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Small noncleaved cell lymphoma presenting as a massive pericardial effusion. A case report
C H Dunphy1, R R Ramos, L M Galindo
1Department of Pathology, St. Louis University Health Sciences Center, Missouri, USA.
Insights
Diagnosing non-Hodgkin's lymphoma (NHL) presenting as pericardial effusion is rare. Combining cytology and flow cytometry offers a rapid, nonsurgical method for diagnosing this uncommon presentation of lymphoma.
Area of Science:
- Oncology
- Hematology
- Cardiology
Background:
- Cardiac involvement is common in advanced non-Hodgkin's lymphoma (NHL), particularly with mediastinal disease.
- Initial presentation of NHL as pericardial effusion is rare, with only 12 reported cases.
- Prior to this study, only 5 of 12 reported cases were diagnosed antemortem via pericardial fluid analysis.
Purpose of the Study:
- To report a rare case of non-Hodgkin's lymphoma presenting as a massive pericardial effusion.
- To highlight the utility of combined cytomorphology and flow cytometry for rapid diagnosis.
Main Methods:
- A 71-year-old female presented with a massive pericardial effusion.
- Diagnosis of small noncleaved cell lymphoma was achieved through cytologic examination and flow cytometric immunophenotyping of pericardial fluid.
- No surgical tissue biopsy was performed.
Main Results:
- The pericardial effusion was diagnosed as small noncleaved cell lymphoma.
- The diagnostic methods used were expeditious and did not require tissue biopsy.
- The patient was staged and treatment was initiated based on the diagnosis.
Conclusions:
- Combining cytomorphology and flow cytometric immunophenotyping enables rapid, nonsurgical diagnosis of NHL presenting as pericardial effusion.
- This diagnostic approach facilitates timely therapeutic decision-making for high-grade lymphoma.
- This case underscores the importance of considering lymphoma in the differential diagnosis of unexplained pericardial effusions.
Background:
Non-Hodgkin's lymphoma (NHL) is commonly associated with cardiac involvement, especially in cases of advanced stages with mediastinal involvement. Much rarer is the initial presentation of NHL as a pericardial effusion; there are only 12 cases reported. In addition, only 5 of these 12 cases were correctly diagnosed based on examination of pericardial fluid prior to death: 3 were based on routine cytology; 1 on immunoperoxidase staining and 1 on an immunofluorescent slide method.
Case:
A 71-year-old, white female presented with a massive pericardial effusion. Small noncleaved cell lymphoma was expeditiously diagnosed by cytologic examination combined with flow cytometric immunophenotyping. No further diagnostic tissue was obtained; the patient was staged and offered treatment with a protocol for high grade lymphoma.
Conclusion:
Combining cytomorphology and flow cytometric immunophenotyping in such cases results in an expeditious, nonsurgical diagnosis, upon which therapeutic decision making may be based.
