151
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Fukunaga H, Kawashima K, Kumakawa H, Hashimoto Y, Takahashi Y. An autopsy of intravascular large B-cell lymphoma with hemophagocytic syndrome. JRSM Open 2017; 8:2054270417695054. [PMID: 28515953 PMCID: PMC5418909 DOI: 10.1177/2054270417695054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Intravascular large B-cell lymphoma presents with highly variable symptoms caused by the occlusion of small vessels by neoplastic cells in a variety of organs.
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Affiliation(s)
- Hisanori Fukunaga
- Soma General Hospital, Fukushima 976-0011, Japan.,Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai 980-8575, Japan
| | - Kazumasa Kawashima
- Department of Gastroenterology and Rheumatology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | | | - Yuko Hashimoto
- Department of Diagnostic Pathology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
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152
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Del Paggio JC, Bradshaw S, Marcotte L. Disturbances in blood flow and 'medicine's greatest imitator'. Intern Med J 2017; 47:586-588. [PMID: 28503874 DOI: 10.1111/imj.13414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 11/23/2016] [Accepted: 01/09/2017] [Indexed: 11/28/2022]
Abstract
First described in 1959, intravascular lymphoma (IVL) remains one of the most clinically challenging diagnoses due to its diverse and non-specific clinical manifestations and evasiveness in detection by standard investigations. Indeed, IVL deserves the title of 'medicine's greatest imitator'. We highlight a case of IVL where the diagnosis came too late in the clinical course, detected by random skin biopsy. Clinicians should strongly consider this diagnosis in presentations with persistent symptomatology despite appropriate interventions.
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Affiliation(s)
- Joseph C Del Paggio
- Division of Medical Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Scott Bradshaw
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - Laura Marcotte
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
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153
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Sawada Y, Ishii S, Koga Y, Tomizawa T, Matsui A, Tomaru T, Ozawa A, Shibusawa N, Satoh T, Shimizu H, Hirato J, Yamada M. Reversible Hypopituitarism Associated with Intravascular Large B-Cell Lymphoma: Case Report of Successful Immunochemotherapy. TOHOKU J EXP MED 2017; 238:197-203. [PMID: 26936510 DOI: 10.1620/tjem.238.197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of diffuse large B-cell lymphoma. There have been only a limited number of reports regarding pituitary dysfunction associated with IVLBCL. We present a 71-year-old woman with hypopituitarism without any hypothalamic/pituitary abnormalities as assessed by magnetic resonance imaging. She presented with edema, abducens palsy, and elevated levels of lactate dehydrogenase and soluble interleukin-2 receptor. Provocative testing showed that the peaks of luteinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone and adrenocorticotropic hormone were evoked to normal levels by simultaneous administration of luteinizing hormone-releasing hormone, thyrotropin-releasing hormone and corticotropin-releasing hormone, but the responses of these four pituitary hormones showed a delayed pattern. She was diagnosed with IVLBCL with cerebrospinal invasion by pathological findings of the bone marrow, skin, and cerebrospinal fluid. She achieved hematological remission after immunochemotherapy. Pituitary function was also restored without hormonal replacement, and the improvement of the pituitary function was confirmed by dynamic testing. We reviewed the literature with respect to hypopituitarism associated with IVLBCL. There were less than 20 case reports and most of the patients died. Endocrinological course was described in only two cases, and both of them required hormonal supplementation. To our knowledge, this is the first case of hypopituitarism induced by IVLBCL that was successfully managed by immunochemotherapy alone. This case suggests that early diagnosis and treatment of IVLBCL might improve anterior pituitary function and enable patients to avoid hormone replacement therapy.
