J Korean Med Sci.  2006 Oct;21(5):936-939. 10.3346/jkms.2006.21.5.936.

A Case of Leukemic Pleural Infiltration in Atypical Chronic Myeloid Leukemia

• Kim HW
• Lee SS
• Ryu MH
• Lee JL
• Chang HM
• Kim TW
• Chi HS
• Kim WK
• Lee JS
• Kang YK

• KMID: 1781919
• DOI: http://doi.org/10.3346/jkms.2006.21.5.936

Abstract

Pleural effusion in chronic myeloid leukemia (CML) is poorly understood and rarely reported in the literature. When the pleural effusion is caused by leukemic pleural infiltration, the differential white blood cell count of the effusion is identical to that of the peripheral blood, and the fluid cytology reveals leukemic blasts. We report here a case of bilateral pleural involvement of atypical CML in an 83-yr old male diagnosed with pancreatic cancer with abdominal wall metastasis and incidental peripheral leukocytosis. Based on bone marrow examination, chromosome analysis and polymerase chain reaction he was diagnosed with Philadelphia chromosome negative, BCR/ABL gene rearrangement negative CML. Following 3 months of treatment with gemcitabine for pancreatic cancer, he developed bilateral pleural effusions. All stages of granulocytes and a few blasts were present in both the pleural fluid and a peripheral blood smear. After treatment with hydroxyurea and pleurodesis, the pleural effusion resolved.

Keyword

Pleural Effusion; Atypical Chronic Myeloid Leukemia; Leukemia, Myeloid, Chronic

MeSH Terms

Pleural Effusion/*etiology/pathology
Male
Leukemic Infiltration/*pathology
Leukemia, Myeloid, Chronic/complications/*pathology
Humans
Aged, 80 and over
Aged

Figure

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  Fig. 1 (A) Smear of marrow aspirate showing increased numbers of granulocytes at all stages of development and blasts (Wright-Giemsa stain, ×400). (B) Smear of marrow aspirate showing hypogranular myelocytes (arrow) (Wright-Giemsa stain, ×1,000).

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  Fig. 2 Computed tomography of the abdomen demonstrating a solid mass in the tail of the pancreas with attachment to the spleen.

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  Fig. 3 Radiograph of the chest revealing bilateral pleural effusion.

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  Fig. 4 Smear of pleural effusion sediment showing several early granulocytes with morphologic features similar to the cells in the bone marrow (Wright-Giemsa stain, ×1,000).

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