A case of primary effusion lymphoma-like lymphoma for which a cell block was useful for diagnosis
Background: Primary effusion lymphoma (PEL) is a rare malignant lymphoma observed as an effusion in the body cavity without forming any tumor masses and is associated with human herpes virus type 8 (HHV-8) infection. We report a case of PEL-like lymphoma (PEL-LL) observed as a pleural effusion in th...
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| Published in | Japanese Journal of Medical Technology Vol. 68; no. 3; pp. 602 - 606 |
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| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japanese Association of Medical Technologists
25.07.2019
一般社団法人 日本臨床衛生検査技師会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0915-8669 2188-5346 |
| DOI | 10.14932/jamt.19-22 |
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| Abstract | Background: Primary effusion lymphoma (PEL) is a rare malignant lymphoma observed as an effusion in the body cavity without forming any tumor masses and is associated with human herpes virus type 8 (HHV-8) infection. We report a case of PEL-like lymphoma (PEL-LL) observed as a pleural effusion in the absence of HHV-8 infection. A cytology cell block of the pleural effusion was useful for diagnosis. Case: A female in her 90s complained of dyspnea. A chest X-ray examination showed a large amount of bilateral pleural effusion, and thoracic drainage was performed. Pleural effusion cytology showed a large number of atypical cells with large irregular nuclei. Immunocytochemical analysis using a cell block showed CD20, CD79a, and bcl-2 positivities. Therefore, the patient was diagnosed as having diffuse large B cell malignant lymphoma. No tumor mass or lymph node swelling was detected by enhanced computed tomography and no HHV-8 was detected. Therefore, this patient was diagnosed as having PEL-LL. Conclusion: In the present case, the use of a cytology cell block from pleural effusion drained for the first time enabled rapid immunocytochemical analysis, resulting in early diagnosis. Several previous studies have shown that PEL-LL disappeared following effusion drainage. Therefore, constructing a cytology cell block from the initial drained effusions is important for the diagnosis of PEL-LL. |
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| AbstractList | Background: Primary effusion lymphoma (PEL) is a rare malignant lymphoma observed as an effusion in the body cavity without forming any tumor masses and is associated with human herpes virus type 8 (HHV-8) infection. We report a case of PEL-like lymphoma (PEL-LL) observed as a pleural effusion in the absence of HHV-8 infection. A cytology cell block of the pleural effusion was useful for diagnosis. Case: A female in her 90s complained of dyspnea. A chest X-ray examination showed a large amount of bilateral pleural effusion, and thoracic drainage was performed. Pleural effusion cytology showed a large number of atypical cells with large irregular nuclei. Immunocytochemical analysis using a cell block showed CD20, CD79a, and bcl-2 positivities. Therefore, the patient was diagnosed as having diffuse large B cell malignant lymphoma. No tumor mass or lymph node swelling was detected by enhanced computed tomography and no HHV-8 was detected. Therefore, this patient was diagnosed as having PEL-LL. Conclusion: