Murro Diana, Slade Jamie Macagba, Gattuso Paolo
Rush University Medical Center, 1750 W. Harrison Street, Chicago, Illinois.
Rush University Medical Center, 1750 W. Harrison Street, Chicago, Illinois.
J Am Soc Cytopathol. 2015 Sep-Oct;4(5):267-275. doi: 10.1016/j.jasc.2015.02.002. Epub 2015 Feb 12.
Bronchoalveolar lavage (BAL) is often performed in leukemia and lymphoma patients with pulmonary infiltrates, mainly to rule out infection. However, malignant hematopoietic infiltrates are uncommon and a comprehensive cytologic study has not yet been performed.
We retrospectively reviewed all BAL samples from our institution for the past 22 years (November 1992-October 2014).
There were 37 cases of hematologic malignancies identified on BAL specimens (21 female patients and 16 male patients, age 22-80 years). Eighteen patients (49%) had pneumonia-like symptoms at the time of initial diagnosis of their malignancy, including fever, dyspnea, respiratory distress/hypoxia, and cough. The biopsy-proven cases were 25 leukemia (12 acute myeloid leukemia, 6 acute promyelocytic leukemia, 2 acute monocytic leukemia, 2 acute myelomonocytic leukemia, 1 chronic myeloid leukemia in blast phase, 1 large granular leukemia, and 1 plasma cell leukemia), 11 lymphoma (8 diffuse large B-cell lymphoma, 1 mantle cell lymphoma, 1 natural killer/T-cell lymphoma, and 1 T-cell lymphoma), and 1 multiple myeloma. Chest X-ray findings included opacities, consolidation, and interstitial edema. Four patients had BAL specimens with concomitant microorganisms. Eighteen patients subsequently died (2 days to 4 years), 15 were alive (3 weeks to 8 years of follow-up), and 4 were lost to follow-up.
BAL is especially important in distinguishing inflammatory/infectious processes from neoplastic disorders because many patients with hematologic malignancies can have pneumonia-like symptoms as part of their initial disease presentation. Causative pathogens are identified in only a minority of malignant BAL specimens from these patients. Lung involvement in patients with hematologic malignancies carries a poor prognosis.
支气管肺泡灌洗（BAL）常用于患有肺部浸润的白血病和淋巴瘤患者，主要目的是排除感染。然而，恶性造血细胞浸润并不常见，且尚未进行全面的细胞学研究。
我们回顾性分析了本机构过去22年（1992年11月至2014年10月）所有的BAL样本。
在BAL标本中确诊了37例血液系统恶性肿瘤（21例女性患者和16例男性患者，年龄22 - 80岁）。18例患者（49%）在恶性肿瘤初诊时有类似肺炎的症状，包括发热、呼吸困难、呼吸窘迫/低氧血症和咳嗽。经活检证实的病例包括25例白血病（12例急性髓系白血病、6例急性早幼粒细胞白血病、2例急性单核细胞白血病、2例急性粒单核细胞白血病、1例慢性髓系白血病急变期、1例大颗粒淋巴细胞白血病和1例浆细胞白血病）、11例淋巴瘤（8例弥漫性大B细胞淋巴瘤、1例套细胞淋巴瘤、1例自然杀伤/T细胞淋巴瘤和1例T细胞淋巴瘤）以及1例多发性骨髓瘤。胸部X线表现包括肺部阴影、实变和间质性水肿。4例患者的BAL标本伴有微生物感染。18例患者随后死亡（2天至4年），15例存活（随访3周至8年），4例失访。
BAL对于区分炎症/感染性过程与肿瘤性疾病尤为重要，因为许多血液系统恶性肿瘤患者在疾病初发时可能出现类似肺炎的症状。在这些患者的恶性BAL标本中，仅少数能鉴定出致病病原体。血液系统恶性肿瘤患者的肺部受累预后较差。
