Autopsy and Case Reports. ISSN 2236-1960. Copyright © 2016. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License which permits unrestricted non-commercial use, distribution, and reproduction in any medium provided article is properly cited. a Anatomic Pathology Department - Faculty of Medicine - University of São Paulo, São Paulo/SP – Brazil. b Instituto do Câncer do Estado de São Paulo - Faculty of Medicine - University of São Paulo, São Paulo/SP – Brazil. c Emergency Department - Hospital das Clínicas - Faculty of Medicine - University of São Paulo, São Paulo/SP – Brazil. Advanced chronic lymphoid leukemia with severe bronchopneumonia: an Autopsy Case Report Felipe Gomes Campos Amaral a , Luiz Guilherme Cernaglia Aureliano Lima b , Veruska Menegatti Anastacio Hatanaka b , Sheila Aparecida Coelho Siqueira a , Amaro Nunes Duarte-Neto a,c Amaral FGC, Lima LGCA, Hatanaka VMA, Siqueira SAC, Duarte-Neto AN. Advanced chronic lymphoid leukemia with severe bronchopneumonia: an Autopsy Case Report. Autopsy Case Rep [Internet]. 2016;6(1):11-20. http://dx.doi. org/10.4322/acr.2016.022 ABSTRACT Chronic lymphocytic leukemia (CLL) is a lymphoid neoplasia with the B immunophenotype, which corresponds to the leukemic form of lymphocytic lymphoma. This entity is characterized, in most cases, by immunosuppression due to impaired function of immune cells, hypogammaglobulinemia, bone marrow infiltration, and immune dysfunction due to the neoplasia and the chemotherapy, when prescribed. We describe the case of a 63-year-old woman with a previous diagnosis of advanced CLL, refractory to treatment, who presented respiratory failure at the emergency department and died soon after hospital admission. The autopsy examination showed a large retroperitoneal mass compressing large vessels and abdominal and pelvic organs; generalized lymphadenopathy; and liver, spleen, bone marrow, heart and kidney infiltration. A Gram-negative bacilli bronchopneumonia with diffuse alveolar damage was detected, which was likely to be the immediate cause of death. Keywords Leukemia; Lymphocytic, Chronic, B-Cell; Respiratory Insufficiency; Pneumonia; Autopsy. CASE REPORT A 63-year-old Caucasian woman, who was previously diagnosed with type-2 diabetes, hypertension, and hypothyroidism, presented a 2-year history of weight loss (nearly 20 kg) intermittent fever, nocturnal sweating, progressive abdominal distension, and generalized lymphadenopathy. Her first complete blood count showed a hemoglobin of 8.0 g/dL (reference value [RV]: 12.3-15.5 g/dL), neutrophils of 3.510/mm 3 (RV: 4.4-11.3 × 10 3 /mm 3 ), lymphocytes of 112,320/mm 3 (RV: 1.2-4.0 × 10 3 /mm 3 , and platelets of 83,000/mm 3 (RV:150-400 × 10 3 /mm 3 ). The flow cytometric immunophenotyping of the peripheral blood, bone marrow aspirate, and a needle biopsy on the right axillary lymph node rendered the diagnosis of chronic lymphoid leukemia (CLL)/lymphocitic lymphoma. The bone marrow aspirate showed more than 90% of mature lymphocytes CD20-positive, CD5-positive, CD10-negative, and immunoglobulin M (IgM)-negative. The lymph node histology showed complete replacement of the lymph node Article / Autopsy Case Report