A significantly enlarged spleen in CLL in the terminal stage of the disease can also cause compression of the adjacent organs and tissues 4 different types of lung lesions in hemoblastosis: Type I – pneumonia, Type II – massive diffuse leukemic infiltration, Type III – intravascular accumulation of leukemic cells or leucostasis, Type IV – specific lung tissue infiltration with lymphosarcoma and lymphogranulomatosis. Most authors note that in CLL, a specific lung lesion is less common than in acute leukemia.
A group of researchers led by S. Ahmed, based on a retrospective mathematical analysis of pulmonary complications in 100 CLL patients, developed prognostic tests that can be used to predict the likelihood of these complications. A high degree of risk was recognized in 68% of patients. The greatest risk was in the development of pneumonia – 75%, pulmonary leukostasis – 9%, malignant pleural effusion – 7%, Richter syndrome – 4%, stenosis of the upper respiratory tract – 2%.
Specific lymphoid infiltration of the lung tissue, septal septa and mediastinal cellulose contributes to bronchopulmonary complications in CLL. Leukemic infiltration in this disease contributes to the development of lymphatic tissue in the lungs. The source of infiltration is lymphoid follicles located around the bronchi and large veins. According to autopsy data, specific lymphoid infiltration of the lungs is observed in 41% of patients. However, extremely rarely, with the classical variant of CLL, massive leukemic infiltration takes place radiographically and macroscopically distinguishable during autopsy, mainly microscopic findings. It is believed that the appearance of massive lymphoid infiltration of the lungs and pleura is a sign of malignant disease transformation. In the phase of malignant transformation of CLL (Stage III), tumor germination from lymph nodes into the mediastinal tissue, damage to the walls of the bronchi and pleura is observed. In this stage, in some cases, lymphoid infiltration can be detected radiographically (0.5–2%). The leukemia infiltration in the lungs in CLL is interstitial, predominantly located along the small vessels and the interalveolar partitions. Microscopic examination revealed in small clusters of lymphocytes in the vessels and infiltrates from lymphocytes around the bronchi, as well as in the thickness of the bronchial walls.