Autopsy and Case Reports
http://autopsyandcasereports.org/article/doi/10.4322/acr.2016.022
Autopsy and Case Reports
Article / Autopsy Case Report

Advanced chronic lymphoid leukemia with severe bronchopneumonia: an Autopsy Case Report

Felipe Gomes Campos Amaral, Luiz Guilherme Cernaglia Aureliano Lima, Veruska Menegatti Anastacio Hatanaka, Sheila Aparecida Coelho Siqueira, Amaro Nunes Duarte-Neto

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Abstract

Chronic lymphocytic leukemia (CLL) is a lymphoid neoplasia with the B immunophenotype, which corresponds to the leukemic form of lymphocytic lymphoma. This entity is characterized, in most cases, by immunosuppression due to impaired function of immune cells, hypogammaglobulinemia, bone marrow infiltration, and immune dysfunction due to the neoplasia and the chemotherapy, when prescribed. We describe the case of a 63-year-old woman with a previous diagnosis of advanced CLL, refractory to treatment, who presented respiratory failure at the emergency department and died soon after hospital admission. The autopsy examination showed a large retroperitoneal mass compressing large vessels and abdominal and pelvic organs; generalized lymphadenopathy; and liver, spleen, bone marrow, heart and kidney infiltration. A Gram-negative bacilli bronchopneumonia with diffuse alveolar damage was detected, which was likely to be the immediate cause of death.

Keywords

Leukemia, Lymphocytic, Chronic, B-Cell, Respiratory Insufficiency, Pneumonia, Autopsy.

References

1. Hallek M, Cheson BD, Catovsky D,  et al. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute-Working Group 1996 guidelines. Blood. 2008;111(12):5446-56. http://dx.doi.org/10.1182/blood-2007-06-093906. PMid:18216293.

2. Swerdlow SH, Campo E, Harris NL, et al, editors. World Health Organization classification of tumours of haematopoietic and lymphoid tissues. 4th ed. Lyon: IARC Press; 2008.

3. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5-29. http://dx.doi.org/10.3322/caac.21254. PMid:25559415.

4. Smith A, Howell D, Patmore R, Jack A, Roman E. Incidence of haematological malignancy by sub-type: a report from the Haematological Malignancy Research Network. Br J Cancer. 2011;105(11):1684-92. http://dx.doi.org/10.1038/bjc.2011.450. PMid:22045184.

5. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64(1):9-29. http://dx.doi. org/10.3322/caac.21208. PMid:24399786.

6. Rai KR, Sawitsky A, Cronkite EP, Chanana AD, Levy RN, Pasternack BS. Clinical staging of chronic lymphocytic leukemia. Blood. 1975;46(2):219-34. PMid:1139039.

7. Binet JL, Auquier A, Dighiero G,  et al. A new prognostic classification of chronic lymphocytic leukemia derived from a multivariate survival analysis. Cancer. 1981;48(1):198-206. http://dx.doi.org/10.1002/1097-0142(19810701)48:1<198::AID- CNCR2820480131>3.0.CO;2-V. PMid:7237385.

8. Dearden C. Disease-specific complications of chronic lymphocytic leukemia. Hematology. 2008;2008(1):450-6. http://dx.doi.org/10.1182/asheducation-2008.1.450. PMid:19074125.

9. DiLillo DJ, Weinberg JB, Yoshizaki A,  et al. Chronic lymphocytic leukemia and regulatory B cells share IL-10 competence and immunosuppressive function. Leukemia. 2013;27(1):170-82. http://dx.doi.org/10.1038/leu.2012.165. PMid:22713648.

10.Batlle M, Ribera JM, Oriol A,  et al. Pneumonia in patients with chronic lymphocytic leukemia: study of 30 episodes. Med Clin. 2001;116(19):738-40. http://dx.doi.org/10.1016/S0025-7753(01)71970-7. PMid:11412696

11.Nowakowski GS, Hoyer JD, Shanafelt TD,  et al. Using smudge cells on routine blood smears to predict clinical outcome in chronic lymphocytic leukemia: a universally available prognostic test. Mayo Clin Proc. 2007;82(4):449-53. http://dx.doi.org/10.4065/82.4.449. PMid:17418074.

12.Viadana E, Bross ID, Pickren JW. An autopsy study of the metastatic patterns of human leukemias. Oncology. 1978;35(2):87-96. http://dx.doi.org/10.1159/000225262. PMid:274679.

