Abstract Introduction Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in the West and its disease process is characterized by accumulation of immunologically dysfunctional mature B lymphocytes. The most common pulmonary imaging finding associated with CLL is infection, but there has been recognition of non-infectious pulmonary involvements such as pleural effusion and leukemic pulmonary infiltrates (LPI). The incidence of these findings is rare in the absence of clinical progression or signs of aggressive transformation of the underlying CLL. It’s clinical implications are unclear. We report a case of pulmonary nodules and of pleural involvement in patients with underlying CLL otherwise monitored without evidence of other clinical progression. Case Report Case 1: A 74-year-old male with past medical history of CLL diagnosed in 2008, stage I lung adenocarcinoma status post wedge resection of the left lower lobe, had surveillance imaging findings of multiple waxing and waning pulmonary nodules. He otherwise remained asymptomatic, stable hematologic counts (stable leukocytosis, mild anemia, no thrombocytopenia), and had stable splenomegaly. Bronchoscopy with cryobiopsies of the left lower lobe and right lower lobe nodules showed involvement of his underlying CLL. Case 2: An 82 year old male with past medical history of CAD was found to have recurrent left pleural effusion, later had occurrence of right pleural effusion. Amongst workup, flow cytometry revealed CD5 positive, CD23 positive B cell lymphoma. Peripheral blood flow confirmed the same B cell population. It remained unclear if the effusions were secondary to CLL in the absence of lymphocytosis and other signs meeting criteria for high-risk disease nor treatment. Ultimately, right pleural biopsies revealed involvement of CLL. Discussion Many patients with CLL are asymptomatic at diagnosis and the disease course is indolent. Management is typically observation. Treatment is reserved for patients who develop lymphadenopathy or Richter’s transformation. Findings of pleural involvement and multiple nodular opacities are uncommon, particularly in the absence of progressive disease and lack of other high-risk features by Rai criteria. The clinical implications of these findings are not well elucidated as current guidelines do not specify how pulmonary involvement should be factored in the absence of symptoms. As diagnostic evaluations of pulmonary findings become more approachable and available, there may be increased incidence of these findings, for which it is prudent to understand if and how they may contribute towards disease severity and progression and resultant management. This abstract is funded by: None
Pichiarello et al. (Fri,) studied this question.