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A case report-application of pericardial effusion cytology and next-generation sequencing technology: quick and secure diagnosis of primary effusion lymphoma

ABSTRACT: Abstract

Background

Primary effusion lymphoma (PEL) is an uncommon subtype of non-Hodgkin lymphoma (NHL) that usually involves the pleura, pericardium, and peritoneum without an obvious tumour mass, with multiple plasma effusions as its main clinical feature. We report a case of a massive pericardial effusion in an elderly male with a final diagnosis of PEL.

Case summary

A 70-year-old male patient was admitted to hospital with symptoms of chest tightness, shortness of breath, fatigue, loss of appetite, and cough with phlegm after a pericardial effusion had been found for 5 months. The next-generation sequencing of pericardial effusion found human herpesvirus type 8 (HHV-8) infection, and further cytomorphological and immunohistochemical examination were done. According to the patient's HHV-8 infection, the pathological features of heterogeneous B cells with plasmablastic differentiation and the immunohistochemical characteristics of PEL, the final diagnosis was made as human immunodeficiency virus-negative PEL.

Discussion

The diversity and non-specificity of PEL symptoms, as well as its rarity, make it difficult to diagnose. In this case, we used the next-generation sequencing technology to screen the pathogen of the patient's pericardial effusion and carried out morphological and immunohistochemical examination of the cells in the pericardial effusion, which provided a clinically operable diagnosis for an uncommon disease, enabling us to make a clear diagnosis faster and start treatment in time.

SUBMITTER: Zheng J

PROVIDER: S-EPMC9269675 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundWe evaluated malignancy according to the characteristics of pericardial fluid in symptomatic Japanese patients undergoing pericardiocentesis and computed tomography (CT).MethodsThis was a retrospective, single-center, observational study of 125 symptomatic patients undergoing pericardiocentesis. The patients were classified into two groups: a malignancy group and a non-malignancy group, according to the primary disease and cytology of the pericardial effusion (PE). We compared the pericardial fluid sample and CT measurements between both groups.ResultsAll patients were diagnosed as having exudative PE by Light's criteria. PE with malignant cells was demonstrated in 76.8% of the malignancy group patients. Pericardial to serum lactate dehydrogenase (LDH) ratio > 0.6, as one of Light's criteria, was associated with malignancy (p = 0.017). Lower serum brain natriuretic peptide (BNP) concentration was also associated with malignancy (BNP: 126.9 ± 89.8 pg/ml vs 409.2 ± 97.7 pg/ml, malignancy vs non-malignancy groups, respectively; p = 0.037). A significant difference was observed in pericardial fluid glucose level between the malignancy and non-malignancy groups (pericardial fluid glucose: 78.24 ± 48.29 mg/dl vs 98.41 ± 44.85, respectively; p = 0.048). Moreover, CT attenuation values (Hounsfield units (HU)) tended to be higher in the malignancy group vs the non-malignancy group (22.7 [interquartile range (IQR), 17.4-26.0] vs 17.4 [IQR, 13.7-26.4], respectively; p = 0.08). The sensitivity and specificity of pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were 40.9% and 89.6%, respectively, in the malignancy group. The positive- and negative predictive values of pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were 85.7% and 50.0%, respectively, in the malignancy group. Pericardial fluid glucose level ≤ 70 mg/dl and CT attenuation values > 20 HU were cutoff values associated with malignancy (p = 0.012).ConclusionsLower pericardial fluid glucose level with higher CT attenuation values may suggest malignancy-related PE.