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Koo CW, Frota Lima LM, Kerper A, Lo YC. Anatomic Approach to Common and Uncommon Manifestations of Thoracic Leukemias with Radiologic-Pathologic Correlation. Radiol Cardiothorac Imaging 2023; 5:e230151. [PMID: 38166347 PMCID: PMC11163245 DOI: 10.1148/ryct.230151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/29/2023] [Accepted: 11/27/2023] [Indexed: 01/04/2024]
Abstract
Leukemias are hematopoietic malignancies characterized by the production of abnormal leukocytes in the bone marrow. Clinical manifestations arise from either bone marrow suppression or leukemic organ infiltration. Lymphadenopathy is the most common direct manifestation of intrathoracic leukemia. However, leukemic cells may also infiltrate the lungs, pleura, heart, bones, and soft tissues. Pulmonary complications in patients with leukemia typically include pneumonia, hemorrhage, pulmonary edema, and sequelae of leukemia treatment. However, pulmonary abnormalities can also be related directly to leukemia, including leukemic pulmonary infiltration. The direct, non-treatment-related effects of leukemia on intrathoracic structures will be the focus of this imaging essay. Given the typical anatomic approach for image interpretation, an organ-based depiction of common and less common intrathoracic findings directly caused by leukemic involvement is presented, emphasizing imaging findings with pathologic correlations. Keywords: Leukemia, Pulmonary, Thorax, Soft Tissues/Skin, Hematologic, Bone Marrow © RSNA, 2023.
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Affiliation(s)
- Chi Wan Koo
- From the Department of Radiology (C.W.K., L.M.F.L.) and Department of
Laboratory Medicine and Pathology (A.K., Y.C.L.), Mayo Clinic, 200 First St SW,
Rochester, MN 55905
| | - Livia Maria Frota Lima
- From the Department of Radiology (C.W.K., L.M.F.L.) and Department of
Laboratory Medicine and Pathology (A.K., Y.C.L.), Mayo Clinic, 200 First St SW,
Rochester, MN 55905
| | - Allison Kerper
- From the Department of Radiology (C.W.K., L.M.F.L.) and Department of
Laboratory Medicine and Pathology (A.K., Y.C.L.), Mayo Clinic, 200 First St SW,
Rochester, MN 55905
| | - Ying-Chun Lo
- From the Department of Radiology (C.W.K., L.M.F.L.) and Department of
Laboratory Medicine and Pathology (A.K., Y.C.L.), Mayo Clinic, 200 First St SW,
Rochester, MN 55905
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Gogia A, Sharma A, Gupta R. Pleural effusion as an unusual presentation of chronic lymphocytic leukemia. CANCER RESEARCH, STATISTICS, AND TREATMENT 2022. [DOI: 10.4103/crst.crst_74_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kaur K, Patel T, Patra S, Trivedi P. Cytomorphology, Immunophenotype, and cytogenetic profile of leukemic serous effusions. Diagn Cytopathol 2021; 49:948-958. [PMID: 33973738 DOI: 10.1002/dc.24772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 02/09/2021] [Accepted: 05/03/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Serous effusions (SE) in leukemic patients can be due to infections, therapy, volume overload, lymphatic obstruction or malignancy having implications on treatment and mortality. The objective of the present study is to highlight the spectrum of cytomorphology, immunophenotype, and cytogenetics in leukemic serous effusions (LSE). MATERIALS Present study is retrospective and descriptive. We reviewed all the SE, which were reported as suspicious or positive of leukemic infiltration from 2016 to 2019 for cytomorphological features. CSF and effusions involved by lymphomas were excluded. Cyto-diagnosis was compared with primary proven diagnosis (by ancillary techniques) and disconcordant cases were analyzed. RESULTS Out of total 9723 effusions, only 0.4% (n = 40) showed leukemic involvement and included nine cases of AML, three of B-ALL, 13 T-ALL, 2 MPAL, 6 CML, 5CLL, one each of chronic myelomonocytic leukemia and AML with myelodysplasia. The most common site of involvement was the pleural cavity (n = 30), followed by the peritoneal cavity (n = 7) and the pericardial cavity (n = 3). T -ALL (41.9%) was the most common leukemia involving pleural fluid followed by AML (23.3%). CML (42.8%) was the most common leukemia involving the ascitic fluid followed by B-ALL (28.6%). Accurate diagnosis was given on cytomorphology in 72.5% (29/40) cases and 15.0% (6/40) were reported as non-Hodgkin lymphoma. CONCLUSION Cytology is an effective tool available to make a diagnosis of LSE. Nuclear indentations in large atypical cells and cells with eosinophilic granular cytoplasm with sparse or abundant eosinophils in the background are an important clue in favor of leukemia over lymphoma.
