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Pleural effusion in non-Hodgkin's lymphoma
F Celikoglu1, A S Teirstein, D J Krellenstein
1Mount Sinai Medical Center, New York.
Chest
|May 1, 1992
Summary
Intrathoracic non-Hodgkin's lymphoma (NHL) can unusually present with pleural effusion as the main sign. Diagnosis often requires invasive procedures beyond initial fluid analysis, confirming pleural lymphoma is the common cause.
Area of Science:
- Oncology
- Pulmonology
- Pathology
Background:
- Intrathoracic non-Hodgkin's lymphoma (NHL) typically shows mediastinal lymphadenopathy and pulmonary masses.
- Pleural effusion as the primary presentation of NHL without peripheral lymphadenopathy is uncommon.
Purpose of the Study:
- To investigate the diagnostic challenges and etiology of NHL presenting predominantly with pleural effusion.
- To evaluate the effectiveness of various diagnostic methods in these specific cases.
Main Methods:
- Retrospective review of 19 patients with NHL and predominant pleural effusion over seven years.
- Analysis of diagnostic yield from pleural fluid cytology, closed pleural biopsy, immunophenotyping, thoracoscopy, and CT-guided biopsy.
Main Results:
- Pleural effusion was the major finding in 19 NHL patients.
- Cytology and closed biopsy had low diagnostic rates (2/19 and 3/19, respectively).
- Immunophenotyping (8/11) and thoracoscopy (7/9) were more effective; CT identified biopsy sites for non-diagnostic fluid/tissue studies. Lymphomatous tissue was obtained from pleura in 17/19 patients.
Conclusions:
- Pleural effusion in NHL is frequently caused by direct pleural involvement (pleural lymphoma) rather than lymphatic obstruction.
- Diagnostic strategies for NHL presenting with effusion should include invasive pleural procedures and immunophenotyping.