The patient is a 52 years old female. 25 days ago, core biopsy of retroperitoneal lymph node non-Hodgkin's mature B cell lymphoma diffusely positive for CD10, CD20, BCL6 and BCL12. Bone marrow biopsy showed erythroid hyperplasia with focal micronormoblastic maturation. She is suffering with bilateral pleural effusions. Repeated thoracentesis done and again pleural fluid formation causing breathlessness. ICD tube drain inserted seven days back. Two weeks ago, R-CHOP cycle 1 chemotherapy was given, but no response or effect seen as there was no drop in blood counts nor any side effects. Our doubt is whether chemo R-CHOP cycle 1 shown effect inside the body or not? If not can we give R-CHOP chemo cycle 2 after 14 days instead of 21 days. PET-CT shows metabolically active nodal disease above and below the diaphragm, in abdomen, mediastinal lymphadenopathy and at neck. Pleural fluid cytology is positive with atypical lymphoid cells, atypical large cells in clusters scattered singly and round with scant amount of cytoplasm and round nucleus with coarse chromatin. Does it mean malignant pleural effusion? After removal of ICD tube drain, is pleurodesis compulsory or not? If pleurodesis is required, then please suggest regarding talc pleurodesis. Also, do we need to consult any special surgeon for pleurodesis or general surgeon sufficient?
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