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Disorders of Leukocytes01:27

Disorders of Leukocytes

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Leukocyte disorders can lead to either leukopenia, characterized by an abnormally low leukocyte count, or leukocytosis, marked by a very high leukocyte number.
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Pleural Effusion II: Symptoms and Management01:28

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Clinical Manifestations:
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Primary lymphoid organs are pivotal in the formation, development, and maturation of lymphocytes, the white blood cells that serve as the backbone of our immune system. This crucial function underscores their fundamental role in maintaining our overall health and immunity. The two primary lymphoid organs of prime importance are the red bone marrow and the thymus.
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The adaptive immune response, a sophisticated defense mechanism, relies on the activation and differentiation of B lymphocytes, or B cells. These processes enable our bodies to mount a tailored response against specific pathogens such as bacteria, free virus particles, toxins, and parasites.
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High-Grade B-Cell Lymphoma With Malignant Effusions as the Initial Presentation.

Zubaidah Al-Jumaili1, Y Helen Zhang1, Wei J Wang1

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American Journal of Clinical Pathology
|March 7, 2023
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High-grade B-cell lymphoma (HGBL) can cause malignant effusions, often overlooked in diagnosis. Early detection using flow cytometry and FISH analysis of body fluids is crucial for timely intervention and improved patient outcomes.

Keywords:
BCL2 rearrangementBCL6 rearrangementMYC rearrangementHigh-grade B-cell lymphomaMalignant effusion

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Area of Science:

  • Hematology
  • Oncology
  • Cytopathology

Background:

  • Malignant effusions are typically associated with metastatic carcinoma.
  • Malignant lymphoma is infrequently considered in the differential diagnosis of malignant effusions.

Purpose of the Study:

  • To highlight the importance of considering high-grade B-cell lymphoma (HGBL) in the differential diagnosis of malignant effusions.
  • To present three cases of young women diagnosed with HGBL presenting as malignant effusions.

Main Methods:

  • Histopathologic examination, including immunohistochemistry, of effusion samples.
  • Immunophenotypic analysis via flow cytometry.
  • Cytogenetic analysis using fluorescence in situ hybridization (FISH) and karyotyping.

Main Results:

  • Three young female patients presented with fluid overload and were diagnosed with HGBL.
  • Effusion samples revealed large lymphoma cells positive for B-cell markers (CD10, CD20, PAX5) and BCL2/BCL6.
  • FISH analysis confirmed MYC, BCL2, or BCL6 rearrangements, indicating double-/triple-hit HGBL.

Conclusions:

  • High-grade B-cell lymphoma should be included in the differential diagnosis for malignant effusions.
  • Flow cytometry and FISH analysis of body fluid specimens are critical for accurate and prompt diagnosis of HGBL.