Massive ascites as the initial manifestation of mantle cell lymphoma: a challenge for the gastroenterologist

Abstract

Involvement of the serosa may be the presenting feature in a wide and complex variety of lymphoproliferative diseases, with differing clinical outcomes covering a spectrum of benign and malignant conditions. Effusions involving peritoneal and pericardial cavities are uncommon during the course of hematological malignancies. Obstructive and/or infiltrative tumor mass or vascular leakage due to stimulation by vascular endothelial growth factor contribute to the pathogenesis. In addition to clinical findings, cytomorphology and flow cytometric immunophenotyping of the serosal fluid yield valuable information in the differential diagnosis of lymphocytic infiltrates. Herein, we describe the case of primary mantle cell lymphoma in a 75-year-old man presenting with abdominal fullness and weight loss, suggesting a gastrointestinal pathology.

Keywords: Cytomorphology; Effusions involving peritoneal and pericardial cavities; Flow cytometric immunophenotyping; Lymphoproliferative diseases; Mantle cell lymphoma.

Fig. 1

Peripheral smear demonstrated small lymphocytes with irregular nuclei (left arrow) and rare cytoplasmic projections (right arrow).

Fig. 2

Appearance of small (upper arrow) to medium-sized lymphocytes (lower arrow) with sparse cytoplasm and irregular nuclei with moderately dispersed chromatin in the ascitic fluid.

Fig. 3

On FCM immunophenotyping of the ascitic fluid, lymphoma cells showed CD5 (1st line 5th image), FMC7 and weak CD23 (2nd line 3rd image), CD20 (2nd line 4th image) and concomitant CD19 and CD5 (3rd line 2nd image) expression, compatible with a diagnosis of chronic lymphocytic leukemia/small lymphocytic lymphoma and MCL.

Fig. 4

Appearance of small lymphocytes (upper arrow) to medium-sized lymphocytes (lower arrow) with sparse cytoplasm and irregular nuclei with moderately dispersed chromatin in the pleural fluid.