Chronic Lymphocytic Leukemıa Hospitalized Due To Pleural Effusion - A Case Report

Case Report

Abstract

Objective: Malignant pleural effusion was detected in 15% of patients who died of malignancy. Chronic lymphocytic leukemia is the most common leukemia in adults. In this case, we aimed to elucidate the importance of pleural biopsy fluid cytology, biochemistry, and imaging.

Case: A 58-year-old male patient with a diagnosis of chronic lymphocytic leukemia was admitted to our institution with complaints of dyspnea and hypoxia. At the time of admission, the patient complained of dyspnea and hypoxia, and evacuatory thoracentesis was performed in order to relieve her symptoms. Fluid biochemistry was exudate, and pathology was benign. Tube thoracostomy was applied upon the recurrence of the fluid. Thorax computerized tomography (CT) revealed no pathology except minimal effusion. Positron emission tomography scans (PET/CT) revealed a slightly increased 18 - Fludeoxyglucose (FDG – 18) uptake in the paramediastinal area. Two closed pleural biopsies were performed, and the result was reported as benign. Upon detection of a 5 cm solid, immobile mass on the right chest wall in control, an incisional biopsy was taken over the lesion. Chemotherapy (CT) and radiotherapy (RT) was initiated. The patient, who was followed up for 3 months for undiagnosed pleural effusion, died from a mass on the chest wall and 2 months after diagnosis of malignant mesothelioma.

Conclusion: In this case, we wanted to emphasize the importance of performing a large-scale open pleural biopsy with absolute vision in recurrent pleural effusions, where fluid cytology, biochemistry, and imaging methods can be misleading and increase the awareness of clinicians.