Small Noncleaved Cell Lymphoma Presenting as a Massive Pericardial Effusion

BACKGROUND: Non-Hodgkin's lymphoma (NHL) is commonly associated with cardiac involvement, especially in cases of advanced stages with mediastinal involvement. Much rarer is the initial presentation of NHL as a pericardial effusion; there are only 12 cases reported. In addition, only 5 of these 12 cases were correctly diagnosed based on examination of pericardial fluid prior to death: 3 were based on routine cytology; 1 on immunoperoxidase staining and 1 on an immunofluorescent slide method. CASE: A 71-year-old, white female presented with a massive pericardial effusion. Small noncleaved cell lymphoma was expeditiously diagnosed by cytologic examination combined with flow cytometric immunophenotyping. No further diagnostic tissue was obtained; the patient was staged and offered treatment with a protocol for high grade lymphoma. CONCLUSION: Combining cytomorphology and flow cytometric immunophenotyping in such cases results in an expeditious, nonsurgical diagnosis, upon which therapeutic decision making may be based.