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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.
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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
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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.
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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)
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Nakako S, Nishimura M, Murakami Y, Mugitani A. Diagnostic significance of adenosine deaminase in pleural effusate for primary effusion lymphoma-like lymphoma. Clin Case Rep 2020; 8:3216-3219. [PMID: 33363910 PMCID: PMC7752432 DOI: 10.1002/ccr3.3296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 08/11/2020] [Indexed: 11/15/2022] Open
Abstract
Our case and review of the literature suggests the possibility that pleural effusate adenosine deaminase levels in patients with primary effusion lymphoma-like lymphoma (PEL-LL) might be much higher than those in patients with other types of lymphomas and those with tuberculous pleural effusion.
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Affiliation(s)
- Soichiro Nakako
- Department of Hematological MedicineOsaka City University HospitalOsakaJapan
| | | | | | - Atsuko Mugitani
- Department of Hematological MedicineFuchu HospitalIzumiJapan
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Moodad S, El Hajj R, Hleihel R, Hajjar L, Tawil N, Karam M, Hamie M, Abou Merhi R, El Sabban M, El Hajj H. Lenalidomide in Combination with Arsenic Trioxide: an Effective Therapy for Primary Effusion Lymphoma. Cancers (Basel) 2020; 12:E2483. [PMID: 32883022 PMCID: PMC7563318 DOI: 10.3390/cancers12092483] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 12/15/2022] Open
Abstract
Primary effusion lymphoma (PEL) is a rare aggressive subset of non-Hodgkin B cell lymphoma. PEL is secondary to Kaposi sarcoma herpes virus (KSHV) and predominantly develops in serous cavities. Conventional chemotherapy remains the treatment of choice for PEL and yields high response rates with no significant comorbidities. Yet, chemotherapy often fails in achieving or maintaining long-term remission. Lenalidomide (Lena), an immunomodulatory drug, displayed some efficacy in the treatment of PEL. On the other hand, arsenic trioxide (ATO) in combination with other agents effectively treated a number of blood malignancies, including PEL. In this study, we present evidence that the combination of ATO/Lena significantly enhanced survival of PEL mice, decreased the volume of exacerbated ascites in the peritoneum, and reduced tumor infiltration in organs of treated animals. In ex vivo treated PEL cells, ATO/Lena decreased the proliferation and downregulated the expression of KSHV latent viral proteins. This was associated with decreased NF-κB activation, resulting in reactivation of viral replication, downregulation of interleukin-6 (IL-6) and IL-10, inhibition of vascular endothelial growth factor, and apoptosis. Our results elucidate the mechanism of action of ATO/Lena and present it as a promising targeted therapeutic modality in PEL management, which warrants further clinical investigation.
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Affiliation(s)
- Sara Moodad
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut 202627, Lebanon; (S.M.); (R.H.); (M.H.)
| | - Rana El Hajj
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, American University of Beirut, Beirut 202627, Lebanon;
| | - Rita Hleihel
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut 202627, Lebanon; (S.M.); (R.H.); (M.H.)
- Department of Anatomy, Cell Biology, and Physiology, Faculty of Medicine, American University of Beirut, Beirut 202627, Lebanon; (L.H.); (M.E.S.)
| | - Layal Hajjar
- Department of Anatomy, Cell Biology, and Physiology, Faculty of Medicine, American University of Beirut, Beirut 202627, Lebanon; (L.H.); (M.E.S.)
| | - Nadim Tawil
- Department of Experimental Pathology, Immunology, and Microbiology, Faculty of Medicine, American University of Beirut, Beirut 202627, Lebanon; (N.T.); (M.K.)
| | - Martin Karam
- Department of Experimental Pathology, Immunology, and Microbiology, Faculty of Medicine, American University of Beirut, Beirut 202627, Lebanon; (N.T.); (M.K.)
| | - Maguy Hamie
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut 202627, Lebanon; (S.M.); (R.H.); (M.H.)
| | - Raghida Abou Merhi
- Department of Biology, Faculty of Sciences, GSBT laboratory, Lebanese University, Hadath 31143, Lebanon;
| | - Marwan El Sabban
- Department of Anatomy, Cell Biology, and Physiology, Faculty of Medicine, American University of Beirut, Beirut 202627, Lebanon; (L.H.); (M.E.S.)
| | - Hiba El Hajj
- Department of Experimental Pathology, Immunology, and Microbiology, Faculty of Medicine, American University of Beirut, Beirut 202627, Lebanon; (N.T.); (M.K.)
