scholarly journals Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma Presenting as Chronic Diarrhea; An Unusual Presentation of a Common Lymphoproliferative Disorder

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Smitha Narayana Gowda ◽  
Hafez Mohammad Abdullah ◽  
Rakshya Sharma ◽  
Mohamed A. Abdallah
Keyword(s):  
Chronic Lymphocytic Leukemia ◽  
Lymphoproliferative Disorder ◽  
Chronic Diarrhea ◽  
Central Nervous System Involvement ◽  
Reticuloendothelial System ◽  
The United States ◽  
Lymphocytic Leukemia ◽  
Small Lymphocytic Lymphoma ◽  
Common Causes ◽  
Variable Presentation

Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder in the United States. It has a variable presentation with most patients having asymptomatic lymphocytosis. Many other patients present with lymphadenopathy or enlargement of other organs of the reticuloendothelial system. However, CLL can present with extramedullary involvement. Most commonly, this is in the form of skin or central nervous system involvement, though rarely it can present with gastrointestinal involvement. Here, we present the case of a 70-year-old Caucasian male who presented with chronic diarrhea for over 4 months. After failing conservative treatment, a colonoscopy was performed which showed diffuse mucosal nodularities with a biopsy revealing CLL. The patient was treated successfully with chemotherapy and his diarrhea improved. This is a differential to keep in mind in patients with chronic diarrhea, once the more common causes have been ruled out.

scholarly journals Central Nervous System Involvement by Small Lymphocytic Lymphoma after a Myxoma-Related Embolic Event

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Nicolas Gallastegui ◽  
Daniel P. Cassidy ◽  
Deborah O. Heros ◽  
Francisco Vega ◽  
Jonathan H. Schatz
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Chronic Lymphocytic Leukemia ◽  
Chemotherapy Regimen ◽  
Central Nervous System Involvement ◽  
Lymphocytic Leukemia ◽  
High Dose ◽  
Sustained Remission ◽  
Small Lymphocytic Lymphoma ◽  
System Involvement

Involvement of the central nervous system by chronic lymphocytic leukemia/small lymphocytic lymphoma is exceedingly rare, and currently no risk factors have been described. We report the case of a patient with concomitant chronic lymphocytic leukemia/small lymphocytic lymphoma and an embolic cerebrovascular accident related to a cardiac myxoma, who developed parenchymal central nervous system involvement of lymphoma on the ischemic bed. The patient was successfully treated with a high-dose fludarabine-based chemotherapy regimen, achieving a sustained remission. We propose that embolic breakage of the blood-brain barrier may be a major risk factor in producing central nervous system involvement. We also propose that a high-dose fludarabine-based chemotherapy regimen may be adequate to achieve a better CNS penetration and improved outcomes.

scholarly journals The pathological features of leukemic cells infiltrating the renal interstitium in chronic lymphocytic leukemia/small lymphocytic lymphoma from a large single Chinese center

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Hui Wang ◽  
Xiaojuan Yu ◽  
Xu Zhang ◽  
Suxia Wang ◽  
Minghui Zhao
Keyword(s):  
Electron Microscopy ◽  
Chronic Lymphocytic Leukemia ◽  
Renal Injury ◽  
Lymphocytic Leukemia ◽  
Leukemic Cells ◽  
Cell Infiltration ◽  
Small Lymphocytic Lymphoma ◽  
Tubulointerstitial Injury ◽  
Renal Interstitium ◽  
Monoclonal Immunoglobulins

Abstract Background Chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is rare in Asians, and patients with CLL/SLL seldomly undergo kidney biopsy. The histopathological features and clinical relevance of tubulointerstitial injury in CLL/SLL have not been extensively characterized. Hence, we attempted to describe the clinical characteristics, renal pathology and clinical outcome of a well-characterized population of CLL/SLL patients with CLL cell infiltration in the renal interstitium from a large single center in China. Methods Between January 1st, 2010 and September 31st, 2020, 31946renal biopsies were performed at Peking University First Hospital, and 10 CLL/SLL patients with CLL cell infiltration in the renal interstitium were included. Complete clinical data were collected from these 10 patients, and renal specimens were examined by routine light microscopy, immunofluorescence and electron microscopy. Results The extent of the infiltrating CLL cells in patients with CLL/SLL varied among different patients and ranged from 10 to 90% of kidney parenchyma. Six (60%) of 10 patients presented with an extent of infiltrating CLL cells ≥50%. Interestingly, we found that three patients (3/10, 30%) expressed monoclonal immunoglobulins in the infiltrating CLL cells, and special cytoplasmic crystalline structures were found in two of the three patients by electron microscopy for the first time. Severe renal insufficiency (Scr ≥200 μmol/L) was associated with ≥50% interstitial infiltration of CLL cells in the renal interstitium. Conclusions The current study confirmed that CLL cells infiltrating the renal interstitium can directly secrete monoclonal immunoglobulins, indicating that the interstitial infiltrating CLL cells possibly cause renal injury directly by secreting monoclonal immunoglobulins in situ. This finding may prove a new clue to elucidate the pathogenetic mechanism of renal injury involved with CLL/SLL.

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