Abstract
Chronic lymphocytic leukemia (CLL) is the most common B-cell leukemia seen in adults in the world. Respiratory tract illnesses are common in patients with CLL and result in significant morbidity and mortality. Patients with leukemic bronchopulmonary involvement (LBPI) often present with vague symptoms like dry cough, progressive dyspnoea, chest pain and hemoptysis and diagnosis becomes challenging in such patients. Pulmonary involvement in patients may occur in various forms. The diagnosis often becomes challenging and requires combination of tests including computed tomography imaging, blood work up, and bronchoscopy or lung biopsy to rule out infectious etiologies. We present a case of leukemic bronchopulmonary involvement diagnosed on cytology leading to the diagnosis of CLL.
Keywords: Chronic lymphoproliferative disorder (CLL), endobronchial biopsy, leukemic bronchopulmonary involvement (LBPI).
References
- Rai KR, Jain P. Chronic lymphocytic leukemia (CLL)- then and now.Am J Hematol 2016;91:330-40
- Inamdar KV, Bueso-Ramos CE. Pathology of chronic lymphocytic leukemia: an update. Annals of diagnostic pathology. 2007 1;11(5):363-89.
- Biswas A, Gaztambide H, Wakefield DN, Sriram PS. A 61-year-old male with generalised lymphadenopathy presenting with shortness of breath and infiltrates on chest radiography. Breathe. 2017 Mar 1;13(1):e17-23.
- Carmier D, Dartigeas C, Mankikian J et.al. Serious bronchopulmonary involvement due to chronic lymphocytic leukemia. European Respiratory Review;2013 22:416-19.
- Barcos M, Lane W, Gomez GA, et al. An autopsy study of 1206 acute and chronic leukemias (1958 to 1982). Cancer 1987; 60:827-37.
- Hill BT, Weil AC, Kalaycio M, Cook JR. Pulmonary involvement by chronic lymphocytic leukemia/small lymphocytic lymphoma is a specific pathologic finding independent of inflammatory infiltration. Leuk Lymphoma 2012; 53: 589-95.
- Agrawal A, Gupta N, Esposito M, Tandon P, Koenig S, Khanijo S. Pathologic findings in bronchopulmonary leukemic infiltrates in patients with chronic lymphocytic leukemia. Clinical Lymphoma Myeloma and Leukemia. 2019 Feb 1;19(2):123-8.
- Abdel-Ghafar AA, El Din El Telbany MA, Mahmoud HM, El-Sakhawy YN. Immunophenotyping of chronic B-cell neoplasms: flow cytometry versus immunohistochemistry. Hematol Rep 2012; 4:e3
- A. Blum, D. Young, S. Broering et al., “Computed tomography scans do not improve the predictive power of 1996 national Cancer institute-sponsored working Group chronic lymphocytic leukemia response criteria,” Journal of Clinical Oncology, vol. 25, no. 35, pp. 5624–5629, 2007
- Kumar V, Abbas AK, Aster JC, eds. Inflammation and Repair, in Robbins Basic Pathology. New York: Elsevier; 2012.
Corresponding Author
Dr Gauri Nakra
DOI: https://dx.doi.org/10.18535/jmscr/v10i7.01
