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Lad D, Malhotra P, Varma N, Sachdeva MS, Das A, Srinivasan R, Bal A, Khadwal A, Prakash G, Suri V, Kumari S, Jain S, Varma S. CLL: Common Leukemia; Uncommon Presentations. Indian J Hematol Blood Transfus 2014; 32:268-75. [PMID: 27429518 DOI: 10.1007/s12288-014-0488-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 12/03/2014] [Indexed: 12/25/2022] Open
Abstract
We report here a series of ten patients with uncommon presentations and associations of chronic lymphocytic leukemia (CLL) not reported hitherto or occasionally reported in literature. The first two cases describe unusual causes of abdominal distension in CLL and unusual sites infiltration by CLL. The next two cases illustrate occurrence of CLL in association with other hematological malignancies. Cases five and six describe unusual infections and their impact on CLL. Cases seven and eight depict associations of rare non-hematological autoimmune conditions with CLL. The last two cases describe transformation at unusual sites. This series of ten cases illustrates how a common leukemia like CLL can present in different forms and how despite so much progress in understanding of this leukemia so little is known of such presentations.
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Affiliation(s)
- Deepesh Lad
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Pankaj Malhotra
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Neelam Varma
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manupdesh Singh Sachdeva
- Department of Hematology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashim Das
- Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Alka Khadwal
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Gaurav Prakash
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Vikas Suri
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Savita Kumari
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Sanjay Jain
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Subhash Varma
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
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Huang YM, Shih LY, Dunn P, Wang PN, Kuo MC, Wu JH, Lin TL, Tang TC, Chang H, Kao HW, Shih HJ, Hung YS. Chronic lymphocytic leukemia presenting with ascites diagnosed by clonality analysis via gene rearrangement assay: A case report. Oncol Lett 2014; 7:1911-1914. [PMID: 24932257 PMCID: PMC4049705 DOI: 10.3892/ol.2014.2044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 03/14/2014] [Indexed: 11/07/2022] Open
Abstract
The diagnosis of chronic lymphocytic leukemia (CLL) presenting with ascites is predominantly based on the morphological and immunophenotypic characteristics, which are comparable to peripheral blood and bone marrow cells. However, it is relatively difficult to diagnose CLL due to the pleomorphism of the lymphocytes in ascites. The current study presents an 80-year-old male with a prior diagnosis of CLL who developed large ascites. Predominant T lymphocytes rendered morphological and immunophenotypic diagnosis difficult. Clonality analysis of immunoglobulin (Ig) gene rearrangements was performed on the lymphocytes from the ascites to diagnose the involvement of CLL, a laparotomy and biopsy from the peritoneal node confirmed the involvement of small lymphocytic lymphoma/CLL. The clonality analysis of Ig gene rearrangements may provide a powerful and accurate method for diagnosing CLL presenting with ascites.
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Affiliation(s)
- Yen-Min Huang
- Department of Internal Medicine, Division of Hematology and Oncology, Chang Gung Memorial Hospital, Keelung, Taoyun 33305, Taiwan, R.O.C. ; Department of Internal Medicine, Division of Hematology and Oncology, Chang Gung Memorial Hospital, Linkou, Taoyun 33305, Taiwan, R.O.C
| | - Lee-Yung Shih
- Department of Internal Medicine, Division of Hematology and Oncology, Chang Gung Memorial Hospital, Linkou, Taoyun 33305, Taiwan, R.O.C. ; School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, R.O.C
| | - Po Dunn
- Department of Internal Medicine, Division of Hematology and Oncology, Chang Gung Memorial Hospital, Linkou, Taoyun 33305, Taiwan, R.O.C. ; School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, R.O.C
| | - Po-Nan Wang
- Department of Internal Medicine, Division of Hematology and Oncology, Chang Gung Memorial Hospital, Linkou, Taoyun 33305, Taiwan, R.O.C. ; School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, R.O.C
| | - Ming-Chung Kuo
- Department of Internal Medicine, Division of Hematology and Oncology, Chang Gung Memorial Hospital, Linkou, Taoyun 33305, Taiwan, R.O.C. ; School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, R.O.C