In the present case, the use of a cytology cell block from pleural effusion drained for the first time enabled rapid immunocytochemical analysis, resulting in early diagnosis. Several previous studies have shown that PEL-LL disappeared following effusion drainage. Therefore, constructing a cytology cell block from the initial drained effusions is important for the diagnosis of PEL-LL. Background: Primary effusion lymphoma (PEL) is a rare malignant lymphoma observed as an effusion in the body cavity without forming any tumor masses and is associated with human herpes virus type 8 (HHV-8) infection. We report a case of PEL-like lymphoma (PEL-LL) observed as a pleural effusion in the absence of HHV-8 infection. A cytology cell block of the pleural effusion was useful for diagnosis. Case: A female in her 90s complained of dyspnea. A chest X-ray examination showed a large amount of bilateral pleural effusion, and thoracic drainage was performed. Pleural effusion cytology showed a large number of atypical cells with large irregular nuclei. Immunocytochemical analysis using a cell block showed CD20, CD79a, and bcl-2 positivities. Therefore, the patient was diagnosed as having diffuse large B cell malignant lymphoma. No tumor mass or lymph node swelling was detected by enhanced computed tomography and no HHV-8 was detected. Therefore, this patient was diagnosed as having PEL-LL. Conclusion: In the present case, the use of a cytology cell block from pleural effusion drained for the first time enabled rapid immunocytochemical analysis, resulting in early diagnosis. Several previous studies have shown that PEL-LL disappeared following effusion drainage. Therefore, constructing a cytology cell block from the initial drained effusions is important for the diagnosis of PEL-LL. 背景：原発性滲出液リンパ腫（primary effusion lymphoma; PEL）は，体腔滲出液中で増殖して腫瘤を形成せず，ヒトヘルペスウイルス8型（HHV-8）感染が発症に関与する稀な悪性リンパ腫である。今回，PELに類似するもののHHV-8感染を認めないPEL様リンパ腫の1例を経験し，胸水セルブロック標本の作製が診断に有用だったので報告する。症例：90代，女性。息切れを訴え来院。多量の両側胸水貯留を認め，胸腔ドレナージが施行された。胸水細胞診で粗造な核クロマチンを有し核形不整と大型核小体が目立つN/C比の高い孤在性の大型異型細胞を均一に多数認め，セルブロック標本による免疫細胞化学とフローサイトメトリー法による細胞表面抗原解析の結果からびまん性大細胞型B細胞性リンパ腫と診断した。CTによる全身検索では腫瘤性病変やリンパ節腫大等はみられず，また，胸水中にHHV-8 DNAは検出されなかった。以上の所見から，PEL様リンパ腫と最終診断された。結論：本症例は初回提出の胸水でセルブロック標本を作製したことにより迅速な免疫細胞化学的検索が可能となり早期診断に至った。PEL様リンパ腫は，体腔液ドレナージのみで消退傾向を示し異型細胞が認められなくなる症例がみられることから，PEL様リンパ腫が疑われる場合は初回採取の体腔液でセルブロック標本を作製することが診断上重要と考えられた。 |
| Author | WATANABE, Izumi KURONUMA, Sayaka YANAGAWA, Naoki UENO, Hiroki OGATA, Shin-ya SUZUKI, Yu UEMATSU, Miyuki GOKON, Shuhei |
| Author_FL | 鈴木 裕 緒形 真也 植松 美由紀 上野 大 渡邊 いづみ 黒沼 彩佳 郷右近 秀平 栁川 直樹 |
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| References | 9) 相川 映美子，他：「Primary effusion lymphoma 6例の細胞学的検討」，日臨細胞誌，2008; 47: 275–281. 2) Wu W et al.: “Human herpesvirus 8-unrelated primary effusion lymphoma-like lymphoma: Report of a rare case and review of 54 cases in the literature,” Am J Clin Pathol, 2013; 140: 258–273. 3) 伊藤 仁，他：「セルブロック作製法と特殊染色（胸腹水）」，病理と臨床，2010; 28: 1136–1140. 4) Kobayashi Y et al.: “Comparison of human herpes virus 8 related primary effusion lymphoma with human herpes virus 8 unrelated primary effusion lymphoma-like lymphoma on the basis of HIV: Report of 2 cases and review of 212 cases in the literature,” Acta Haematol, 2007; 117: 132–144. 7) 白石 幸恵，他：「心嚢ドレナージのみで消退傾向を示した心嚢水primary effusion lymphoma-like lymphomaの1例」，国立医療学会誌，2014; 68: 11–15. 