Case Report: CLL Found at the Time of Lung Transplantation
Posted: Wednesday, November 3, 2021
A case presentation published in Transplantation Proceedings highlighted the incidental detection of chronic lymphocytic leukemia (CLL) in the hilar lymph nodes of a patient who was undergoing lung transplantation. Tsuyoshi Takahashi, MD, PhD, of Washington University, St. Louis, and colleagues admitted that although such unexpected discoveries are uncommon, therapeutic strategies for solid-organ transplant recipients can be challenging, and a detailed review of pathologic sections is key.
The 68-year-old male patient was referred to their clinic for consideration for lung transplantation and underwent a series of procedures to assess lung function. Their initial findings revealed a severe restrictive ventilatory defect and interstitial fibrosis consistent with usual interstitial pneumonitis.
Lung transplantation was recommended, and 2 months after enrolling on the transplant list, the patient underwent bilateral transplantation. Lymph nodes in the right hilum were then removed for further testing, as they appeared enlarged during surgery. Histopathologic examination, a whole-body scan, and peripheral blood flow cytometry were conducted to determine the cause of lymphadenopathy.
Histopathologic examination revealed effacement of normal nodal architecture by the proliferation of small lymphocytes that co-expressed CD20, CD23, CD43, and CD5. However, the whole-body scan did not reveal further lymphadenopathy. Peripheral blood flow cytometry revealed normal hemoglobin and platelet levels; however, the clonality of the B lymphocytes was found to be positive for CD19, CD20 with co-expression of CD5, CD23, and CD200. This ultimately led to a diagnosis of Rai stage I CLL. The patient was not initially treated for leukemia and remained on the triple-drug maintenance immunosuppression regimen to prevent graft rejection.
At 1 year after surgery, a large recurrent left pleural effusion was found and removed via video-assisted surgery. Pathology testing revealed no signs of CLL, and the patient had stable lung function 24 months after surgery.
Disclosure: For full disclosures of the study authors, visit, sciencedirect.com.