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Affiliation(s)
- Kanwalpreet Kaur
- Department of Oncopathology, Gujarat Cancer and Research Institute, Ahmedabad, India
| | - Trupti Patel
- Pathology, PDCC Oncopathology, Associate Professor, Department of Oncopathology, Gujarat Cancer and Research Institute, Ahmedabad, India
| | - Sanjiban Patra
- Department of Oncopathology, Gujarat Cancer and Research Institute, Ahmedabad, India
| | - Priti Trivedi
- Head of Department, Department of Oncopathology, Gujarat Cancer and Research Institute, Ahmedabad, India
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Shroff GS, Truong MT, Carter BW, Benveniste MF, Kanagal-Shamanna R, Rauch G, Viswanathan C, Boddu PC, Daver N, Wu CC. Leukemic Involvement in the Thorax. Radiographics 2020; 39:44-61. [PMID: 30620703 DOI: 10.1148/rg.2019180069] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Leukemias are malignancies in which abnormal white blood cells are produced in the bone marrow, resulting in compromise of normal bone marrow hematopoiesis and subsequent cytopenias. Leukemias are classified as myeloid or lymphoid depending on the type of abnormal cells produced and as acute or chronic according to cellular maturity. The four major types of leukemia are acute myeloid leukemia, chronic myeloid leukemia, acute lymphoblastic leukemia, and chronic lymphocytic leukemia. Clinical manifestations are due to either bone marrow suppression (anemia, thrombocytopenia, or neutropenia) or leukemic organ infiltration. Imaging manifestations of leukemia in the thorax are myriad. While lymphadenopathy is the most common manifestation of intrathoracic leukemia, leukemia may also involve the lungs, pleura, heart, and bones and soft tissues. Myeloid sarcomas occur in 5%-7% of patients with acute myeloid leukemia and represent masses of myeloid blast cells in an extramedullary location. ©RSNA, 2019.
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Affiliation(s)
- Girish S Shroff
- From the Departments of Diagnostic Radiology (G.S.S., M.T.T., B.W.C., M.F.B., G.R., C.V., C.C.W.), Hematopathology (R.K.S.), and Leukemia (P.C.B., N.D.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Mylene T Truong
- From the Departments of Diagnostic Radiology (G.S.S., M.T.T., B.W.C., M.F.B., G.R., C.V., C.C.W.), Hematopathology (R.K.S.), and Leukemia (P.C.B., N.D.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Brett W Carter
- From the Departments of Diagnostic Radiology (G.S.S., M.T.T., B.W.C., M.F.B., G.R., C.V., C.C.W.), Hematopathology (R.K.S.), and Leukemia (P.C.B., N.D.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Marcelo F Benveniste
- From the Departments of Diagnostic Radiology (G.S.S., M.T.T., B.W.C., M.F.B., G.R., C.V., C.C.W.), Hematopathology (R.K.S.), and Leukemia (P.C.B., N.D.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Rashmi Kanagal-Shamanna
- From the Departments of Diagnostic Radiology (G.S.S., M.T.T., B.W.C., M.F.B., G.R., C.V., C.C.W.), Hematopathology (R.K.S.), and Leukemia (P.C.B., N.D.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Greg Rauch
- From the Departments of Diagnostic Radiology (G.S.S., M.T.T., B.W.C., M.F.B., G.R., C.V., C.C.W.), Hematopathology (R.K.S.), and Leukemia (P.C.B., N.D.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Chitra Viswanathan
- From the Departments of Diagnostic Radiology (G.S.S., M.T.T., B.W.C., M.F.B., G.R., C.V., C.C.W.), Hematopathology (R.K.S.), and Leukemia (P.C.B., N.D.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Prajwal C Boddu
- From the Departments of Diagnostic Radiology (G.S.S., M.T.T., B.W.C., M.F.B., G.R., C.V., C.C.W.), Hematopathology (R.K.S.), and Leukemia (P.C.B., N.D.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Naval Daver
- From the Departments of Diagnostic Radiology (G.S.S., M.T.T., B.W.C., M.F.B., G.R., C.V., C.C.W.), Hematopathology (R.K.S.), and Leukemia (P.C.B., N.D.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
| | - Carol C Wu
- From the Departments of Diagnostic Radiology (G.S.S., M.T.T., B.W.C., M.F.B., G.R., C.V., C.C.W.), Hematopathology (R.K.S.), and Leukemia (P.C.B., N.D.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030
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Cristo TG, Biezus G, Noronha LF, Gaspar T, Dal Pont TP, Withoeft JA, Furlan LV, Costa LS, Traverso SD, Casagrande RA. Feline Leukaemia Virus Associated with Leukaemia in Cats in Santa Catarina, Brazil. J Comp Pathol 2019; 170:10-21. [PMID: 31375152 DOI: 10.1016/j.jcpa.2019.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 04/29/2019] [Accepted: 05/07/2019] [Indexed: 02/06/2023]
Abstract
