Endobronchial lymphocytic infiltration: Unusual manifestation of chronic lymphocytic leukemia

doi:10.1016/0002-9343(84)90380-2

The American Journal of Medicine

Volume 77, Issue 4, October 1984, Pages 755-759

https://doi.org/10.1016/0002-9343(84)90380-2 Get rights and content

Abstract

This report describes a patient with chronic lymphocytic leukemia followed over a 15-year period. The distinctive feature of her course was the infiltration of the bronchial wall by malignant lymphocytes, which produced endobronchial obstruction, atelectasis, and infection. Symptomatic improvement occurred following local irradiation and steroid therapy. A review of the literature establishes that the development of endobronchlal infiltration during the course of chronic lymphocytic leukemia and other lymphoproliferatlve disorders is distinctly uncommon.

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Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in Western countries. Although various patterns of lung involvement with CLL have been reported, data on clinicoradiologic presentation are sparse.
A computer-assisted search was conducted to identify patients encountered at Mayo Clinic from 1998 to 2022 and had leukemic pulmonary infiltrates (LPI) with CLL demonstrated on lung biopsy. Medical records and chest imaging studies were reviewed to identify clinical and radiologic features.
Among 13 patients, median age was 77 years (range: 60–88) and included 10 men (77 %). All patients were known to have CLL with a median duration of 96 months (range: 50–408), and none were on treatment. Most common symptoms were dyspnea (62 %), cough (54 %), and fatigue (46 %); 2 patients (15 %) were asymptomatic. Dominant abnormality on CT consisted of single or multiple nodular/mass-like opacities in 10 patients (77 %), while diffuse centrilobular nodules, pleural mass, and diffuse bronchial wall thickening were each seen in one patient, respectively; intrathoracic lymphadenopathy was present in all.
After diagnosis of LPI, treatment for CLL was administered to 7 patients (54 %); 6 patients (86 %) exhibited improvement. During follow-up (median 41 months), 8 (62 %) patients died. Causes of death included progressive CLL or treatment-related complications (2 patients), pneumonia (1 patient), unrelated causes (3 patients), and unknown in 2 patients.
LPI in CLL is generally encountered in patients with known untreated CLL. The main imaging feature is single mass-like opacity or multiple nodular/mass-like opacities, associated with intrathoracic lymphadenopathy.
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Patients with CLL can present with progressive airflow obstruction resulting from infiltration of leukemic cells in the small airways. They can also develop constrictive bronchiolitis as a manifestation of paraneoplastic autoimmune multiorgan syndrome.6,7 Diagnosis of BPLI is made using thoracic imaging and lung biopsy.
Pulmonary Manifestations of Lymphoma and Leukemia
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In those with regional adenopathy, endobronchial lymphoma may result from tumor extension from regional lymph nodes. Variants of B-cell (CLL) and T-cell (ALL) neoplasms may present similarly.53–55 AML affects the tracheobronchial tree in the form of bronchial chloroma (Fig. 3).37,56,57
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2010, Revue des Maladies Respiratoires
Les manifestations pulmonaires non-infectieuses observées au cours des hémopathies lymphoplasmocytaires autres que les lymphomes sont mal connues et ont rarement fait l’objet de publications dédiées.
Le but de ce travail est donc de faire le point, à travers une revue de la littérature, sur les différentes manifestations pulmonaires spécifiques décrites au cours de ces hémopathies. Seront ainsi abordées la leucémie aiguë lymphoblastique, la leucémie lymphoïde chronique et la leucémie à tricholeucocytes, ainsi que les proliférations plasmocytaires telles que le myélome, le syndrome de POEMS et la maladie de Waldenström.
Les atteintes pulmonaires associées aux hémopathies lymphoïdes sont variées et leur caractérisation doit faire envisager des techniques diagnostiques parfois invasives.
The non infectious pulmonary manifestations occurring in lymphoplasmocytic proliferations others than lymphomas are poorly understood and have rarely been the object of dedicated publications.
The purpose of this work is to review the literature of the various specific lung manifestations occurring during these malignant haematological diseases. We will also consider acute lymphoblastic leukaemia, chronic lymphocytic leukaemia and hairy cell leukaemia, as well as malignant plasmocytic disorders such as myeloma, POEMS syndrome and Waldenström's macroglobulinaemia.
During the course of lymphoplasmocytic diseases, lung manifestations are variable and sometimes require invasive techniques for definitive diagnosis.
Chronic lymphocytic leukemia presenting with symptomatic peritoneal infiltration
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¹: From the Department of Medicine, Albert Einstein Medical Center. Northern Division, York and Tabor Roads, Philadelphia, Pennsylvania.

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Case reportEndobronchial lymphocytic infiltration: Unusual manifestation of chronic lymphocytic leukemia

Abstract

Chest

Blood

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Br J Dis Chest

Blood

Hodgkin's disease and the non-Hodgkin's lymphomas

Lymphocytic lymphomas

Chronic lymphocytic leukemia

Leukemia: a clinical and pathologic study of one hundred and twenty-three fatal cases in a series of 14,000 necropsies

Arch Intern Med

Pathology of the leukemic tissue

Pulmonary reticuloses

Case report
Endobronchial lymphocytic infiltration: Unusual manifestation of chronic lymphocytic leukemia