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Kropf J, Gerges M, Perez Perez A, Ellis A, Mathew M, Ayesu K, Ge L, Carlan SJ. T Cell Primary Effusion Lymphoma in an HIV-Negative Man with Liver Cirrhosis. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e919032. [PMID: 31956261 PMCID: PMC6993277 DOI: 10.12659/ajcr.919032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Patient: Male, 73-year-old Final Diagnosis: T cell lymphoma Symptoms: Dyspnea Medication: — Clinical Procedure: Thoracentesis Specialty: Oncology
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Affiliation(s)
- Jacqueline Kropf
- Department of Internal Medicine, Orlando Regional Healthcare, Orlando, FL, USA
| | - Mina Gerges
- Department of Internal Medicine, Orlando Regional Healthcare, Orlando, FL, USA
| | - Ariel Perez Perez
- Department of Internal Medicine, Orlando Regional Healthcare, Orlando, FL, USA
| | - Austin Ellis
- Department of Internal Medicine, Orlando Regional Healthcare, Orlando, FL, USA
| | - Mevin Mathew
- University of Central Florida College of Medicine, Orlando, FL, USA
| | - Kwabena Ayesu
- Department of Internal Medicine, Orlando Regional Healthcare, Orlando, FL, USA
| | - Li Ge
- Department of Pathology, Orlando Regional Healthcare, Orlando, FL, USA
| | - Steve J Carlan
- Division of Academic Affairs and Research, Orlando Regional Healthcare, Orlando, FL, USA
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Yuan L, Cook JR, Elsheikh TM. Primary effusion lymphoma in human immune deficiency (HIV)-negative non-organ transplant immunocompetent patients. Diagn Cytopathol 2019; 48:380-385. [PMID: 31846233 PMCID: PMC9291093 DOI: 10.1002/dc.24371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/05/2019] [Accepted: 12/09/2019] [Indexed: 12/27/2022]
Abstract
Primary effusion lymphoma (PEL) is a rare non‐Hodgkin's lymphoma most commonly occurring in the context of human immune deficiency (HIV) infection. Herpes virus 8 (HHV‐8) has been associated with PEL and considered to be the etiologic agent. In addition, most cases (60%‐90%) also show evidence of Epstein‐Barr virus (EBV) infection. We describe here an elderly man who was HIV seronegative and immunocompetent, and presented with worsening weakness and ascites. The diagnosis of PEL was rendered cytologically and supported by the results of flow cytometry. The presence of HHV‐8 was demonstrated by immunohistochemistry, whereas EBV‐associated genetic material was absent by EBER ISH. No lymphadenopathy or organ involvement with lymphoma was found. Systemic chemotherapy with lenalidomide was started given the poor prognosis and commodities of severe coronary artery disease; however, the patient did not respond and succumbed to his disease in 4 months. We present detailed cytologic and clinical findings of this very rare occurrence, and review literature of all reported PEL cases of HIV‐negative, nontransplant, immunocompetent patients.
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Affiliation(s)
- Lisi Yuan
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - James R Cook
- Department of Laboratory Medicine, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
| | - Tarik M Elsheikh
- Department of Pathology, Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio
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Abstract
Primary effusion lymphoma (PEL) is a rare and aggressive disease, affecting a unique population of patients who are often elderly or immunocompromised. PEL is associated with human herpesvirus type-8 infection and most commonly presents as malignant effusions of the body cavities. Patients diagnosed with PEL often have a compromised immune system from secondary conditions such as HIV. Chemotherapy has traditionally been the cornerstone of treatment for patients with a good performance status and no significant comorbidities. However, an optimal regimen does not exist. Most patients with PEL experience a relapse after frontline therapy within 6-8 months and subsequently require further treatment. In recent years, our understanding of the molecular drivers and environmental factors affecting the pathogenesis of PEL has expanded. This review will discuss the pathogenesis of PEL and various management approaches available in the frontline and relapsed setting as well as targeted agents that have shown promise in this disease.
