Kakihana Kazuhiko, Ohashi Kazuteru, Sakai Fumikazu, Kamata Noriko, Hosomi Yukio, Nishiwaki Mina, Yokoyama Reiko, Kobayashi Takeshi, Yamashita Takuya, Akiyama Hideki, Sakamaki Hisashi
Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan.
Radiology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-ku, Japan.
Int J Hematol. 2009 Jan;89(1):118-122. doi: 10.1007/s12185-008-0225-x. Epub 2008 Dec 18.
Pulmonary leukemic infiltration (PLI) is more common than generally recognized, but accurate antemortem diagnosis with pathological proof is rarely achieved. We describe herein the clinical courses of two patients with PLI following hematopoietic stem cell transplantation (HSCT). One case is a male patient with acute biphenotypic leukemia, and the other is a female patient with myelodysplastic syndrome. In both cases, hyperleukocytosis did not proceed to PLI. Moreover, the former case presented PLI as the initial manifestation of relapsed leukemia and the latter was accompanied with the fungal pneumonia. High-resolution computed tomography (HRCT) of the chest at onset of PLI showed diffuse small nodular lesions along peribronchovascular bundle, and diagnosis of leukemic infiltration was made based on pathological findings obtained from transbronchial lung biopsy. Biopsy specimens further revealed leukemic infiltration along the lymphatic surrounding the peribronchial or perivascluar regions, which corresponded well with HRCT findings. Thus, radiological and pathological corroborating assessment was important to reach the correct diagnosis.
肺部白血病浸润（PLI）比一般认为的更为常见，但生前准确诊断并获得病理证据的情况很少见。我们在此描述了两例造血干细胞移植（HSCT）后发生PLI的患者的临床病程。一例是患有急性双表型白血病的男性患者，另一例是患有骨髓增生异常综合征的女性患者。在这两例中，白细胞增多症均未发展为PLI。此外，前一例以PLI作为复发性白血病的初始表现，后一例伴有真菌性肺炎。PLI发病时胸部高分辨率计算机断层扫描（HRCT）显示沿支气管血管束有弥漫性小结节病变，并根据经支气管肺活检获得的病理结果诊断为白血病浸润。活检标本进一步显示沿支气管周围或血管周围区域的淋巴管有白血病浸润，这与HRCT结果高度相符。因此，影像学和病理学的相互佐证评估对于做出正确诊断很重要。
