A morphological study of segmental bronchi in patients with CLL showed a decrease in the number of neutrophils, eosinophils, plasma and mast cells in the submucosal layer. In patients who died due to the progression of CLL, an increase in the number of lymphocytes at all levels of the bronchial tree was observed. In most patients, the height of the mucosal epithelium and the thickness of the mucous membrane of the segmental bronchi were significantly reduced. In many patients, thinning of the basement membrane is noted, and growth of connective tissue in the submucosal layer. Atrophic changes of the mucous membrane should be explained by a violation of endobronchial microhemocirculation, which largely depends on the extent of leucostasis .
The walls of many vessels of the bronchopulmonary apparatus in patients with CLL, compared with the control group, looked somewhat thickened due to edema and lymphoid infiltration. Dilation of the vessels of the lungs and bronchi, some of which was filled with lymphocytes, was noted. The ratio of vascular diameter to thickness in patients with CLL was 12.9 ± 0.05, in the control group it was slightly lower – 11.8 ± 0.04. The degree of vascular plethora was changed, in CLL patients (67 ± 2.7%) it was higher than in the control group (55.3 ± 3.7%; P <0.05).
The thickness of the interalveolar septa in many of the dead was increased due to their edema (55 ± 5.2 compared to 40 ± 0.08 μm in the control; P <0.01). Due to the large number of emphysematous transformed tissue in patients with CLL, an increase in the area of the alveoli is observed (172 ± 28 μm 2 ), but due to the large variability of this indicator, this increase, compared with the control, was not significant (132 ± 10 μm 2 ; P> 0.05).
Specific lymphoproliferative pleurisy was diagnosed in 21 patients. 19 found to be fatal. In cytological examination of exudate, lymphocytes were found in a large number of these patients. Histological examination revealed diffuse or focal lymphoid pleural infiltration .
The study of the diaphragm in 45 patients with a significant increase in the liver and spleen revealed the predominance of myocytes of medium size (cross-sectional area – 501 ± 14.2 μm 2 ), but there was an increase in the newly formed large myocytes (1969 ± 31 μm 2 ) and small (286, 8 ± 17 microns 2 ) sizes. Necrobiotic changes in myocytes were diagnosed . In these patients, a significant growth of stroma was observed around the vessels and the intermuscular space. Revealed large areas lipomat Oz . Such dystrophic changes are caused by dysfunction of the diaphragm, due to its compression with enlarged liver and spleen. A histological examination showed lymphoid and filtration of the diaphragm and lymphocytic stasis in the vessels, which also contributes to the violation of the contractile ability of the diaphragm and dystrophic changes in muscle fibers. In 30 patients there was no significant increase in the liver and spleen. The sizes of myocytes of the diaphragm in such patients did not have significant differences with those of practically healthy individuals, without concomitant bronchopulmonary diseases and hemoblastosis, who died from injuries (96% were also average myocytes) . However, many patients without severe hepato – and splenomegaly showed lymphoid infiltration of the diaphragm and accumulation of lymphocytes in the lumen of the vessels. Lymphoid infiltration of the diaphragm has never reached a size where it could be determined macroscopically, in all cases these were histological findings.