Second lung malignancy and Richter syndrome in chronic lymphocytic leukemia: case report and literature review

Abstract

BackgroundChronic lymphocytic leukemia (CLL) is the most frequent lymphoproliferative disease. Transformation into Richter disease and occurrence of second malignancies involving the lungs are rare complications. The hallmarks of any thoracic involvement are still unknown.Case presentationWe report a case of a 56-year-old male patient, with history of tobacco smoking, who presented with recurrent hemoptysis, fatigue and weight loss. Physical examination was normal except a slightly enlarged supraclavicular lymph node. Chest x-ray revealed a mediastinal widening due to enlarged paratracheal nodes and a left parahilar infiltrate. Blood tests showed a hyperlymphocytosis and a biological inflammatory syndrome. CT scan showed bilateral mediastinal and axillary lymphadenopathy, as well as left supraclavicular lymphadenopathy, with a left upper lobe alveolar attenuation and a solitary contralateral pulmonary nodule. Examination of Virchow’s node and bone marrow biopsies confirmed metastasis of a pulmonary adenocarcinoma, as well as chronic lymphocytic leukemia with Richter’s transformation. The clinical course was unfavorable since the first days of therapy as the patient passed away in a matter of a few days.ConclusionsSteady surveillance of CLL patients and systematic screening for second solid tumors, particularly lung cancer, and Richter’s transformation seem to be relevant more than ever. Early diagnosis might help us understand the pathways leading to these complications and adapt therapy.

An Unusual Coexistence of Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma with Endometrioid-Type Endometrial Cancer in a 58-Year-Old Woman: A Case Study with Literature Review

“…A comprehensive literature review showed various malignancies coexisting with CLL/SLL [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. For example, CLL/SLL has been reported coincidentally with adenocarcinoma of the stomach, kidney, breast, colon, liver, and lung [ 3 , 10 , 11 , 12 ]. Based on our knowledge, this is the first study reporting the coexistence of endometrioid-type G2 endometrial cancer with CLL/SLL.…”

“…Interestingly, an increased risk for the coexistence of a second malignancy, of epithelial and mesenchymal origin, has been reported in patients with CLL/SLL, for example, in lung cancer [ 3 ] or bladder and prostate cancers [ 4 ]. The development of a second malignancy was comparable in patients without or with chemotherapy [ 5 ].…”

Troisier sign and Virchow node: the anatomy and pathology of pulmonary adenocarcinoma metastasis to a supraclavicular lymph node

“…The VN has been well-established as a signal node for the spread of gastric cancer 4 - 9. In addition, the VN has been identified as a seeding location for cancers arising from myriad locations apart from the stomach, including the intestines,7 urogenital system,10 - 18 esophagus,19 common bile duct,20 liver,21 - 23 as well as the pancreas,24 , 25 and lungs 26. The VN has also been reported with squamous cell carcinoma and lymphoma 16 , 27 , 28.…”