Lymphoproliferative conditions of the serosa

Our plain-English summary of Lymphoproliferative conditions of the serosa, by R. Attanoos (Archives of Pathology & Laboratory Medicine, 2012).

The study

• Author: R. Attanoos
• Journal: Archives of Pathology & Laboratory Medicine
• Published: 2012;136(3):268-76
• Type of article: Review
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Context: A diverse and complex variety of lymphoproliferative diseases may involve the serosa, with widely differing clinical outcomes encompassing a spectrum of benign and malignant conditions.

Objective: To review lymphoproliferative disease involving the serosa and to provide a practical approach to the evaluation of lymphoid and plasma cell infiltrates in the serosa, together with a review of various tumors and tumorlike conditions that may mimic lymphoproliferative disease.

Data Sources: Analysis of published literature.

Conclusions: All forms of hematologic malignancy may involve the various serosal sites, although this is usually observed as secondary involvement in persons with known lymph nodal, marrow-based, or extranodal disease. Primary pericardial, pleural, and peritoneal lymphomas are rare; many nonneoplastic conditions may mimic lymphoma and a variety of nonhematolymphoid tumors may simulate hematologic malignancies. An understanding of the role of ancillary tests, together with an appreciation of their limitations, will prevent misdiagnosis.

In plain English

This article was a review of published literature by a pathologist at University Hospital Llandough in Cardiff, United Kingdom. It did not study its own group of patients and did not measure asbestos exposure. The author described lymphoproliferative conditions, diseases involving lymphocytes and plasma cells, that affect the serosa: the linings of the chest (pleura), heart (pericardium) and abdomen (peritoneum). The review also described how pathologists can tell reactive inflammation from lymphoma using tests such as immunohistochemistry and molecular genetic tests. It stated that blood cancers in these linings usually come from known disease elsewhere, and that lymphomas starting in the pleura, pericardium or peritoneum are rare. Among conditions that can be mistaken for lymphoma, it described lymphohistiocytoid mesothelioma. This is a rare variant of malignant mesothelioma, fewer than 1% of cases, which the review said is asbestos related in most cases and has no prognostic implication. Thymic epithelial tumors of the pleura were also described as possible mimics. The author concluded that understanding ancillary tests and their limitations will prevent misdiagnosis.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Narrative review of published literature (not an original study of patients)
• Who was studied: No study population of its own. The review covered published reports on lymphoid and plasma cell diseases, and their mimics, involving the pleura, pericardium and peritoneum.
• Exposure: Asbestos exposure was not studied. The only mention of asbestos is the review's statement that lymphohistiocytoid mesothelioma, a lymphoma mimic, is asbestos related in most cases.
• Main results:
  • The review stated that all forms of hematologic malignancy (blood cancer) may involve the serosal linings, usually as secondary spread in people with known disease in lymph nodes, marrow or other sites.
  • Lymphohistiocytoid mesothelioma was described as a rare variant of malignant mesothelioma, comprising fewer than 1% of cases, which can be mistaken for lymphoma.
  • In lymphohistiocytoid mesothelioma, broad-spectrum cytokeratin and mesothelial markers were described as highlighting the tumor cells hidden among the lymphoid cells.
  • Thymic epithelial tumors arising in the pleura and peritoneum were described as possible mimics of lymphoma.
  • The review cited an earlier review by Nakatsuka and coworkers of 106 cases of pyothorax-associated lymphoma in Japan. In that review, follow-up data were available for 102 patients and median survival was 9 months.
  • Primary effusion lymphoma was described as having an extremely poor prognosis regardless of treatment, with median survival of less than 6 months.
  • Citing earlier literature, the review stated that lymphoma or leukemia involves the pleura in approximately 15% of patients with non-Hodgkin lymphoma during their illness.
  • For molecular clonality testing, the review stated that fresh tissue is preferable because fixed tissue has a 20% false-negative rate.
• The authors' conclusion: The author concluded that understanding the role of ancillary tests, and appreciating their limitations, will prevent misdiagnosis.
• Limitations the authors state:
  • The author stated that the list of tumors and tumorlike conditions that mimic lymphoproliferative disease is not fully inclusive.

Topics

Medical terms in this study, explained in our Lexicon: Pericardial, Misdiagnosis.

Related studies

• Diffuse neoplasms of the pleural serosa — L. Cardinale, F. Ardissone, et al. (2013)
• Epithelioid lesions of the serosa — S. Anttila (2012)
• Pulmonary crystal-storing histiocytoma in a patient without a lymphoproliferative disorder — W.S. Lee, S.R. Kim, et al. (2009)
• The mesothelial cell — S.E. Mutsaers (2004)
• Reactive and neoplastic serosal tissue. A light-microscopic, ultrastructural, and immunocytochemical study — J.W. Bolen, S.P. Hammar, et al. (1986)
• The pathology of mesotheliomata and an analysis of their association with asbestos exposure — D.O. Hourihane (1964)

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