0
Pulmonary Manifestations of Systemic Disease: Pulmonary Manifestations of Systemic Disease |

Diffused Pulmonary Infiltrates With T-Cell Large Granular Lymphocytic Leukemia FREE TO VIEW

Ran Li, MD; Pihua Gong, MMed; Zhancheng Gao, MD
Author and Funding Information

Peking University People's Hospital, Beijing, China


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(4_S):A458. doi:10.1016/j.chest.2016.02.477
Text Size: A A A
Published online

SESSION TITLE: Pulmonary Manifestations of Systemic Disease

SESSION TYPE: Case Report Slide

PRESENTED ON: Saturday, April 16, 2016 at 09:45 AM - 11:15 AM

INTRODUCTION: Here we presented a case with bilateral diffused pulmonary infiltration accompanied with a rare T-cell large granular lymphocytic leukemia (T-cell LGL leukemia).

CASE PRESENTATION: A 50-year-old Chinese male presented with fever, pancytopenia and splenomegaly 4 years ago. Splenectomy was performed, but lymphocytosis was revealed in follow-up. He developed recurrent non-productive cough with exertional dyspnea in recent one and a half years, which temporarily improved after antibiotic treatment. However, serial chest CT scans showed progressive bilateral diffused pulmonary infiltrates (fig 1). Bone marrow examination prior to admission revealed a prominent lymphocytosis with a proportion of 96%, predominated by mature lymphocytes. Flow cytometry showed monoclonal CD3+CD8+TCRVβ cells, among which TCRVβ20 cells accounted for 84.93%. T-cell LGL leukemia was confirmed by transmission electron microscopy. He was admitted to our hospital for an unrelieved deteriorating episode twenty days ago. The peripheral leukocyte count was 51.89×109/L, with 90.3% lymphocytes. Bronchoscopy showed no bronchial mucosal congestion or purulent secretion. The cytometry of bronchoalveolar lavage fluid showed 22% macrophages and 78% lymphocytes. Video-assisted thoracoscopic lung wedge resection was performed, and the pathology showed perivascular infiltration of lymphocyte-like cells with large and irregular nuclear, consistently in size (figure 2). Immunohistochemical staining revealed CD3 (major+), CD5 (major+), CD8 (major+), CD20 (minor+), CD23 (-), CD38 (focal+), CD56 (-), cyclinD1 (-), CD4 (minor+), CD7 (minor+), κ (+), λ (+), TIA (+), GramB (+), Ki-67 (scattered +). Finally, the pulmonary infiltration was confirmed as a local involvement of T-cell LGL leukemia. Fifteen milligram (mg) of methotrexate per week and 40mg methylprednisolone per day was administered. His symptoms, count of lymphocytes and lung infiltrates were improved after treatment for a month.

DISCUSSION: T-cell LGL leukemia is characterized by clonal proliferation of large granular lymphocytes (LGLs) and cytopenia. Approximately 40% of patients have an associated autoimmune disease, such as rheumatoid arthritis, and one-third of patients are asymptomatic at diagnosis1. There is no previous reports about diffused pulmonary infiltrates caused by T-cell LGL leukemia so far. Infection should be considered in differential diagnosis, since it may occur due to neutropenia. Currently, there is no standard treatment, while immunosuppressive therapy with low doses of methotrexate or cyclophosphamide is commonly used2.

CONCLUSIONS: Pulmonary infiltration is a rare manifestation of T-cell LGL leukemia.

Reference #1: Rashid A, Khurshid M, Ahmed A. T-cell large granular lymphocytic leukemia: 4 cases. Blood Res 2014; 49: 203-5.

Reference #2: Zhang D, Loughran TP Jr. Large granular lymphocytic leukemia: molecular pathogenesis, clinical manifestations, and treatment. Hematology Am Soc Hematol Educ Program 2012; 2012: 652-9.

DISCLOSURE: The following authors have nothing to disclose: Ran Li, Pihua Gong, Zhancheng Gao

No Product/Research Disclosure Information


Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543