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Dr. Aslam presented a rare case with peritoneal lymphomatosis and
concluded that a histologic examination is crucial in the diagnosis, while
cytology might sometimes mislead the workup.1 However, we present here
another such case with raised CA 125 and demonstrate that cytology with a
flow cytometry examination can help in the diagnosis.
This 44-year-old female suffered from autoimmune disord...
This 44-year-old female suffered from autoimmune disorder and had
been using steroids for several months. She was admitted to our ward due
to progressive abdominal fullness, back soreness and shortness of breath.
An abdominal echo revealed a pelvic mass with ascites. A computed
tomography (CT) scan showed bilateral ovarian masses and multiple
lymphadenopathies over the pelvic, abdominal and retroperitoneal areas.
Biomarkers including CEA, SCC, AFP, CA 199, CA 153 were all within normal
range except for a raised CA 125 level (125.27 U/ml, normal range 2.4~36.6
Ascitic fluid showing a turbid appearance was aspirated and sent for
cytologic and microbiologic studies, however no micro-organisms grew from
the culture. The cytologic study revealed massive lymphocytes with bizarre
morphology. Flow cytometry was used to determine the characteristics of
the cells, and showed positive for CD10, CD19, CD20, and negative for CD7.
Under the impression of suspected lymphoma with peritoneal
lymphomatosis, CT guided biopsy of the lymph node was done. The resulting
histology examination revealed a diffuse large B cell lymphoma which was
positive for LCA, CD20 and negative for cytokeratin and CD7 (fig 1). She
received systemic chemotherapy with R-CEOP regimen, but unfortunately died
Peritoneal lymphomatosis is a rare manifestation of malignant
lymphoma. Although there are some criteria that tell the difference of
peritoneal lymphomatosis from carcinomatosis, most of the cases are
indistinguishable from the clinical presentations and image studies.2,3
Even the tumor markers, such as a raised CA 125 as in this case, cannot
rule out the diagnosis of peritoneal lymphomatosis completely.4 These
factors stress the importance of putting lymphoma into the list of
diagnoses in such patients. We also highlight the important role of
cytology examinations with flow cytometry, which might also help the
physician in the diagnosis of peritoneal lymphomatosis and avoid
unnecessary studies and treatment.
Hui-Hua Hsiao,1, 2 Yi-Chang Liu,1, 2 Jui-Feng Hsu,1 Sheng-Fung Lin1,2
1 Faculty of Medicine, College of Medicine, Kaohsiung Medical
2 Division of Hematology-Oncology, Department of Internal
Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
Correspondence to: Dr SF Lin, Department of Internal Medicine,
Kaohsiung Medical University Hospital, 100, Tzu-You 1st Road, Kaohsiung
Competing interests: none
1. Aslam MB. Peritoneal lymphomatosis, a morphological look alike to
peritoneal carcinomatosis: a autopsy report. J Clin Pathol 2009;62:480.
2. Kim Y, Cho O, Song S, et al. Peritoneal lymphomatosis: CT findings.
Abdom Imaging 1998;23:87-90.
3. Karaosmanoglu D, Karcaaltincaba M, Oguz B, et al. CT findings of
lymphoma with peritoneal, omental and mesenteric involvement: Peritoneal
lymphomatosis. Eur J Radiol 2008; in press
4. Horger M, Muller-Schimpfle M, Yirkin I, et al. Extensive peritoneal and
omental lymphomatosis with raised CA 125 mimicking carcinomatosis: CT and
intraoperative findings. Br J Radiol 2004;77:71-3.
Diffuse infiltration of medium-sized, monotonous round cells with
hyperchromatic nuclei and scant cytoplasm (H&E stain, x400). Upper right:
Positive CD20 reaction to the lymphoma cells and no reaction to