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Signs and Symptoms of Chest Diseases |

Chronic Lymphocytic Leukemia With Pulmonary Parenchymal Involvement

Navin Kaini*, MD; Sadia Benzaquen, MD
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University of Cincinnati, Cincinnati, OH


Chest. 2012;142(4_MeetingAbstracts):994A. doi:10.1378/chest.1391557
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Abstract

SESSION TYPE: Miscellaneous Case Report Posters II

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Chronic lymphocytic leukemia is a lymphoproliferative disorder with progressive accumulation of functionally incompetent lymphocytes which are monoclonal in origin. It may involve any lymphoid tissue, but pulmonary parenchymal involvement is rare. We present a case of chronic lymphocytic leukemia with unusual involvement of lung parenchyma and trachea-bronchial lymph nodes.

CASE PRESENTATION: Our patient is an 85 years old male with history of squamous cell carcinoma of skin, melanoma of the scalp resected few months ago and chronic lymphocytic leukemia diagnosed 1 month ago through excisional biopsy of a supra-clavicular lymph node. Patient was referred by his oncologist to the pulmonary clinic for work up of some abnormalities in the CAT scan of the chest and PET CT. CT scan of the chest showed nodular thickening surrounding the basilar segments of the right lower lobe, right apical nodule 1.4 x 1.2 cm in size, and right hilar lymphadenopathy. PET CT scan showed mild increased FDG uptake (maximal SUV of 1.8) within a nodule in the right upper lung and mild increased uptake along the right lower lobe bronchovascular bundle. The patient underwent bronchoscopy procedure with transbronchial biopsies, brushing and transbronchial needle aspiration of the right lower lobe infiltrate with radial probe ultrasound and fluoroscopy, as well as Endobronchial ultrasound with trans-bronchial needle aspiration (21 gauze needle) of the right hilar and subcarinal lymphadenopathy. All the pathology results of the lung parenchyma and lymph nodes including the flow cytometry were positive for chronic lymphocytic leukemia. The RUL was too peripheral to be reached endoscopically.

DISCUSSION: Virtually any lymphoid tissue may be involved and enlarged with chronic lymphocytic leukemia. The most commonly affected sites are cervical, supraclavicular and axillary. It could rarely involve lymph nodes on trachea-bronchial tree. Our case had pulmonary parenchymal involvement of chronic lymphocytic leukemia, with positive cytopathology of lung parenchyma, hilar and subcarinal lymph nodes. We believe the right apex nodule is a pulmonary involvement of chronic lymphocytic leukemia. There are few case reports of CLL involvement of lung. Prognostic implication of pulmonary involvement in chronic lymphocytic leukemia is not yet known because of its rare association with pulmonary parenchyma.

CONCLUSIONS: Although rare, Chronic lymphocytic leukemia could affect the lung parenchyma.

1) Klatte EC, Yardley J, Smith EB, Rohn R, Campbell JA. The pulmonary manifestations and complications of leukemia. AJR 1963;89:598-60

2) Kovalski R, Hansen-Flaschen J, Lodato RF, Pietra GG. Localized leukemic pulmonary infiltrates: diagnosis by bronchoscopy and resolution with therapy. Chest 1990;97:674-678

3) Pulmonary involvement by chronic lymphocytic leukemia/small lymphocytic lymphoma is a specific pathologic finding independent of inflammatory infiltration. Hill BT, Weil AC, Kalaycio M, Cook JR.

DISCLOSURE: The following authors have nothing to disclose: Navin Kaini, Sadia Benzaquen

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University of Cincinnati, Cincinnati, OH

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