An enlarged lymph nodes in the chest cavity was detected in 73 (76.8%) deaths from CLL (according to the data of an intravital radiological study of 228 patients with CLL, an increase in the lymph nodes in the chest cavity was diagnosed in 66.7% of patients). At the same time, an increase in mediastinal lymph nodes was observed in 65 patients, aortic arches in 30 people, paratracheal in 10, paraesophageal in 8, bifurcation in 12, bronchopulmonary in 65 cases.
In 14 patients, the enlarged bronchopulmonary lymph nodes appeared in the form of large packages, dense, rocky consistency, were brazed into conglomerates and caused compression, infiltration, and lung tissue and bronchi. Histological analysis of these lymph nodes revealed signs of transformation into large-cell lymphosarcoma (Richter syndrome). In all these patients, death occurred when pneumonia was added. For patients who died without obvious signs of sarcoma transformation, compression syndrome in the chest cavity is not typical. The lymph nodes of the mediastinum, even with a significant increase, remained soft consistency and did not squeeze the surrounding tissue.
Leukostasis in vessels with CLL is not clinically determined, as a rule . But as mentioned earlier, their presence explains the impaired microhemocirculation , which contributes to the development of morphological changes in the bronchi and lungs, a severe and prolonged course of inflammatory processes of the bronchopulmonary system. In order to identify statistically significant indicators that could indicate the presence of leukostasis in the pulmonary vessels, a discriminant analysis was carried out for which the statistical package STATISTIKA 6.0 was used. The study included patients who did not have a concomitant pulmonary disease. All this sick a full instrumental examination of the bronchopulmonary system was performed in vivo, and after autopsy, morphological changes in the lungs and bronchi were studied. The results of discriminative analysis are as follows:
Statistically significant signs (P <0.05): 1) Leukocytosis in peripheral blood is more than 100 × 10 9 / l (p = 0.0001); 2) Reduction of PM during endobronchial LDF less than 50 PE (p = 0.001); 3) Reduction of Ac when performing endobronchial LDF less than 2.5 PE (p = 0.0015); 4) Reducing Hell when conducting endobronchial LDF less than 2.5 PE (p = 0.0025); 5) prolonged and recurrent infections of the bronchopulmonary system (bronchitis, pneumonia) (p = 0.032); 6) B – symptoms, p = 0.035.
The combination of the above indicators with a high degree of probability may indicate the presence of leucostasis in the vessels of the microcirculatory bed of the bronchopulmonary system in patients with CLL. As it was established by previous studies, the risk of developing leukostasis occurs with an increase in leukocytosis more than 50 × 10 9 / l, with leukocytosis more than 200 × 10 9 / l, they almost always develop . The decrease in the microhemocirculation parameter, the amplitudes of oscillations in the cardiac and respiratory ranges in CLL is largely due to the presence of leucostasis in the vessels of the microvasculature. “B” symptoms (fever, night sweat and weight loss) in CLL appear in the later stages of tumor progression, when the tumor process gets out of control of cytostatics and progressive leukocytosis is observed in the blood. In these patients, a prolonged and recurrent AML is observed.
Statistically insignificant signs: 1) A decrease in hemoglobin of less than 100 g / l (p = 0.2); 2) Increase in bronchopulmonary lymph nodes according to CT data (p = 0.28); 3) Reduction of the total MPKr index during lung rheography of less than 50 ohms / min (p = 0.9).