10) Chan JKC et al.: “Diffuse large B-cell lymphoma associated with chronic inflammation,” WHO classification of tumors of haematopoietic and lymphoid tissues, 309–311, Swerdlow SH et al. (eds.), WHO press, World Health Organization, Switzerland, 2017. 8) 野口 裕史，他：「心嚢液に発生したHHV-8感染陰性primary effusion lymphomaの1例」，日臨細胞誌，2011; 50: 220–225. 11) 佐藤 聖子，他：「HHV-8陰性PEL-like lymphomaの1例，および自験5例の臨床病理学的検討」，日本検査血液学会雑誌，2016; 17: 47–53. 6) Terasaki Y et al.: “Disappearance of malignant cells by effusion drainage alone in two patients with HHV-8-unrelated HIV-negative primary effusion lymphoma-like lymphoma,” Int J Hematol, 2011; 94: 279–284. 1) Said J, Cesarman E: “Primary effusion lymphoma,” WHO classification of tumors of haematopoietic and lymphoid tissues, 323–324, Swerdlow SH et al. (eds.), WHO press, World Health Organization, Switzerland, 2017. 5) 高橋 凪，他：「心タンポナーデにより発症したprimary effusion lymphoma様のびまん性大細胞型B細胞リンパ腫」，市立秋病医誌，2017; 27: 21–27. |
| References_xml | – reference: 4) Kobayashi Y et al.: “Comparison of human herpes virus 8 related primary effusion lymphoma with human herpes virus 8 unrelated primary effusion lymphoma-like lymphoma on the basis of HIV: Report of 2 cases and review of 212 cases in the literature,” Acta Haematol, 2007; 117: 132–144. – reference: 6) Terasaki Y et al.: “Disappearance of malignant cells by effusion drainage alone in two patients with HHV-8-unrelated HIV-negative primary effusion lymphoma-like lymphoma,” Int J Hematol, 2011; 94: 279–284. – reference: 9) 相川 映美子，他：「Primary effusion lymphoma 6例の細胞学的検討」，日臨細胞誌，2008; 47: 275–281. – reference: 5) 高橋 凪，他：「心タンポナーデにより発症したprimary effusion lymphoma様のびまん性大細胞型B細胞リンパ腫」，市立秋病医誌，2017; 27: 21–27. – reference: 7) 白石 幸恵，他：「心嚢ドレナージのみで消退傾向を示した心嚢水primary effusion lymphoma-like lymphomaの1例」，国立医療学会誌，2014; 68: 11–15. – reference: 3) 伊藤 仁，他：「セルブロック作製法と特殊染色（胸腹水）」，病理と臨床，2010; 28: 1136–1140. – reference: 1) Said J, Cesarman E: “Primary effusion lymphoma,” WHO classification of tumors of haematopoietic and lymphoid tissues, 323–324, Swerdlow SH et al. (eds.), WHO press, World Health Organization, Switzerland, 2017. – reference: 10) Chan JKC et al.: “Diffuse large B-cell lymphoma associated with chronic inflammation,” WHO classification of tumors of haematopoietic and lymphoid tissues, 309–311, Swerdlow SH et al. (eds.), WHO press, World Health Organization, Switzerland, 2017. – reference: 11) 佐藤 聖子，他：「HHV-8陰性PEL-like lymphomaの1例，および自験5例の臨床病理学的検討」，日本検査血液学会雑誌，2016; 17: 47–53. – reference: 2) Wu W et al.: “Human herpesvirus 8-unrelated primary effusion lymphoma-like lymphoma: Report of a rare case and review of 54 cases in the literature,” Am J Clin Pathol, 2013; 140: 258–273. – reference: 8) 野口 裕史，他：「心嚢液に発生したHHV-8感染陰性primary effusion lymphomaの1例」，日臨細胞誌，2011; 50: 220–225. |
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| Snippet | Background: Primary effusion lymphoma (PEL) is a rare malignant lymphoma observed as an effusion in the body cavity without forming any tumor masses and is... |
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| SubjectTerms | cell-block cytology human herpes virus type 8 (HHV-8) primary effusion lymphoma (PEL) primary effusion lymphoma-like lymphoma (PEL-LL) セルブロック ヒトヘルペスウイルス8型 原発性滲出液リンパ腫 原発性滲出液リンパ腫様リンパ腫 細胞診 |
| Title | A case of primary effusion lymphoma-like lymphoma for which a cell block was useful for diagnosis |
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