title: Primary Effusion Lymphoma: Cytological Diagnosis of a Rare Entity--Report of Two Cases in HIV-Uninfected Patients from a Single Institution.
abstract: BACKGROUND
  Primary effusion lymphoma (PEL) is a Kaposi's sarcoma-associated herpesvirus (KSHV)-related large B-cell lymphoma often affecting immunocompromised adults. However, several cases in nonimmunocompromised elderly patients have been reported. It usually occurs as a massive, serosal effusion without tumoral masses and lymphadenopathies. The most frequent diagnostic materials are cytological smears, displaying large lymphocytes with variable morphological aspects but with a specific 'null-cell' phenotype associated with the expression of KSHV-related latency-associated nuclear antigen.
  
  
  METHODS
  We report 2 cases of PEL that occurred in elderly, HIV-uninfected patients. In the first case, an 83-year-old man presented with severe dyspnea of 1 week duration. Radiological images documented pericardial effusion causing cardiac tamponade, without lymphadenopathies and solid masses. In the second case, an HIV-uninfected 94-year-old man was affected by anorexia, fatigue, shortness of breath and nonproductive cough. Radiological studies revealed bilateral pleural effusion, without evidence of abnormal lymphadenopathies and lung and/or pleural masses. Thoracentesis was immediately performed. Cytological evaluations of pericardial (first case) and pleural (second case) fluid effusion showed anaplastic and immunoblastic lymphocytes, respectively, expressing LCA/CD45, CD30 and KSHV.
  
  
  CONCLUSIONS
  Albeit rare, PEL should be kept in mind in the diagnostic algorithm of serosal cytological evaluation in elderly HIV-uninfected patients.
authors.affiliation: Pathology Unit, Garbagnate Milanese Hospital, AO G. Salvini, Garbagnate Milanese, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Nicola
authors.forename: Monica
authors.initials: M
authors.lastname: Onorati
authors.forename: Chiara Luisa
authors.initials: CL
authors.lastname: Bianchi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pepe
authors.forename: Stefano
authors.initials: S
authors.lastname: Bellone
authors.forename: Franca
authors.initials: F
authors.lastname: Di Nuovo
mesh_terms: D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000032:analysis; D017809:Fatal Outcome; D019288:Herpesvirus 8, Human / Q000302:isolation & purification; D006801:Humans; D007121:Immunocompetence; D007150:Immunohistochemistry; D007558:Italy; D054685:Lymphoma, Primary Effusion / Q000150:complications / Q000276:immunology / Q000473:pathology* / Q000821:virology; D008297:Male; D010490:Pericardial Effusion / Q000209:etiology; D016066:Pleural Effusion, Malignant / Q000209:etiology; D011237:Predictive Value of Tests; D000069258:Thoracentesis
chemical_list: D014408:Biomarkers, Tumor