Pathologic Findings in Bronchopulmonary Leukemic Infiltrates in Patients With Chronic Lymphocytic Leukemia.

INTRODUCTION: Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder worldwide. Although thoracic complications are frequent in CLL, only limited data exists regarding these complications. Pleural, parenchymal, and airway disease may occur owing to CLL itself, treatment-related adverse events, typical or opportunistic infections, or from preexisting comorbidities. The etiology of parenchymal infiltrates is often attributed to pneumonia and can be difficult to properly identify without a diagnostic procedure. PATIENTS AND METHODS: We conducted a retrospective chart review of patients admitted from 2000 through 2016 with a diagnosis of CLL and abnormal radiography that underwent a bronchoscopy with biopsy, surgical lung biopsy, or transthoracic biopsies for nonresolving infiltrates after a course of antibiotics. We described the incidence of bronchopulmonary leukemic infiltrates (BPLI), describe other diagnosis achieved by the biopsy, and also describe the pathologic findings associated with BPLI in these patients. RESULTS: There were 111 procedures performed on 98 patients that yielded a diagnosis in 82 patients. In 16 patients, no histologic or pathologic diagnosis was identified after the biopsy. BPLI was diagnosed in 32 (39%) cases. In 27 (85%) of 32 cases, the biopsies returned with only BPLI owing to CLL (without inflammation), whereas 5 (15%) of 32 cases showed concomitant acute or chronic inflammation. CONCLUSION: Direct infiltration by leukemic cells may cause pulmonary symptoms and signs indistinguishable from infection. Biopsy is necessary to establish a definitive diagnosis, and physicians caring for these patients, including pathologists, should be aware of the clinicopathologic picture of BPLI to render an informative diagnosis.

A case of hepatic tuberculosis: A tuberculoma.

Tuberculosis (TB) is a common cause of morbidity and mortality worldwide and its eradication in the United States has stalled for the first time in decades. Isolated hepatic TB is an extremely uncommon form of extrapulmonary TB. Here we present a case of a tuberculous liver abscess and suggest that TB should be considered in patients who fail to respond to antibiotics and prompt diagnostic intervention.

Thoracic Complications in Chronic Lymphocytic Leukemia.

BACKGROUND: Chronic lymphocytic leukemia (CLL) is the most common lymphoproliferative disorder worldwide. Although thoracic complications are frequent in CLL, only limited data exist regarding the etiologies of these complications. MATERIALS AND METHODS: A retrospective chart review was performed on all patients admitted to a tertiary care, CLL referral center, with CLL and a respiratory complaint from 2001 through 2013, to categorize pulmonary complaints and diagnoses. RESULTS: There were 277 patients with CLL admitted on 409 occasions with respiratory complaints. The median age was 73 years, with a male to female ratio of 2:1. The majority of patients had a high-risk Rai classification and had received prior treatment. Common presenting symptoms included dyspnea, cough, and sputum production. The most common diagnoses were pneumonia (62.8%), with an identified organism in 44.7%, pleural effusions (31.8%), lung cancer (6.9%), and leukemic infiltrates (5.9%). Invasive procedures were performed 138 times: 70 bronchoscopies, 24 surgical lung biopsies, 10 computed tomography-guided lung biopsies, and 34 thoracenteses. In-hospital mortality was 24.9%. In a multivariable analysis, an elevated blood urea nitrogen level and creatinine, thrombocytopenia, and a presenting symptom of dyspnea correlated significantly with in-hospital mortality. CONCLUSION: Thoracic manifestations in CLL are common among hospitalized patients. Although infectious pneumonia remains most common, unusual or opportunistic infections may be increasing, and direct lung damage owing to CLL itself or to newer biologic agents are being diagnosed with lung tissue sampling. Recognition of these complications will allow earlier diagnosis, which may change management including removal of offending biologic agents or augmentation of treatment for CLL when infiltrative leukemic cells are present.