The rapid growth of lymph nodes and their acquisition of stony density, compression and infiltration of neighboring organs and tissues with edema and pain syndrome are characteristic of the malignant transformation of Richter syndrome CLL (transformation into large cell lymphosarcoma). The development of large-cell lymphosarcoma in patients with mature cell lymphoproliferative diseases is a poor, prognostic sign and, as a rule, is accompanied by worsening of the condition, the appearance of common symptoms and generalization of the extramedullary tumor process. Life expectancy after the discovery of a large-cell lymphosarcoma usually does not exceed six months, despite the use of methods of combined chemotherapy adequate for high-grade lymphomas. At the same time, according to the data, the development of large cell lymphosarcoma in CLL patients does not always mean the later stage of the tumor progression, the terminal state and poor prognosis.
According to the author, the life expectancy of CLL patients after verification of Richter syndrome ranged from 3.5 months to 9 years. At this stage of the disease, compression with enlarged lymph nodes of the bronchi and lung tissue is most likely, accompanied by impaired ventilation of the lungs and the drainage function of the bronchi. A number of authors point to the possibility of significant compression by the transformed lymph nodes of the trachea and bronchi, causing dyspnea and asthma attacks, described a case of an isolated lesion of a bronchial tree with endobronchial tumor growth in Richter syndrome. The possibility of compression and rupture of the thoracic lymphatic duct in patients with CLL is noted. But this complication in CLL is rare, much more often it is characteristic of non-Hodgkin’s lymphomas and lymphogranulomatosis.
Emphasizes the need for strict implementation of recommendations for examination of the organs of the thoracic cavity in patients with systemic lymphoproliferative diseases. Sometimes it is necessary to apply such diagnostic methods as radiography of the chest, image diagnostics, helium-67 scanning, positron emission tomography, lymph node biopsy.