CHEST Guidelines-A-72-Year-Old-Woman-With-Dyspnea,-Multiple-Pulmona

A-72-Year-Old-Woman-With-Dyspnea,-Multiple-Pulmona

Pdf Summary

A 72-year-old woman with a history of hypertension and hypothyroidism presented with worsening shortness of breath, leg swelling, cough, and intermittent hemoptysis. A former smoker, she had been previously evaluated for cough, revealing mediastinal lymphadenopathy. Initial treatment with steroids for presumed sarcoidosis was ineffective, prompting further investigation upon her current admission.<br /><br />Physical examination showed decreased breath sounds and end-inspiratory wheezes. Laboratory tests indicated leukocytosis. Imaging studies revealed mediastinal adenopathy and nodular opacities in the lungs. Extensive testing ruled out infections, and a CT scan showed worsening lymphadenopathy and new lung nodules.<br /><br />A biopsy from a navigational bronchoscopy identified sheets and nests of neoplastic cells with a monocytic appearance, leading to a diagnosis of myeloid sarcoma (MS) with monocytic differentiation. MS is a rare cancer associated with acute myeloid leukemia (AML), more often occurring in men. It can present in various organs, making diagnosis challenging based on symptoms alone. <br /><br />The patient was treated with chemotherapy and local radiation to manage her respiratory distress. Despite interventions, she experienced worsening respiratory failure and subsequently chose hospice care after developing neutropenic sepsis.<br /><br />Myeloid sarcomas are often part of systemic myeloid diseases and can manifest in multiple organ systems. Diagnosis may require tissue biopsy for confirmation. Treatments commonly include chemotherapy akin to that used for AML and sometimes radiation for local control. MS' rarity and diverse presentation necessitate a high suspicion index, especially in patients with atypical cytopathology and myeloid history.

Keywords

myeloid sarcoma

acute myeloid leukemia

respiratory distress

neoplastic cells

monocytic differentiation

mediastinal lymphadenopathy

biopsy

chemotherapy

neutropenic sepsis

hospice care