Leukaemia is a haemopoietic neoplasm originating from myeloid or lymphoid precursors in the bone marrow and may be either acute or chronic. These tumours are rare, but occur more frequently in cats because of an association with the feline leukaemia virus (FeLV) and feline immunodeficiency virus (FIV). To the best of our knowledge, no studies conducted in Brazil to date have analysed the association between leukaemia and FeLV and FIV infection in cats. The aim of this study was to perform a histopathological analysis of feline leukaemia and evaluate the association between leukaemia and FeLV and FIV infection in cats. The study evaluated 37 cats with leukaemia diagnosed between 2009 and 2017. The animals underwent necropsy examination, histopathology and immunohistochemistry with anti-FeLV gp70 and anti-FIV p24 gag antibodies. Of the evaluated animals, 54% (20/37) were males and 43.2% (16/37) were females. With respect to the life stage of the animals, 24.3% (9/37) were junior, 32.4% (12/37) were prime, 18.9% (7/37) were mature and 10.8% (4/37) were senior, and five animals were of unknown age. Myeloid leukaemia occurred in 56.8% (21/37) of the cases and lymphocytic leukaemia occurred in 43.2% (16/37) of the cases. Acute leukaemia (73%, 27/37) was more common than chronic leukaemia (27%, 10/37). The positivity for FeLV (78.4%, 29/37) and FIV (16.2%, 6/37) indicated a high association between FeLV infection and tumour development in the study region.
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Affiliation(s)
- T G Cristo
- Laboratory of Animal Pathology, Agroveterinary Sciences Center, University of Santa Catarina State, Av. Luís de Camões 2090, Conta Dinheiro, Lages, Santa Catarina, Brazil; Postgraduate Programme in Animal Science, University of Santa Catarina State, Av. Luís de Camões 2090, Conta Dinheiro, Lages, Santa Catarina, Brazil
| | - G Biezus
- Laboratory of Animal Pathology, Agroveterinary Sciences Center, University of Santa Catarina State, Av. Luís de Camões 2090, Conta Dinheiro, Lages, Santa Catarina, Brazil; Postgraduate Programme in Animal Science, University of Santa Catarina State, Av. Luís de Camões 2090, Conta Dinheiro, Lages, Santa Catarina, Brazil
| | - L F Noronha
- Laboratory of Animal Pathology, Agroveterinary Sciences Center, University of Santa Catarina State, Av. Luís de Camões 2090, Conta Dinheiro, Lages, Santa Catarina, Brazil; Veterinary Medicine, University of Santa Catarina State, Av. Luís de Camões 2090, Conta Dinheiro, Lages, Santa Catarina, Brazil
| | - T Gaspar
- Laboratory of Animal Pathology, Agroveterinary Sciences Center, University of Santa Catarina State, Av. Luís de Camões 2090, Conta Dinheiro, Lages, Santa Catarina, Brazil; Veterinary Medicine, University of Santa Catarina State, Av. Luís de Camões 2090, Conta Dinheiro, Lages, Santa Catarina, Brazil
| | - T P Dal Pont
- Laboratory of Animal Pathology, Agroveterinary Sciences Center, University of Santa Catarina State, Av. Luís de Camões 2090, Conta Dinheiro, Lages, Santa Catarina, Brazil; Veterinary Medicine, University of Santa Catarina State, Av. Luís de Camões 2090, Conta Dinheiro, Lages, Santa Catarina, Brazil
| | - J A Withoeft
- Laboratory of Animal Pathology, Agroveterinary Sciences Center, University of Santa Catarina State, Av. Luís de Camões 2090, Conta Dinheiro, Lages, Santa Catarina, Brazil; Veterinary Medicine, University of Santa Catarina State, Av. Luís de Camões 2090, Conta Dinheiro, Lages, Santa Catarina, Brazil
| | - L V Furlan
- Laboratory of Animal Pathology, Agroveterinary Sciences Center, University of Santa Catarina State, Av. Luís de Camões 2090, Conta Dinheiro, Lages, Santa Catarina, Brazil; Veterinary Medicine, University of Santa Catarina State, Av. Luís de Camões 2090, Conta Dinheiro, Lages, Santa Catarina, Brazil
| | - L S Costa
- Laboratory of Animal Pathology, Agroveterinary Sciences Center, University of Santa Catarina State, Av. Luís de Camões 2090, Conta Dinheiro, Lages, Santa Catarina, Brazil; Veterinary Medicine, University of Santa Catarina State, Av. Luís de Camões 2090, Conta Dinheiro, Lages, Santa Catarina, Brazil
| | - S D Traverso
- Laboratory of Animal Pathology, Agroveterinary Sciences Center, University of Santa Catarina State, Av. Luís de Camões 2090, Conta Dinheiro, Lages, Santa Catarina, Brazil
| | - R A Casagrande
- Laboratory of Animal Pathology, Agroveterinary Sciences Center, University of Santa Catarina State, Av. Luís de Camões 2090, Conta Dinheiro, Lages, Santa Catarina, Brazil; Postgraduate Programme in Animal Science, University of Santa Catarina State, Av. Luís de Camões 2090, Conta Dinheiro, Lages, Santa Catarina, Brazil.
