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Cytologically malignant lymphoid pericardial effusion with benign clinical outcome

Micha Maeder1, Peter Spieler, Reto Krapf

  • 1Department of Internal Medicine, Cantonal Hospital of St. Gallen, Switzerland. micha.maeder@kssg.ch

Swiss Medical Weekly
|August 18, 2005
PubMed

Insights

DNA aneuploidy in pericardial fluid, initially suggestive of lymphoma, was found to be non-specific. Long-term survival in two patients indicates viral pericarditis, not primary cardiac or effusion lymphoma.

Area of Science:

  • Oncology
  • Pathology
  • Cytometry

Background:

  • Primary cardiac lymphoma (PCL) and primary effusion lymphoma (PEL) are rare non-Hodgkin's lymphomas (NHL) presenting as isolated malignant pericardial effusion.
  • Diagnosis often involves cytological methods and DNA-image cytometry (ICM-DNA), with DNA-aneuploidy considered highly specific for malignancy.

Observation:

  • Two patients with cardiac tamponade underwent pericardiocentesis for large pericardial effusions.
  • Pericardial fluid analysis revealed atypical lymphoid cells and significant DNA-aneuploidy via ICM-DNA.
  • Staging examinations did not reveal other tumor manifestations.

Findings:

  • Despite highly atypical cytomorphology and DNA-aneuploidy, both patients achieved long-term cancer-free survival without systemic chemotherapy.
  • This suggests pronounced reactive lymphocytic changes, likely due to viral pericarditis, rather than PCL or PEL.

Implications:

  • DNA-aneuploidy in pericardial fluid may not be absolutely specific for detecting malignant lymphoid cells.
  • Rethinking diagnostic criteria for pericardial effusions with atypical cytology and aneuploidy is warranted.
Abstract

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