T-急性リンパ性白血病/リンパ球性リンパ腫患者における進行性肺病変：トリッキーで稀な症例報告

Aggressive lung involvement in a patient with T-acute lymphoblastic leukaemia/lymphoblastic lymphoma: a tricky and rare case report.

• Chika Miyaoka
• Takeshi Saraya
• Kojiro Honda
• Masachika Fujiwara
• Haruyuki Ishii
• Hajime Takizawa

抄録

39歳の男性が胸部X線でびまん性肺浸潤を認めて当院に入院した。3年前にT型急性リンパ性白血病・リンパ腫と診断され，化学療法と臍帯血幹細胞移植を2回行っていたが，末梢血に芽球も白血球症もなかった．末梢血に芽球も白血球症もなかったが，緊急気管支鏡検査で芽球が肺胞腔/肺胞隔膜および静脈壁に浸潤していることが確認された．これらの病理学的所見は、胸部CT（Computed Tomography）での肺胞間隔隔膜の肥厚とグランドガラスの不鮮明さに対応していた。胸部CTで浸潤を認めた急性リンパ芽球性白血病/リンパ腫患者では、白血球過多や血液中の芽球細胞がない場合でも、骨髄性白血病の肺病変と同様に白血病性肺病変を鑑別診断で考慮すべきである。

A 39-year-old man was admitted to our university hospital because of diffuse pulmonary infiltrates on chest X-ray. He had been diagnosed with T-acute lymphoblastic leukaemia/lymphoblastic lymphoma three years before and had been treated with chemotherapy and cord blood stem cell transplantation twice. Although he had neither blast cells in the peripheral blood nor leucocytosis, urgent bronchoscopy findings demonstrated blast cells invading both the alveolar spaces/alveolar septa and the vein walls. These pathological findings corresponded to ground-glass opacities and thickening of the interlobular septa on thoracic computed tomography (CT). In acute lymphoblastic leukaemia/lymphoblastic lymphoma patients presenting with infiltrates on thoracic CT, leukaemic pulmonary involvement should be considered in the differential diagnoses, even in the absence of hyperleucocytosis or blast cells in the blood, similar to pulmonary involvement in myeloid leukaemias.

© 2020 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology.