Jul 15, 2014 - Figure 1. (A) Radiographic imaging at time of presentation. Right middle lobe narrowing and right hilar mass (white arrow) at time of ...
IMAGES IN PULMONARY, CRITICAL CARE, SLEEP MEDICINE AND THE SCIENCES Bronchial Chloroma Saadia A. Faiz1, Nelson G. Ordonez2, Rodolfo C. Morice1, Lara Bashoura1, and Carlos A. Jimenez1 1 Department of Pulmonary Medicine, and 2Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
Figure 1. (A) Radiographic imaging at time of presentation. Right middle lobe narrowing and right hilar mass (white arrow) at time of presentation. (B) One month after presentation after treatment with salvage chemotherapy. Reduction in right hilar mass (white arrow) and resolution of narrowing of right middle lobe aperature.
Figure 2. Bronchoscopic evaluation. (A) Distal bronchus intermedius; (B) right middle lobe aperature with erythema; (C) endobronchial ultrasound of right hilar mass. 11RI = station 11, right inferior hilar lymph node.
Author Contributions: S.A.F. and C.A.J.: Conception and design, acquisition of radiological and pathological data, drafting the article, critical revision of intellectual content and final approval of the version to be published; N.G.O., L.B., R.C.M.: conception and design, acquisition of radiological and pathological data, and critical revision of intellectual content. Am J Respir Crit Care Med Vol 190, Iss 2, pp e5–e6, Jul 15, 2014 Copyright © 2014 by the American Thoracic Society DOI: 10.1164/rccm.201309-1624IM Internet address: www.atsjournals.org
Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences
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IMAGES IN PULMONARY, CRITICAL CARE, SLEEP MEDICINE AND THE SCIENCES
Figure 3. Pathology. (A) Hematoxylin and eosin staining of endobronchial biopsy showing poorly differentiated blast cells; (B) immunohistochemical studies demonstrating positivity for myeloperoxidase in neoplastic cells.
A 64-year-old man with acute myelogenous leukemia (AML) in remission undergoing consolidation chemotherapy presented with neutropenic fever, dyspnea, and recurrent right-sided pneumonia. Bone marrow showed no evidence of leukemia. The patient had a 90-pack-year smoking history, and chest radiographs revealed right middle lobe (RML) infiltrate with a hilar mass occluding the RML bronchus (Figure 1). He underwent bronchoscopy with endobronchial ultrasound and transbronchial needle aspiration of right hilar mass, bronchoalveolar lavage, and endobronchial biopsy at the RML (Figure 2). Endobronchial biopsy of the RML revealed AML in the bronchial mucosa (Figure 3). Autopsy series have documented leukemic infiltration in hilar lymph nodes, visceral pleural, and lung parenchyma; however, extramedullary relapse (aside from cerebrospinal fluid) is uncommon in AML (1, 2). Isolated endobronchial relapse is exceptionally rare (1, 3). n Author disclosures are available with the text of this article at www.atsjournals.org.
References 1. Genet P, Pulik M, Lionnet F, Petitdidier C, Gaulier A, Fourcade C. Leukemic relapse presenting with bronchial obstruction caused by granulocytic sarcoma. Am J Hematol 1994;47: 142–143.
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2. Ross JS, Ellman L. Leukemic infiltration of the lungs in the chemotherapeutic era. Am J Clin Pathol 1974;61:235–241. 3. Mortimer J, Blinder MA, Schulman S, Appelbaum FR, Buckner CD, Clift RA, Sanders JE, Storb R, Thomas ED. Relapse of acute leukemia after marrow transplantation: natural history and results of subsequent therapy. J Clin Oncol 1989;7:50–57.
American Journal of Respiratory and Critical Care Medicine Volume 190 Number 2 | July 15 2014