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Pleural effusions in hematologic malignancies and their management with indwelling pleural catheters. Curr Opin Pulm Med 2019; 24:384-391. [PMID: 29629920 DOI: 10.1097/mcp.0000000000000490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Pleural effusions in patients with hematologic malignancy may represent malignant pleural effusion (MPE) or occur secondary to infection, treatment effects, and other common causes. The impact of MPE on prognosis in this cohort remains unclear. Indwelling pleural catheters (IPCs) are routinely placed for palliation of recurrent symptomatic MPEs, but perceived concerns over infection and bleeding may limit their use in patients with hematologic malignancies. However, recent evidence suggests IPCs are both well tolerated and effective in this cohort. In this review, the evaluation of pleural effusions in hematologic malignancies and their management with an IPC are outlined. RECENT FINDINGS Two retrospective studies have been published regarding the use of IPCs in hematologic malignancies. Lymphomatous effusions are the most common cause of MPE in this cohort. The rates of complications and pleurodesis with IPC in hematologic malignancies are similar to those with solid organ tumors. SUMMARY Pleural effusions in patients with hematologic malignancies may be managed safely with an IPC. Sterile technique, barrier protection, standardized algorithms for placement and removal, and quality assurance initiatives are crucial to centers that place IPCs for all patients. The safety of IPC in hematologic malignancies warrants a paradigm shift in the management of pleural disease for this cohort.
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Vakil E, Ost D, Vial MR, Stewart J, Sarkiss MG, Morice RC, Casal RF, Eapen GA, Grosu HB. Non-specific pleuritis in patients with active malignancy. Respirology 2017; 23:213-219. [DOI: 10.1111/resp.13187] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 07/24/2017] [Accepted: 07/24/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Erik Vakil
- McGovern Medical School; University of Texas Health Sciences Center at Houston; Houston TX USA
- Department of Pulmonary Medicine; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - David Ost
- Department of Pulmonary Medicine; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Macarena R. Vial
- Interventional Pulmonology Unit, Santiago Alemana Clinic; Desarrollo University; Santiago Chile
| | - John Stewart
- Department of Cytology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Mona G. Sarkiss
- Department of Anesthesiology; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Rodolfo C. Morice
- Department of Pulmonary Medicine; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Roberto F. Casal
- Department of Pulmonary Medicine; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Georgie A. Eapen
- Department of Pulmonary Medicine; The University of Texas MD Anderson Cancer Center; Houston TX USA
| | - Horiana B. Grosu
- Department of Pulmonary Medicine; The University of Texas MD Anderson Cancer Center; Houston TX USA
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Bashoura L, Eapen GA, Faiz SA. Pulmonary Manifestations of Lymphoma and Leukemia. Clin Chest Med 2017; 38:187-200. [DOI: 10.1016/j.ccm.2016.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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9
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Bode-Lesniewska B. Flow Cytometry and Effusions in Lymphoproliferative Processes and Other Hematologic Neoplasias. Acta Cytol 2016; 60:354-364. [PMID: 27578145 DOI: 10.1159/000448325] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 07/08/2016] [Indexed: 12/22/2022]
Abstract
Cytopathologists are regularly confronted with lymphocyte-rich effusions, and the definite decision of whether the lymphocytosis is of a purely reactive nature or a presentation of an indolent lymphoma may be an extremely difficult one based on microscopy alone. Flow cytometry (FC) offers many advantages in terms of its application in body cavity fluids, and it has proven to be very useful both in the setting of a known disease and for new lymphoma diagnoses. In this paper, the studies published in recent years dealing with the applications of FC in body cavity effusions in the context of hematologic neoplasia are reviewed, stressing the integrative diagnostic approach. The incorporation of microscopical, immunophenotypical, and molecular findings from examinations of the cellular content of effusions and the interpretation of results in relation to the current WHO classification of hematolymphoid malignancies give cytopathologists new perspectives on advanced and clinically highly relevant diagnostics.
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Tan J, Liu Z, Deng H, Wu H, Jiang G, Li J, Tao Y, Zhang W. [Non- Hodgkin's lymphoma initially manifested with pleuraleffusion: seven case reports and literatures review]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:70-3. [PMID: 26876259 PMCID: PMC7342292 DOI: 10.3760/cma.j.issn.0253-2727.2016.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Indexed: 11/29/2022]
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