Persisting right-sided chylothorax in a patient with chronic lymphocytic leukemia: a case report

Abstract

IntroductionChylothorax caused by chronic lymphocytic leukemia is very rare and the best therapeutic approach, especially the role of modern immunochemotherapy, is not yet defined.Case presentationWe present the case of a 65-year-old male Caucasian patient with right-sided chylothorax caused by a concomitantly diagnosed chronic lymphocytic leukemia. As first-line treatment four cycles of an immunochemotherapy, consisting of fludarabine, cyclophosphamide and rituximab were administered. In addition, our patient received total parenteral nutrition for the first two weeks of treatment. Despite the very good clinical response of the lymphoma to treatment, the chylothorax persisted and percutaneous radiotherapy of the thoracic duct was applied. However, eight weeks after the radiotherapy the chylothorax still persisted and our patient agreed to a surgical intervention. A ligation of the thoracic duct via a muscle sparing thoracotomy was performed, resulting in a complete cessation of the pleural effusion. Apart from the first two weeks our patient was treated on an out-patient basis for nearly six months.ConclusionIn this case of chylothorax caused by chronic lymphocytic leukemia, immunochemotherapy in combination with conservative treatment, and even consecutive radiotherapy, were not able to stop pleural effusion, despite the very good clinical response of the chronic lymphocytic leukemia to treatment.Out-patient management using repetitive thoracocenteses can be safe as bridging until definitive surgical ligation of the thoracic duct.

Dasatinib-Related Chylothorax

“…Nontraumatic etiologies include malignancy, sarcoidosis, retrosternal goiter, amyloidosis, superior vena cava thrombosis, benign tumors, congenital duct abnormalities, and diseases of the lymph vessels such as yellow nail syndrome, lymphangioleiomyomatosis, and hemangiomatosis [ 10 ]. Hematologic malignancies including lymphoma, chronic lymphocytic leukemia, and Waldenström macroglobulinemia were reported to be associated with chylothorax [ 11 , 12 , 13 , 14 , 15 ]. Among the above hematologic malignancies, non-Hodgkin’s lymphoma is the most common.…”

Chylothorax due to leukemic infiltration in a patient with chronic lymphocytic leukemia

“…In patients with non-Hodgkin lymphoma and Hodgkin disease pleural effusions are reported with a frequency of 20% and 30%, respectively [6] . In patients with malignancy, chylous pleural effusions are usually associated with damage of the thoracic duct and related lymphatic channels of the thorax, neck, and abdomen [7] . CLL usually involves the peripheral blood and bone marrow but involvement of the thorax, consisting of pulmonary infiltrates and pleural effusion, rarely occur [2] .…”

“…Patients with pleural involvement by CLL usually have a long-standing diagnosis of CLL and thus they may have a limited prognosis [6] , [7] . But the patients who had either successful thoracic duct ligation, mediastinal irradiation or pleurodesis were reported longer survival [6] .…”

“…Chronic lymphocytic leukemia (CLL) is an indolent type of B-cell non-Hodgkin's lymphoma that can be found in the bone marrow and blood, or predominantly in lymph nodes [3] . Pleural effusion occurs commonly in non-Hodgkin's lymphoma, but is less often in CLL [7] . Here, we present a case of chylothorax in a patient with CLL which was diagnosed by immunoflow cytometric analyses.…”

Spontaneous Resolution of Chylothorax-Associated Lymphoma Treated with External Beam Radiotherapy: A Case Report and Comprehensive Review of the Literature

“… Little [ 16 ] 66 M Metastatic prostate cancer, lungs, supraclavicular LN Left 4,400 cGy to the mediastinum and left supraclavicular LN Resolved and controlled at 5 months. Scholz [ 17 ] 65 M CLL Right 2,400 cGy to the mediastinum and thoracic duct Persisted at 8 weeks. Swenson [ 18 ] 28 M Lymphosarcoma, abdomen Bilateral 3,150 rads in 25# Resolution at the end of radiotherapy 48 M Lymphosarcoma, abdomen Left 3,850 rads in 25# Resolution mid-way through radiotherapy.…”