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A patient presented with breathlessness, weight loss and nocturnal sweating. Investigations revealed mild airway obstruction. Bronchoscopy was normal but CT scan demonstrated pleural thickening and a small area of shadowing within the right lung (fig 1). Pleural biopsy yielded lymphoid tissue in keeping with chronic lymphocytic leukaemia (CLL). Bone marrow (BM) examination was unremarkable. The patient was commenced on oral chlorambucil. At the multidisciplinary team meeting, given this unusual presentation, with apparent lack of nodal or BM involvement, a query over the diagnosis was raised. The pathology was reviewed; this showed two tissue cores, one consisting …
Funding Lesley Christie’s Fellowship is supported by the Royal College of Pathologists and the Jean Shanks foundation.
Competing interests None.
Provenance and Peer review Not commissioned; not externally peer reviewed.