13.O’Mahony D, Piekarz RL, Bandettini WP, Arai AE, Wilson WH, Bates SE. Cardiac involvement with lymphoma: a review of the literature. Clin Lymphoma Myeloma. 2008;8(4):249-52. http://dx.doi.org/10.3816/CLM.2008.n.034. PMid:18765314.

14.Schwartz JB, Shamsuddin AM. The effects of leukemic infiltrates in various organs in chronic lymphocytic leukemia. Hum Pathol. 1981;12(5):432-40. http://dx.doi.org/10.1016/S0046-8177(81)80023-8. PMid:7250955.

15.Barcos M, Lane W, Gomez GA,  et al. An autopsy study of 1206 acute and chronic leukemias (1958 to 1982). Cancer. 1987;60(4):827-37. http://dx.doi.org/10.1002/1097-0142(19870815)60:4<827::AID- CNCR2820600419>3.0.CO;2-A. PMid:3474054.

16.Aymard B, Beghoura R, Molina TJ. Renal infiltrate by a plasmocytoïd chronic B lymphocytic leukaemia and renal failure: a rare occurrence in nephropathology: a case report and review of the literature. Nephrol Ther. 2011;7(6):479-87. http://dx.doi.org/10.1016/j.nephro.2011.02.001. PMid:21439927.

17.Erten N, Saka B, Caliskan YK, Besisik S, Karan MA, Tascioglu C. Acute renal failure due to leukaemic infiltration in chronic lymphocytic leukaemia: case report. Int J Clin Pract Suppl. 2005;59(147):53-5. http://dx.doi.org/10.1111/j.1368-504X.2005.00049.x. PMid:15875623.

18.Xiao JC, Walz-Mattmüller R, Ruck P, Horny HP, Kaiserling E. Renal involvement in myeloproliferative and lymphoproliferative disorders. A study of autopsycases. Gen Diagn Pathol. 1997;142(3-4):147-53. PMid:9065578.

19.Applefeld MM, Milner SD, Vigorito RD, Shamsuddin AM. Congestive heart failure and endocardial fibroelastosis caused by chronic lymphocytic leukemia. Cancer. 1980;46(6):1479-84. http://dx.doi.org/10.1002/1097-0142(19800915)46:6<1479::AID- CNCR2820460631>3.0.CO;2-R. PMid:7417948.

20.Assiri AH, Lamba M, Veinot JP. Chronic lymphocytic leukemia involving the coronary arteries with accompanying acute myocardial infarction. Cardiovasc Pathol. 2005;14(6):324-6. http://dx.doi.org/10.1016/j.carpath.2005.07.006. PMid:16286042.

21.Habboush HW, Dhundee J, Al Okati D, Davies AG. Constrictive pericarditis in B cell chronic lymphatic leukaemia. Clin Lab Haematol. 1996;18(2):117-9. http://dx.doi.org/10.1046/j.1365-2257.1996.00164.x. PMid:8866146.

22.Tandon B, Peterson L, Gao J, et al. Nuclear overexpression of lymphoid-enhancer-binding factor 1 identifies chronic lymphocytic leukemia/small lymphocytic lymphoma in small B-cell lymphomas. Mod Pathol. 2011;24(11):1433-43. http://dx.doi.org/10.1038/modpathol.2011.103. PMid:21685909.

23.Menter T, Dirnhofer S, Tzankov A. LEF1: a highly specific marker for the diagnosis of chronic lymphocytic B cell leukemia / small lymphocytic B cell lymphoma. J Clin Pathol. 2015;68(6):473-8. http://dx.doi.org/10.1136/jclinpath-2015-202862. PMid:25713417.

24.Schlette EJ, Schlette EJ, Admirand J, et al. p53 expression by immunohistochemistry is an importantdeterminant of survival in patients with chronic lymphocytic leukemiareceiving frontline chemo-immunotherapy. Leuk Lymphoma. 2009;50(10):1597-605. http://dx.doi.org/10.1080/10428190903165241. PMid:19863337.

25.Admirand JH, Knoblock RJ, Coombes KR,  et al. Immunohistochemical detection of ZAP70 in chronic lymphocytic leukemia predicts immunoglobulin heavy chain gene mutation status and time to progression. Mod Pathol. 2010;23(11):1518-23. http://dx.doi.org/10.1038/modpathol.2010.131. PMid:20657554.

26.Möller P, Feichter GE, Fritze D, Haag D, Schüle B. J-chain- producing immunoblastic lymphoma in a case of Richter’s syndrome. Immunohistochemical evidence for a gradual malignant transformation of a single B-cell clone and flow cytophotometric data. Virchows Arch A Pathol Anat Histol. 1982;396(2):213-24. PMid:6812283.

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