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Lung biopsy in chronic lymphocytic leukemia
1Department of Pathology, University of Utah Medical Center, Salt Lake City 84132.
Insights
Chronic lymphocytic leukemia (CLL) can cause lung disease, presenting as interstitial infiltrates and respiratory symptoms. Treatment with chemotherapy and steroids effectively improved symptoms and radiographic findings in patients with CLL-related pulmonary involvement.
Area of Science:
- Pulmonology
- Oncology
- Pathology
Background:
- Pulmonary involvement is a recognized complication of chronic lymphocytic leukemia (CLL).
- Patients with CLL may present with respiratory symptoms and interstitial infiltrates on chest imaging.
- The specific pathological patterns and causative agents of pulmonary disease in CLL require further elucidation.
Purpose of the Study:
- To investigate the clinical presentation, pathological findings, and treatment outcomes of pulmonary involvement in patients with chronic lymphocytic leukemia (CLL).
- To determine the role of CLL as the primary cause of pulmonary disease versus incidental findings.
- To assess the response to therapy in CLL patients with lung involvement.
Main Methods:
- Retrospective review of nine patients with biopsy-proven pulmonary involvement and chronic lymphocytic leukemia (CLL).
- Analysis of clinical symptoms, chest radiographic findings, and histopathological examination of lung biopsies.
- Review of microbiological culture results and treatment regimens, including chemotherapy and steroid therapy.
Main Results:
- Eight out of nine patients had CLL identified as the predominant cause of pulmonary disease, characterized by dense lymphocytic infiltrates along bronchovascular bundles.
- One patient had nonspecific organizing pneumonia with incidental CLL findings.
- Respiratory symptoms and interstitial infiltrates improved following chemotherapy and/or steroid therapy in all patients.
Conclusions:
- Chronic lymphocytic leukemia (CLL) is a significant cause of pulmonary disease in affected patients, manifesting with interstitial infiltrates and respiratory symptoms.
- Lung biopsies are crucial for differentiating CLL-related lung disease from other pulmonary conditions.
- Chemotherapy and steroid therapy are effective in managing pulmonary complications associated with CLL.
Abstract:
Nine patients with chronic lymphocytic leukemia (CLL), with pulmonary involvement confirmed by biopsy, presented with progressive cough and/or shortness of breath and had interstitial infiltrates on chest radiographs. Biopsies showed a dense lymphocytic infiltrate that followed bronchovascular bundles. We considered CLL the predominant finding, and the cause of the patient's pulmonary disease, in eight cases; in one, a histologically nonspecific organizing pneumonia was the main lesion and CLL was an incidental finding. Culture results were available in six cases and were negative except in one case with presumed contaminants. A granulomatous reaction was present in five cases and was necrotizing in two, although culture results were negative. The only case with a recognizable organism had noninvasive fungal hyphae growing in many of the small airways. All of the patients' respiratory symptoms improved after chemotherapy and/or steroid therapy, and the chest radiographs also showed clearing.