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Pleural effusion in hematological pathology.

Neeraja Yerrapotu1, Abid Rahman1, Ali Gabali1

  • 1Department of Pathology, Detroit Medical Center, Karmanos Cancer Center and Wayne State University School of Medicine, Detroit, Michigan, United States.

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This study details a patient with chronic myelomonocytic leukemia-2 (CMML-2) who developed atypical cells in pleural fluid. Immunostains helped differentiate these cells, aiding diagnosis.

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Area of Science:

  • Hematology
  • Oncology
  • Pathology

Background:

  • Chronic myelomonocytic leukemia-2 (CMML-2) is a myeloid malignancy.
  • Pleural effusions can occur in patients with hematologic malignancies.

Observation:

  • A 51-year-old male with CMML-2 presented with symptoms of pleural effusion.
  • Computed tomography revealed right-sided pleural effusion and atelectasis.
  • Pleural fluid cytology identified atypical cells alongside reactive mesothelial cells.

Findings:

  • Immunohistochemical staining using the SCIP approach was performed on atypical cells.
  • Atypical cells were positive for vimentin, CD68, and CD163.
  • Atypical cells were negative for cytokeratin, calretinin, BerEP4, and MOC31, suggesting a non-mesothelial, non-epithelial origin.

Implications:

  • These findings aid in the differential diagnosis of pleural effusions in CMML-2 patients.
  • Immunostaining patterns are crucial for accurate tumor classification.
  • Further research may elucidate the specific nature and origin of these atypical cells.