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Multiplexed Fluorescent Immunohistochemical Staining, Imaging, and Analysis in Histological Samples of Lymphoma
Published on: January 9, 2019
Combined cytomorphologic and immunophenotypic analysis in the diagnostic workup of lymphomatous effusions
M Bangerter1, A Hildebrand, M Griesshammer
1Departments of Medicine I and III, University of Ulm, Robert-Koch-Strasse 8, D-89081 Ulm, Germany. markus.bangerter@medizin.uni-ulm.de
Insights
Combining cytomorphology and immunophenotyping accurately diagnoses non-Hodgkin lymphoma (NHL) in effusions. This dual approach achieved 100% sensitivity and specificity, improving upon individual method limitations for lymphoma detection.
Area of Science:
- Hematopathology
- Cytopathology
- Immunology
Background:
- Lymphomatous effusions pose diagnostic challenges.
- Accurate differentiation between malignant and reactive effusions is critical for patient management.
- Non-Hodgkin lymphoma (NHL) can present as effusions, requiring precise diagnostic methods.
Observation:
- Cytomorphology alone struggled to distinguish low-grade NHL from reactive effusions.
- Immunophenotyping alone had difficulties detecting high-grade NHL.
- Combined analysis of cytomorphology and immunophenotyping in 54 patients revealed distinct diagnostic capabilities.
Findings:
- The integrated approach demonstrated 100% sensitivity and 100% specificity in diagnosing lymphomatous effusions.
- Individual methods showed limitations: cytomorphology missed low-grade NHL, and immunophenotyping missed high-grade NHL.
- The combined strategy successfully identified 33 cases of NHL involvement in effusions, including newly diagnosed and previously known cases.
Implications:
- The combined use of cytomorphology and immunophenotyping offers a robust strategy for diagnosing lymphomatous effusions.
- This integrated method enhances diagnostic accuracy, particularly in differentiating malignant from reactive processes.
- Accurate diagnosis of NHL in effusions is crucial for timely and appropriate therapeutic interventions.
Objective:
To analyze the results of cytomorphology and immunophenotyping in 54 patients with lymphomatous effusions.
Study Design:
We report the results of cytomorphology and immunophenotyping in 54 patients with lymphomatous effusions. Twenty-three of the 54 had a previous diagnosis of NHL. In the remaining 31 patients, lymphomatous involvement was clinically suspected.
Results:
Thirty-three lymphomatous effusions were positive for involvement by NHL. Twenty-one of these 33 patients (64%) had a previous diagnosis of NHL. Of the remaining 12 patients with newly diagnosed NHL, 11 had high grade lymphoma, and one had follicular center lymphoma. Twenty effusions were considered to be reactive; only two of these patients had NHL. One effusion revealed involvement by a previously unknown carcinoma. We observed seven false negative results if only one of both methods was considered. A high grade NHL was not diagnosed by immunophenotyping in one case, and six cases of low grade NHL could not be detected by cytomorphology. The combined strategy of cytomorphology and immunophenotyping had a sensitivity of 100% and specificity of 100% in our study, confirmed by follow-up studies.
Conclusion:
Both methods have shown difficulties in the examination of lymphomatous effusions. Cytomorphology has problems distinguishing reactive effusions from low grade NHL. The detection of high grade NHL by immunophenotyping is difficult. However, both methods together offer the advantage of dual staining ability and are most helpful in distinguishing clonal lymphomatous from reactive effusions.
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