Abstract：
Serous effusions occur in a small group of patients with classic Hodgkin lymphoma (cHL). Most effusions are benign inflammatory fluids. Malignant effusions predominantly in patients with treated relapsed diseases or rarely as a primary manifestation are diagnostically challenging to cytopathologists. Established cases of cHL with effusions were retrieved. Cytology slides were screened looking for Reed-Sternberg-Hodgkin (RSH) cells and patterns of background inflammatory cells. Cellblocks and their corresponding immunocytochemistry (ICC) slides were examined. The cytologic findings were correlated with nodal biopsy histopathologic and immunohistochemical features. We found six cases of benign and malignant pleural and pericardial effusions in patients with mediastinal nodular sclerosis-type cHL. Various cytomorphologic patterns were observed. Slides revealed sparsely scattered either isolated or aggregated mononuclear, binucleated and multinucleated RSH-like cells. Some may have been either disregarded as reactive mesothelial or histiocytic cells, or confused with other RSH-like malignant cells. The background varied between characteristic mixed inflammatory milieu, predominantly small lymphocytic or lymphohistiocytic with or without reactive mesothelial cells. Cytologic examination showed three positive cases (two cases with RSH cells confirmed by cellblock section ICC, one case with a mixed inflammatory infiltrate), and three benign effusions (one case with atypical RSH-like reactive mesothelial cells confirmed by ICC). Effusions associated with cHL exhibit different cytologic patterns. A high level of vigilance with utility of ICC has an important role in suspecting primary cases and confirming recurrences in known cases. The various cytologic patterns of cHL-associated benign and malignant effusions might reflect parallel pathophysiologic mechanisms.
摘要：
浆液性积液发生在一小部分经典霍奇金淋巴瘤（cHL）患者中。大多数积液是良性炎症液体。对于细胞病理学家来说，恶性积液主要存在于复发性疾病患者中，或很少作为主要表现。检索了已确定的有积液的cHL病例。筛选细胞学载玻片,寻找Reed-Sternberg-Hodgkin(RSH)细胞和背景炎性细胞的模式。检查细胞块及其相应的免疫细胞化学（ICC）载玻片。细胞学检查结果与淋巴结活检组织病理学和免疫组织化学特征相关。我们发现纵隔结节硬化型cHL患者中有6例良性和恶性胸膜和心包积液。观察到各种细胞形态学模式。幻灯片显示稀疏分散的孤立或聚集的单核，双核和多核RSH样细胞。有些可能被忽略为反应性间皮或组织细胞，或与其他RSH样恶性细胞混淆。背景在特征性混合炎症环境之间变化，主要是小淋巴细胞或淋巴组织细胞，有或没有反应性间皮细胞。细胞学检查显示3例阳性（2例经细胞阻滞切片ICC证实为RSH细胞，一例混合炎症浸润)，良性积液3例（ICC证实1例不典型RSH样反应性间皮细胞）。与cHL相关的积液表现出不同的细胞学模式。对ICC的效用保持高度警惕对于怀疑主要病例和确认已知病例的复发具有重要作用。cHL相关良性和恶性积液的各种细胞学模式可能反映了并行的病理生理机制。
