PMID- 36879405
OWN - NLM
STAT- MEDLINE
DCOM- 20230503
LR  - 20230505
IS  - 1943-7722 (Electronic)
IS  - 0002-9173 (Linking)
VI  - 159
IP  - 5
DP  - 2023 May 2
TI  - High-Grade B-Cell Lymphoma With Malignant Effusions as the Initial Presentation.
PG  - 420-428
LID - 10.1093/ajcp/aqac182 [doi]
AB  - OBJECTIVES: Malignant effusion is usually caused by metastatic carcinoma. 
      Malignant lymphoma is often not included as a top differential diagnosis of 
      malignant effusion. Here, we describe 3 cases of young female patients with no 
      significant past medical history who presented with fluid overload and were 
      diagnosed with high-grade B-cell lymphoma (HGBL). METHODS: We conducted 
      histopathologic examination and immunophenotypic and cytogenetic analyses on 
      three cases using immunohistochemistry, flow cytometry, fluorescence in situ 
      hybridization (FISH), and karyotyping. We also included patients' clinical and 
      radiological findings in our case reports. RESULTS: Histologic examination of the 
      effusion samples showed numerous intermediate to large lymphoma cells with 
      irregular nuclear contours and fine chromatin. The lymphoma cells were positive 
      for CD10, CD20, BCL2, BCL6, and PAX5 and negative for CD34, cyclin D1, HHV-8, and 
      TdT. In situ hybridization for Epstein-Barr virus (EBV)-encoded small RNAs was 
      negative. The proliferation index by Ki-67 stain was more than 80%. Flow 
      cytometry showed CD10-positive B cells with monotypic immunoglobulin light chain 
      expression. Fluorescence in situ hybridization analysis demonstrated MYC, BCL2, 
      or BCL6 rearrangements. These 3 patients were diagnosed as having HGBL with 
      double-/triple-hit rearrangements. Despite receiving aggressive chemotherapy, all 
      3 patients had a dismal clinical course, with 2 patients dying less than 2 years 
      after initial diagnosis. CONCLUSIONS: High-grade B-cell lymphoma should be 
      considered in the differential diagnoses of malignant effusions. Flow cytometric 
      and FISH analyses of the body fluid specimens are essential to reach an accurate 
      and timely diagnosis.
CI  - (c) The Author(s) 2023. Published by Oxford University Press on behalf of American 
      Society for Clinical Pathology. All rights reserved. For permissions, please 
      e-mail: journals.permissions@oup.com.
FAU - Al-Jumaili, Zubaidah
AU  - Al-Jumaili Z
AUID- ORCID: 0000-0002-8665-2581
AD  - Department of Pathology and Laboratory Medicine, The University of Texas Health 
      Science Center at Houston, Houston, TX, US.
FAU - Helen Zhang, Y
AU  - Helen Zhang Y
AD  - Department of Pathology and Laboratory Medicine, The University of Texas Health 
      Science Center at Houston, Houston, TX, US.
FAU - Wang, Wei J
AU  - Wang WJ
AD  - Department of Pathology and Laboratory Medicine, The University of Texas Health 
      Science Center at Houston, Houston, TX, US.
FAU - Mai, Brenda
AU  - Mai B
AD  - Department of Pathology and Laboratory Medicine, The University of Texas Health 
      Science Center at Houston, Houston, TX, US.
FAU - Wang, Xiaohong I
AU  - Wang XI
AD  - Department of Pathology and Laboratory Medicine, The University of Texas Health 
      Science Center at Houston, Houston, TX, US.
FAU - Ahmed, Ahmed
AU  - Ahmed A
AUID- ORCID: 0000-0002-0577-3235
AD  - Department of Pathology and Laboratory Medicine, The University of Texas Health 
      Science Center at Houston, Houston, TX, US.
FAU - Wang, Wei
AU  - Wang W
AD  - Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 
      Houston, TX, US.
FAU - Hu, Shimin
AU  - Hu S
AD  - Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 
      Houston, TX, US.
FAU - James You, M
AU  - James You M
AD  - Department of Hematopathology, The University of Texas MD Anderson Cancer Center, 
      Houston, TX, US.
FAU - Hu, Zhihong
AU  - Hu Z
AD  - Department of Pathology and Laboratory Medicine, The University of Texas Health 
      Science Center at Houston, Houston, TX, US.
AD  - Department of Laboratory Medicine, The University of Texas MD Anderson Cancer 
      Center, Houston, TX, US.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Am J Clin Pathol
JT  - American journal of clinical pathology
JID - 0370470
RN  - 0 (Proto-Oncogene Proteins c-bcl-6)
RN  - 0 (Proto-Oncogene Proteins c-myc)
RN  - 0 (Proto-Oncogene Proteins c-bcl-2)
SB  - IM
MH  - Humans
MH  - Female
MH  - Proto-Oncogene Proteins c-bcl-6/genetics
MH  - *Epstein-Barr Virus Infections
MH  - In Situ Hybridization, Fluorescence
MH  - Proto-Oncogene Proteins c-myc/genetics
MH  - Proto-Oncogene Proteins c-bcl-2/genetics
MH  - Herpesvirus 4, Human
MH  - *Lymphoma, B-Cell/pathology
MH  - Gene Rearrangement
MH  - *Lymphoma, Large B-Cell, Diffuse/pathology
OTO - NOTNLM
OT  - BCL2 rearrangement
OT  - BCL6 rearrangement
OT  - MYC rearrangement
OT  - High-grade B-cell lymphoma
OT  - Malignant effusion
EDAT- 2023/03/08 06:00
MHDA- 2023/05/03 06:42
CRDT- 2023/03/07 00:13
PHST- 2022/09/07 00:00 [received]
PHST- 2022/12/16 00:00 [accepted]
PHST- 2023/05/03 06:42 [medline]
PHST- 2023/03/08 06:00 [pubmed]
PHST- 2023/03/07 00:13 [entrez]
AID - 7069762 [pii]
AID - 10.1093/ajcp/aqac182 [doi]
PST - ppublish
SO  - Am J Clin Pathol. 2023 May 2;159(5):420-428. doi: 10.1093/ajcp/aqac182.