KCP 801 (Pericardial effusion)

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1 KCP 801 (Pericardial effusion)
대구 가톨릭 대학 병원 맹영인

2 Clinical information 46세 남자 주소: 발열, 설사

3 병원 재방문 20일 전부터 전신 쇠약, 근 육통, 설사, 2개월간 5kg 의 체중감소가 있어 입원
Clinical information 복부 CT상 장간막 지방염 (mesentary panniculitis) 및 반응성 림프절 종대, 좌측부신에 약간 두꺼워진 소견이 관 찰되어 3개월간 경과 관찰하던 환자로 병원 재방문 20일 전부터 전신 쇠약, 근 육통, 설사, 2개월간 5kg 의 체중감소가 있어 입원

4 다음날 흉부 불편감 및 호흡곤란있어 시행 한 심초음파 소견상 중등도의 심낭삼출이 있어 심낭천자를 시행하였음.
Clinical information 혈액 검사 헤모글로빈 저하 12.7g/dL 혈소판 저하 96000/uL LDH 증가 678U/L 좌측 부신의 종물에 대해 침생검을 시행 다음날 흉부 불편감 및 호흡곤란있어 시행 한 심초음파 소견상 중등도의 심낭삼출이 있어 심낭천자를 시행하였음.

5 Pericardial effusion cytology

6 X100

7 X400

8 X400

9 X400

10 X400

11 Cell population (1) - Histiocytes
Mono- and binucleated cells Nulclei Peripherally located Oval and kidney shaped Finely granular chromatin Tiny nucleoli Cell borders blend with background Large multinucleated cells Phagocytic activity

12 X100

13 X200

14 X1000

15 X1000

16 X1000

17 Cell population (2) – lymphoid cell
Larger cell size (2-4 times) Irregular nuclear membrane Nuclear protrusion, cleaved Dense and multiple nucleoli Relatively scanty cytoplasm Hand mirror cells Karyorrhexis Abnormal mitoses

18 Inflammatory reaction ?
Lymphocyte Small Mature Polyclonal “Nuclear protrusion” Never observed in normal lymphocytes “abnormal mitoses” Considered as a landmark of cancer

19 Diagnosis Atypical lymphoid cells, mixed with reactive histiocytes, suggesting lymphoproliferative and hematologic malignancy

20 Acute blastic leukemia
Lymphoma Cell size Larger cell size 2-4 times Large cells with variable size Cytoplasm Thin rim Transparent Relatively scanty (Some may be abundant) Nuclei Nuclear protrusion (Hypersegmentation) Spherical, oval Irregular contour Nucleoli Large Pink nuclear inclusion (empty space) Large, multiple Hand mirror cell Present May be present Other Mitotic activity (abnormal mitoses) Karyorrhexis: particularly common in lymphoma

21 Acute blastic leukemia
Lymphoma Cell size Larger cell size 2-4 times Large cells with variable size Cytoplasm Thin rim Transparent Relatively scanty (Some may be abundant) Nuclei Nuclear protrusion (Hypersegmentation) Spherical, oval Irregular contour Nucleoli Large Pink nuclear inclusion (empty space) Large, multiple Hand mirror cell Present May be present Other Mitotic activity (abnormal mitoses) Karyorrhexis: particularly common in lymphoma

22 Cytologic recognition in effusion
Malignant lymphoma (4 groups) Large-cell lymphoma Small-cell lymphoma Hodgkin lymphoma Miscellaneous lymphoproliferative and hematologic disorders

23 Cytologic recognition in effusion
Malignant lymphoma (4 groups) Large-cell lymphoma Small-cell lymphoma Hodgkin lymphoma Miscellaneous lymphoproliferative and hematologic disorders

24 Diagnosis Malignant lymphoma, Large-cell lymphoma

25 If possible, Romanowsky stain Cell block Immunohistochemical study Flow cytometry Clinicopathological correlation

26 References L.G. Koss, Koss’ diagnostic cytology, 5th edition, LWW.
E.S. Cibas, Cytology, Diagnostic principles and clinical correlates, 3rd edition, Saunders M.G. Alexandrakis et al. Pleural effusions in hematologic m alignancies. Chest A.A. Renshaw et al. Leukemia/Lymphoma in Cerebrospinal Fluid - Renshaw et al. Arch Pathol Lab Med - Vol 130, December 2006