Acute Myeloblastic Leukemia with Initial Manifestations in the Central Airway

Abstract

A 69-year-old man presented with 4-month’s history of cough, bloody sputum, and exertional dyspnea. He smoked for 50 years. His past medical history was unremarkable. The physical examination was normal. The complete blood count and the tumor markers were in the normal range. C-reactive protein level was 10.5 mg/liter. The tuberculosis skin test was negative. Autoantibody assessment was negative for antinuclear antibody and antineutrophil cytoplasmic antibody. The chest radiograph showed a narrow central airway. Chest computed tomography (Figure 1) demonstrated a thickened central airway wall from the aortic arch level to the carina level, nodular infiltrations in the right lung, and enlargement of mediastinal lymph nodes. Bronchoscopy (Figure 2) revealed cauliflower-like neoplasms with an irregular surface around the central airway wall which began 5 cm from the glottis. The mucosa was friable, red, and hemorrhagic. There was approximately a 60% stenosis of the airway. The histopathology of the transbronchial biopsy specimen revealed a diffuse proliferation of small round-to-oval cells with high N/C ratio, felt to be small cell carcinoma. Immunohistochemistry staining was positive for myeloid markers including myeloperoxidase, leukocyte common antigen, and lysozyme, negative for CD3, CD20, CD79 , CD45RO, establishing a diagnosis of the central airway granulocytic sarcoma. The patient refused further examination and therapy. Two months later, the patient developed stridor and worsening dyspnea. To relieve his symptoms, the patient was treated by stent placement in the central airway. The complete blood count revealed a leukocyte count of