Pleural Infiltration in Atypical Chronic Myeloid Leukemia A 937 B Fig. 1. (A) Smear of marrow aspirate showing increased numbers of granulocytes at all stages of development and blasts (Wright-Giemsa stain, ×400). (B) Smear of marrow aspirate showing hypogranular myelocytes (arrow) (Wright-Giemsa stain, ×1,000). Fig. 2. Computed tomography of the abdomen demonstrating a solid mass in the tail of the pancreas with attachment to the spleen. ed intermittently when WBC count of the peripheral blood decreased to 10×109/L or less. Beginning in November 2004, he was treated with gemcitabine for pancreatic cancer, inter- rupted periodically because of infectious diarrhea, acute renal failure due to use of aminoglycoside antibiotics and skin rash. At that time, treatment with hydroxyurea was stopped due to thrombocytopenia. After 3 months of treatment with gemcitabine, the patient experienced progressive dyspnea and fatigue, as well as being Fig. 3. Radiograph of the chest revealing bilateral pleural effusion. tachypneic (30/min) and pale. Pulmonary examination revealed decreased bilateral breathing sounds and chest radiograph showed bilateral pleural effusion (Fig. 3). Right thoracente- sis was performed and 1,400 mL of serous fluid was aspirat- ed. Analysis of the pleural fluid showed glucose 109 mg/dL, protein 2.2 g/dL (serum protein 4.6 g/dL), albumin 1.1 g/dL (serum albumin 2.0 g/dL), LDH 386 IU/L (serum LDH 1,064 IU/L, reference range 120-250 IU/L), adenosine deaminase 23U/L, hematocrit 6.0%, WBC count 2,390 / L (neutrophil