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Cytomorphology, Immunophenotype, and cytogenetic profile of leukemic serous effusions
Kanwalpreet Kaur1, Trupti Patel2, Sanjiban Patra1
1Department of Oncopathology, Gujarat Cancer and Research Institute, Ahmedabad, India.
Insights
Diagnosing leukemic serous effusions (LSE) is crucial for patient outcomes. Cytomorphology offers an effective diagnostic tool for LSE, aiding in distinguishing leukemia from lymphoma.
Area of Science:
- Hematology
- Cytopathology
- Oncology
Background:
- Serous effusions (SE) in leukemia patients can arise from various causes, impacting treatment and survival.
- Accurate diagnosis of leukemic serous effusions (LSE) is essential for appropriate patient management.
Purpose of the Study:
- To analyze the cytomorphology, immunophenotype, and cytogenetics of leukemic serous effusions.
- To evaluate the diagnostic utility of cytopathology in identifying LSE.
Main Methods:
- Retrospective descriptive study of SE reported as suspicious or positive for leukemic infiltration (2016-2019).
- Exclusion of cerebrospinal fluid (CSF) and lymphoma-involved effusions.
- Comparison of cytodiagnosis with primary proven diagnoses and analysis of discordant cases.
Main Results:
- Leukemic involvement was found in 0.4% (40/9723) of SE, including various leukemia subtypes (AML, ALL, CML, CLL).
- Pleural cavity was the most common site (30/40), followed by peritoneal (7/40) and pericardial (3/40).
- Cytomorphology achieved accurate diagnosis in 72.5% of cases, with 15% misdiagnosed as non-Hodgkin lymphoma.
Conclusions:
- Cytology is an effective method for diagnosing LSE.
- Specific cytomorphological features, such as nuclear indentations and eosinophilic cytoplasm, can suggest leukemia over lymphoma.
Background:
Serous effusions (SE) in leukemic patients can be due to infections, therapy, volume overload, lymphatic obstruction or malignancy having implications on treatment and mortality. The objective of the present study is to highlight the spectrum of cytomorphology, immunophenotype, and cytogenetics in leukemic serous effusions (LSE).
Materials:
Present study is retrospective and descriptive. We reviewed all the SE, which were reported as suspicious or positive of leukemic infiltration from 2016 to 2019 for cytomorphological features. CSF and effusions involved by lymphomas were excluded. Cyto-diagnosis was compared with primary proven diagnosis (by ancillary techniques) and disconcordant cases were analyzed.
Results:
Out of total 9723 effusions, only 0.4% (n = 40) showed leukemic involvement and included nine cases of AML, three of B-ALL, 13 T-ALL, 2 MPAL, 6 CML, 5CLL, one each of chronic myelomonocytic leukemia and AML with myelodysplasia. The most common site of involvement was the pleural cavity (n = 30), followed by the peritoneal cavity (n = 7) and the pericardial cavity (n = 3). T -ALL (41.9%) was the most common leukemia involving pleural fluid followed by AML (23.3%). CML (42.8%) was the most common leukemia involving the ascitic fluid followed by B-ALL (28.6%). Accurate diagnosis was given on cytomorphology in 72.5% (29/40) cases and 15.0% (6/40) were reported as non-Hodgkin lymphoma.
Conclusion:
Cytology is an effective tool available to make a diagnosis of LSE. Nuclear indentations in large atypical cells and cells with eosinophilic granular cytoplasm with sparse or abundant eosinophils in the background are an important clue in favor of leukemia over lymphoma.
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