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(Chest. 1999;116:832-835.)
© 1999 American College of Chest Physicians

Richter's Transformation Presenting as an Obstructing Endobronchial Lesion*

Deborah A. Milkowski, CPT, MC, USAF; Brian D. Worley, MAJ, MC, USA and Michael J. Morris, LTC, MC, USA

* From the Pulmonary Disease/Critical Care Service, Department of Medicine (CPT Milkowski), Wilford Air Force Medical Center, Lackland AFB; and the Pulmonary Disease/Critical Care Service, Department of Medicine (MAJs Worley and Morris), Brooke Army Medical Center, Fort Sam Houston, TX.

Correspondence to: MAJ Brian D. Worley, Pulmonary/Critical Care Service (MCHE-MDP), Brooke Army Medical Center, 3851 Roger Brooke Dr, Fort Sam Houston, TX 78234-6200; e-mail: MAJ Brian Worley{at}BAMC.SMTPLINK.AMEDD.ARMY.MIL

A 60-year-old man with chronic lymphocytic leukemia presented to our institution with a recurring lingular pneumonia. On fiberoptic bronchoscopy, the patient was found to have an endobronchial mass obstructing the lingula and left upper lobe. Biopsy specimens of the mass demonstrated anaplastic large cell lymphoma consistent with Richter's transformation. Only one case of endobronchial Richter's transformation has been previously reported in the literature. This was described as peribronchial and endobronchial leukemic infiltrates within the bronchial mucosa. We report the first case of an obstructive endobronchial mass secondary to Richter's transformation. The endobronchial mass was treated with a Nd-YAG laser to maintain airway patency while the patient underwent chemotherapy, resulting in complete resolution of the mass within the airway.

Key Words: chronic lymphocytic leukemia • endobronchial • histoplasmosis • Nd-YAG laser • Richter's transformation






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Copyright © 1999 by the American College of Chest Physicians.