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Pleural Effusion in Lymphoproliferative Disorders: A Clinico-pathological Study

The Long Island Jewish Medical Center, The Long Island Campus For Albert Einstein College of Medicine, New Hyde Park, NY

PURPOSE: To evaluate the clincopathologic features of pleural effusion in patients with lymphoproliferative disorders and to determine clinical variables that correlate with malignant pleural effusion and mortality in these patients.

PATIENTS & METHODS: Medical records of 74 patients with lymphoproliferative disorders who were hospitalized on 79 occasions and underwent thoracentesis from 1993-2002 were reviewed. Their median age was 68 yrs (4-92) and M:F was 40:34. Fifty patients had non-Hodgkin lymphoma, 18 had CLL, and 6 had Hodgkin disease. Fifty-two patients had stage >= 3 disease and 37 had received prior chemotherapy. Of 79 cases, 32 had mediastinal/and or hilar lymphadenopathy and 22 had pulmonary infiltrates. Cytological examination was performed in all 79 specimens, whereas immunophenotyping and/or genetic study was done in 38 specimens. Fisher’ Exact test was carried out to determine clinical variables that correlated with malignant pleural effusion and hospital mortality.

RESULTS: Of 79 cases of pleural effusion, 40 were bilateral and 72 were exudates. Forty-six effusions were diagnosed as malignant, 32 as reactive and 2 as empyema. Six were chylous effusion and 4 of them were malignant. Among the clinical variables examined for their correlation with malignant effusion, presence of secondary cancer and pleural fluid total nucleated cell count >1000/ul were significantly correlated with malignant effusion with a relative risk of malignant effusion of 1.59 (95% CI 1.67-2.17) and 1.53 (95% CI 1.02-2.29) respectively. Twenty of 74 patients died during their hospitalization. Presence of pleural fluid:serum LDH ratio >1, pneumonia, and secondary cancer significantly correlated with increased mortality with relative risk of death of 9 (95% CI 2.26-35.83), 3.54 (95% CI 1.68-7.45), and 3.12 (95% CI 1.60-6.00) respectively.

CONCLUSIONS: Malignant effusion is a common cause of pleural effusion in patients with lymphoproliferative disorders. Secondary cancer and a high pleural fluid neucleated cell count correlated with presence of a malignant effusion, whereas a high pleural fluid to serum LDH ratio, pneumonia and secondary cancer correlated with increased hospital mortality.

CLINICAL IMPLICATIONS: Pleural fluid examination can predict hospital mortality of patients with lymphoproliferative disorders.

DISCLOSURE: A.K. Siddiqui, None.