Acute monoblastic leukemia with t(10;11)(p12;q23) presenting with pulmonary involvement: a case report and literature review.

A forty-three-year-old Thai man presented with acute fever and dyspnea for one week with bilateral patchy infiltration, pancytopenia with monoblast. Bone marrow study was consistent with acute monoblastic leukemia. Lung lesions rapidly progressed to acute respiratory failure, which required intubation. Bronchoscopy with bronchoalveolar lavage revealed monotonous monoblast infiltration. Induction chemotherapy with 7 + 3 regimen was administered to halt the progression of leukemic pulmonary infiltration. Although there was clinical improvement, the chest radiograph developed crescent formation in the right upper lung field. Invasive pulmonary aspergillosis was suspected and successfully treated with antifungal agent. After peripheral blood recovery, bone marrow evaluation was performed and complete remission was established. HLA matching was sent to prepare for hematopoietic stem cell transplantation (HSCT). The literature review showed that the appropriate treatment for the patients with t(10;11)(p12;q23) was HSCT, but there was no data concerning correlation of t(10;11)(p12;q23) and pulmonary infiltration. This may be due to the low incidence of leukemic infiltration of acute leukemia patients, which is 0.48% and 3.06% in acute myeloid leukemia and acute monoblastic leukemia, respectively.

A case of endobronchial aspergilloma

Pulmonary aspergillosis may be classified under three categories, depending upon whether the host is atopic or immunocompromised: invasive aspergillosis, allergic bronchopulmonary aspergillosis (ABPA) or aspergilloma. However, it is not always possible to effectively categorize this disease. We experienced a case of endobronchial aspergilloma, which was difficult to categorize, in a healthy male patient. The chest X-ray and computed tomography showed an ill-defined nodule mimicking lung cancer. Fiberoptic bronchoscopy revealed an aspergilloma without cavity formation in the left lower laterobasal segmental bronchial orifice. The aspergilloma was removed and the patient's symptoms were relieved. We present this unusual case with a review of the literature.

Aspergiloses pulmonares / Pulmonary aspergilloses

Comentam-se a ubiqüidade dos aspergilos em natureza, a inevitável inalaçäo de seus propágulos por seres humanos, a fraca patogenicidade do fungo para o indivíduo normal e a gravidade das manifestaçöes que causa em imunodeficientes. Descreve-se a morfologia típica dos aspergilos em cultivo e ressalta-se a impossibilidade de reconhecer suas hifas em cortes histológicos de tecidos. Säo considerados três tipos de aspergilose pulmonar: alérgica, invasiva e de colonizaçäo. Descrevem-se as duas formas clínicas de tipo alérgico, uma incidindo em pessoas atópicas, a outra resultante da inalaçäo repetida de antígenos; as possibilidades diagnósticas e o tratamento säo comentados. Distingue-se a forma de tipo invasivo em indivíduos normais da que ocorre em imunodeprimidos. Na primeira, ressalta-se a ocorrência de lesöespontaneamente regressivas, e discutem-se as manifestaçöes progressivas. Na segunda, consideram-se três formas clínicas, dependentes do grau de imunocompromentimento; elas apresentam quadros clínico-radiológicos incaracterísticos, porém sugestivos na forma necrosante aguda. O diagnóstico das doenças de tipo invasivo requer a visualizaçäo e o isolamento biopsia; outras possibilidades säo apontadas. O tratamento é discutido. A colonizaçäo intracavitária pulmonar pode ser incipiente ou bem-sucedida; nesta, é descrito o sugestivo quadro clínico-radiológico, as possibilidades diagnósticas e o tratamento