| | - Jin-Hou Wu
- Department of Internal Medicine, Division of Hematology and Oncology, Chang Gung Memorial Hospital, Linkou, Taoyun 33305, Taiwan, R.O.C. ; School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, R.O.C
| | - Tung-Liang Lin
- Department of Internal Medicine, Division of Hematology and Oncology, Chang Gung Memorial Hospital, Linkou, Taoyun 33305, Taiwan, R.O.C. ; School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, R.O.C
| | - Tzung-Chih Tang
- Department of Internal Medicine, Division of Hematology and Oncology, Chang Gung Memorial Hospital, Linkou, Taoyun 33305, Taiwan, R.O.C. ; School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, R.O.C
| | - Hung Chang
- Department of Internal Medicine, Division of Hematology and Oncology, Chang Gung Memorial Hospital, Linkou, Taoyun 33305, Taiwan, R.O.C. ; School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, R.O.C
| | - Hsiao-Wen Kao
- Department of Internal Medicine, Division of Hematology and Oncology, Chang Gung Memorial Hospital, Linkou, Taoyun 33305, Taiwan, R.O.C. ; School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, R.O.C
| | - Hsuan-Jen Shih
- Department of Internal Medicine, Division of Hematology and Oncology, Chang Gung Memorial Hospital, Linkou, Taoyun 33305, Taiwan, R.O.C
| | - Yu-Shin Hung
- Department of Internal Medicine, Division of Hematology and Oncology, Chang Gung Memorial Hospital, Linkou, Taoyun 33305, Taiwan, R.O.C
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Yonal I, Nazlıgul E, Tas G, Agan MR, Yenerel MN, Nalcaci M. A case of chronic lymphocytic leukemia with massive ascites. Rare Tumors 2012; 4:e51. [PMID: 23372915 PMCID: PMC3557565 DOI: 10.4081/rt.2012.e51] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 08/22/2012] [Accepted: 10/03/2012] [Indexed: 11/23/2022] Open
Abstract
An 81-year old woman with a history of chronic lymphocytic leukemia (CLL) was admitted with night sweats and abdominal distension. A complete blood count showed hemoglobin 5 g/dL, white blood cell (WBC) count 28.5×10(9)/L and platelets 38.4×10(9)/L. Peripheral blood smear examination showed a large number of smudge cells and lymphocytosis composed of mature-looking lymphocytes with clumped nuclear chromatin. Computed tomography scan demonstrated enlarged cervical, axillary, paraaortic, retroperitoneal and mesenteric lymph nodes with concomitant omental thickening and ascites. Also, the liver and the spleen were enlarged in the presence of multiple ill-defined hypoechoic areas in the latter. Histopathological analysis of the cervical lymph node biopsy was consistent with CLL. Bone marrow examination showed diffuse infiltration of the marrow with small lymphocytes. Analysis of the ascitic fluid revealed an exudate with WBC 1220 cells/mL. Cytocentrifuge preparation of the ascitic fluid showed small mature lymphoid cells containing hyperchromatic nuclei with coarsely granular chromatin. On flow cytometric analysis of the ascitic fluid, expression of CD5, CD19, CD20, CD22, CD23, CD45 and HLA-DR was compatible with a diagnosis of CLL, in accordance with the results of the peripheral blood analysis. The patient was treated with chemotherapy consisting of cyclophosphamide, vincristine and prednisolone but died within one month after development of non-chylous ascites.
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Affiliation(s)
- Ipek Yonal
- Department of Internal Medicine, Division of Hematology and
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Siddiqui N, Al-Amoudi S, Aleem A, Arafah M, Al-Gwaiz L. Massive ascites as a presenting manifestation of chronic lymphocytic leukemia. World J Gastroenterol 2008; 14:3594-7. [PMID: 18567094 PMCID: PMC2716628 DOI: 10.3748/wjg.14.3594] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Revised: 04/30/2008] [Accepted: 05/07/2008] [Indexed: 02/06/2023] Open
Abstract
Ascites is not an uncommon manifestation of certain solid tumors like gastrointestinal malignancies, ovarian cancer and breast cancer. However, it is unusual to encounter ascites in patients with hematological malignancies especially chronic leukemia. The patient described here presented with massive ascites and blood lymphocytosis. Further studies confirmed the diagnosis of chronic lymphocytic leukemia with ascites. The ascitic fluid was exudative, consisting of mature-looking B-lymphocytes, which were morphologically and immunophenotypically similar to peripheral blood and bone marrow cells. The patient was treated with chemotherapy and achieved a good response and diminution of ascitic fluid accumulation.
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