Pleural effusion of a second neoplasm in a patient with B‐CLL: Two immunological compartments

• Published in: American journal of hematology 2003-07, Vol.73 (3), p.184-189
• Main Authors: Atanackovic, D., Brettner, S., Hegewisch‐Becker, S.
• Format: Article
• Language: English
• Subjects: adhesion molecules; Antigens, CD; Biological and medical sciences; chemokine receptors; CLL; Hematologic and hematopoietic diseases; Humans; Leukemia, Lymphocytic, Chronic, B-Cell - pathology; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Lung Neoplasms - immunology; Lung Neoplasms - pathology; Lung Neoplasms - secondary; Lymph Nodes - immunology; Lymph Nodes - pathology; Lymphocytes - pathology; Male; Medical sciences; Middle Aged; Neoplasms, Second Primary - immunology; Neoplasms, Second Primary - pathology; Pleural Effusion - etiology; Pneumology; T cells; tumor immunology; Tumors of the respiratory system and mediastinum
• ISSN: 0361-8609; 1096-8652
• DOI: 10.1002/ajh.10340

We report the case of a patient with a chronic lymphocytic leukemia (CLL) who later developed a metastasized large‐cell neuroendocrine carcinoma of the lung that was complicated by a malignant pleural effusion. In contrast to the peripheral blood where the malignant B‐CLL cells represented >99% of all lymphocytes, lymphocytes infiltrating the malignant effusion were mainly T cells. Nearly all of these T cells were CD4+. This stood in sharp contrast to the peripheral blood where the CD4+/CD8+ ratio remained balanced. A detailed analysis of the CD4+ T cells within the malignant effusion revealed that these cells uniformly expressed a CCR7+ CD62L+ “non‐effector” phenotype. When the monoclonal B cells within the malignant effusion were analyzed, we found that these cells, in contrast to the B‐CLL cells in the peripheral blood, were negative for CD23 and expressed much higher levels of the adhesion molecules L‐selectin (CD62L) and CD11a. A deficient expression of these adhesion molecules might have led to a “trapping” of the majority of B‐CLL cells in the peripheral blood. This phenomenon might have contributed to the development of two highly different immunological compartments in this patient with CLL and pleural effusion of a solid tumor. Am. J. Hematol. 73:184–189, 2003. © 2003 Wiley‐Liss, Inc.