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Pleural Effusion in Lymphoproliferative Disorders: A Clinico-pathological Study FREE TO VIEW

Anita K. Siddiqui, MD; Shahid Ahmed, MD; Kanti R. Rai, MD; Harry N. Steinberg, MD
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The Long Island Jewish Medical Center, The Long Island Campus For Albert Einstein College of Medicine, New Hyde Park, NY


Chest


Chest. 2003;124(4_MeetingAbstracts):81S. doi:10.1378/chest.124.4_MeetingAbstracts.81S-c
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Abstract

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.

Monday, October 27, 2003

8:00 AM - 9:30 AM


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