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Cytologic aspects of T-cell acute lymphoblastic leukemia presenting as a massive pericardial effusion: a case report

Debdatta Basu1, Neelaiah Siddaraju, Paari Murugan

  • 1Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.

Acta Cytologica
|June 19, 2009
PubMed

Insights

Acute lymphoblastic leukemia (ALL) can rarely present as cardiac tamponade with leukemia cells in pericardial fluid. Cytopathologists must carefully examine lymphoid-rich effusions to avoid misdiagnosis of this critical condition.

Area of Science:

  • Hematology
  • Cytopathology
  • Oncology

Background:

  • Acute lymphoblastic leukemia (ALL) presenting with cardiac tamponade and pericardial effusion is rare.
  • Cytopathologists must exercise caution with lymphoid-rich pericardial effusions to prevent false-negative diagnoses.

Observation:

  • A 27-year-old male presented with symptoms of cardiac tamponade and a pericardial effusion.
  • Pericardial fluid cytology revealed atypical lymphoid cells with blastoid morphology, initially resembling mature lymphocytes.
  • Hematologic workup confirmed T-cell acute lymphoblastic leukemia (FAB L1) with 90% lymphoblasts in the bone marrow.

Findings:

  • The case highlights the uncommon presentation of ALL with cardiac tamponade and malignant cells in pericardial fluid.
  • Morphological analysis of pericardial fluid cytology is crucial for early detection of ALL.
  • Immunophenotyping confirmed T-cell lineage and blast characteristics.

Implications:

  • Clinicians and cytopathologists must recognize the potential for ALL to manifest initially as pericardial effusion and cardiac tamponade.
  • Prompt and accurate diagnosis of lymphoid cells in pericardial fluid is critical for patient management and prognosis.
  • This emphasizes the importance of integrating clinical, cytologic, and hematologic findings in diagnosing rare oncologic emergencies.
Abstract

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