul, Korea
- Corresponding Author: Yoon Kyung Jeon, MD, PhD, Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-740-8323, Fax: +82-2-743-5530, E-mail:
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