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Affiliation(s)
- Mayur Narkhede
- Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC, USA,
| | - Shagun Arora
- Division of Hematology and Oncology, University of California, San Francisco, CA, USA
| | - Chaitra Ujjani
- Lombardi Comprehensive Cancer Center, Georgetown University Hospital, Washington, DC, USA,
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8
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Kanakry JA, Ambinder RF. Virus-Associated Lymphoma. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Birsen R, Boutboul D, Crestani B, Seguin-Givelet A, Fieschi C, Bertinchamp R, Giol M, Malphettes M, Oksenhendler E, Galicier L. Talc pleurodesis allows long-term remission in HIV-unrelated Human Herpesvirus 8-associated primary effusion lymphoma. Leuk Lymphoma 2017; 58:1993-1998. [PMID: 28084853 DOI: 10.1080/10428194.2016.1271947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Rudy Birsen
- a Department of Clinical Immunology , Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP) , Paris , France
| | - David Boutboul
- a Department of Clinical Immunology , Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP) , Paris , France.,b Inserm U1126, Centre Hayem, Hôpital Saint-Louis , Paris , France
| | - Bruno Crestani
- c Inserm U1152 , Université Paris Diderot Paris 7 , Paris , France.,d Department of Pneumology , Hôpital Bichat, Assistance Publique Hôpitaux de Paris (APHP) , Paris , France
| | - Agathe Seguin-Givelet
- e Department of Thoracic and Vascular Surgery , Hôpital Avicenne, Assistance Publique Hôpitaux de Paris (APHP) , Paris , France.,f Faculté de médecine SMBH , Université Sorbonne Paris Cité, Université Paris 13 , Bobigny , France
| | - Claire Fieschi
- a Department of Clinical Immunology , Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP) , Paris , France.,b Inserm U1126, Centre Hayem, Hôpital Saint-Louis , Paris , France.,g EA3518, Université Paris Diderot Paris 7 , Paris , France
| | - Remi Bertinchamp
- a Department of Clinical Immunology , Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP) , Paris , France
| | - Mihaela Giol
- h Department of Thoracic Surgery , Hôpital Tenon, Assistance Publique Hôpitaux de Paris (APHP) , Paris , France
| | - Marion Malphettes
- a Department of Clinical Immunology , Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP) , Paris , France.,b Inserm U1126, Centre Hayem, Hôpital Saint-Louis , Paris , France
| | - Eric Oksenhendler
- a Department of Clinical Immunology , Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP) , Paris , France.,g EA3518, Université Paris Diderot Paris 7 , Paris , France
| | - Lionel Galicier
- a Department of Clinical Immunology , Hôpital Saint-Louis, Assistance Publique Hôpitaux de Paris (APHP) , Paris , France.,g EA3518, Université Paris Diderot Paris 7 , Paris , France
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[Clinical characteristics of four cases of HIV unrelated primary effusion lymphoma patients with pleural effusion as initial symptom]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2016; 37:616-9. [PMID: 27535866 PMCID: PMC7364996 DOI: 10.3760/cma.j.issn.0253-2727.2016.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nicola M, Onorati M, Bianchi CL, Pepe G, Bellone S, Di Nuovo F. Primary Effusion Lymphoma: Cytological Diagnosis of a Rare Entity--Report of Two Cases in HIV-Uninfected Patients from a Single Institution. Acta Cytol 2015; 59:425-8. [PMID: 26658724 DOI: 10.1159/000441938] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/23/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Primary effusion lymphoma (PEL) is a Kaposi's sarcoma-associated herpesvirus (KSHV)-related large B-cell lymphoma often affecting immunocompromised adults. However, several cases in nonimmunocompromised elderly patients have been reported. It usually occurs as a massive, serosal effusion without tumoral masses and lymphadenopathies. The most frequent diagnostic materials are cytological smears, displaying large lymphocytes with variable morphological aspects but with a specific 'null-cell' phenotype associated with the expression of KSHV-related latency-associated nuclear antigen. CASES We report 2 cases of PEL that occurred in elderly, HIV-uninfected patients. In the first case, an 83-year-old man presented with severe dyspnea of 1 week duration. Radiological images documented pericardial effusion causing cardiac tamponade, without lymphadenopathies and solid masses. In the second case, an HIV-uninfected 94-year-old man was affected by anorexia, fatigue, shortness of breath and nonproductive cough. Radiological studies revealed bilateral pleural effusion, without evidence of abnormal lymphadenopathies and lung and/or pleural masses. Thoracentesis was immediately performed. Cytological evaluations of pericardial (first case) and pleural (second case) fluid effusion showed anaplastic and immunoblastic lymphocytes, respectively, expressing LCA/CD45, CD30 and KSHV. CONCLUSION Albeit rare, PEL should be kept in mind in the diagnostic algorithm of serosal cytological evaluation in elderly HIV-uninfected patients.
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Affiliation(s)
- Marta Nicola
- Pathology Unit, Garbagnate Milanese Hospital, AO G. Salvini, Garbagnate Milanese, Italy
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