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Affiliation(s)
- Yusuke Sawada
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine
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154
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Taschner CA, Süß P, Sajonz B, Urbach H, Simon-Gabriel CP, Prinz M. Freiburg Neuropathology Case Conference. Clin Neuroradiol 2017; 27:245-250. [DOI: 10.1007/s00062-017-0589-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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155
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Steen ST, Slater ED, Barbaro CE, Huebner ER. An unexpected finding of hepatic lymphoma after emergent cholecystectomy. J Surg Case Rep 2017; 2017:rjx051. [PMID: 28458857 PMCID: PMC5400415 DOI: 10.1093/jscr/rjx051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 01/19/2017] [Accepted: 02/27/2017] [Indexed: 12/17/2022] Open
Abstract
Herein we describe a case report of a patient with elevated liver enzymes, leukocytosis, anemia and fevers after cholecystectomy surgery done for presumed acute cholecystitis. Numerous post-surgical tests showed no acute surgical complications to account for the laboratory abnormalities. Due to systemic symptoms of joint pain and the chronicity of the symptoms, a liver biopsy was recommended by the gastroenterology service to rule out infectious or auto-immune causes. After the liver biopsy, the patient was diagnosed with intravascular large B-cell lymphoma (IVLBCL), a subset of diffuse large B-cell lymphoma. After a thorough lymphoma evaluation, the IVLBCL was found to be isolated to the liver and treated successfully with chemotherapy. This is only the second case report in the literature of this entity.
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Affiliation(s)
- Shawn T Steen
- Department of Surgery, Ventura County Medical Center, Ventura, CA, USA
| | - Evan D Slater
- Department of Medical Oncology, Ventura County Medical Center, Ventura, CA, USA
| | - Casey E Barbaro
- Department of Surgery, Ventura County Medical Center, Ventura, CA, USA
| | - Emma R Huebner
- Department of Surgery, Ventura County Medical Center, Ventura, CA, USA
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156
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di Fonzo H, Contardo D, Carrozza D, Finocchietto P, Rojano Crisson A, Cabral C, de Los Angeles Juarez M. Intravascular Large B Cell Lymphoma Presenting as Fever of Unknown Origin and Diagnosed by Random Skin Biopsies: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:482-486. [PMID: 28461685 PMCID: PMC5421743 DOI: 10.12659/ajcr.903816] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Patient: Female, 66 Final Diagnosis: Intravascular B-cell lymphoma Symptoms: Fever of unknown origin Medication: — Clinical Procedure: — Specialty: Hematology
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Affiliation(s)
- Horacio di Fonzo
- Department of Internal Medicine, Hospital de Clinicas "Jose de San Martin", University of Buenos Aires, Buenos Aires, Argentina
| | - Damian Contardo
- Department of Internal Medicine, Hospital de Clinicas "Jose de San Martin", University of Buenos Aires, Buenos Aires, Argentina
| | - Diego Carrozza
- Department of Internal Medicine, Hospital de Clinicas "Jose de San Martin", University of Buenos Aires, Buenos Aires, Argentina
| | - Paola Finocchietto
- Department of Internal Medicine, Hospital de Clinicas "Jose de San Martin", University of Buenos Aires, Buenos Aires, Argentina
| | - Adriana Rojano Crisson
- Department of Internal Medicine, Hospital de Clinicas "Jose de San Martin", University of Buenos Aires, Buenos Aires, Argentina
| | - Cecilia Cabral
- Department of Pathology, Hospital de Clinicas "Jose de San Martin", University of Buenos Aires, Buenos Aires, Argentina
| | - Maria de Los Angeles Juarez
- Department of Pathology, Hospital de Clinicas "Jose de San Martin", University of Buenos Aires, Buenos Aires, Argentina
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157
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Poropatich K, Dittmann D, Chen YH, Raparia K, Wolniak K, Gao J. A Small Case Series of Intravascular Large B-Cell Lymphoma with Unexpected Findings: Subset of Cases with Concomitant Extravascular Central Nervous System (CNS) Involvement Mimicking Primary CNS Lymphoma. J Pathol Transl Med 2017; 51:284-291. [PMID: 28415157 PMCID: PMC5445203 DOI: 10.4132/jptm.2017.02.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 12/22/2022] Open
Abstract
Background Intravascular large B-cell lymphoma (IVLBCL) is a rare type of extranodal lymphoma with growth mainly in the lumina of vessels. We studied a small series of IVLBCL and focused on its central nervous system (CNS) involvement. Methods Searching the medical records of Northwestern Memorial Hospital, we identified five cases of IVLBCL from January 2007 to January 2015. Clinical information, hematoxylin and eosin stained histologic slides and immunohistochemistry studies were reviewed for all cases. Polymerase chain reaction (PCR) analysis for the immunoglobulin (Ig) heavy and light chain gene rearrangement was performed on all five cases. Results Three of the five cases of IVLBCL were autopsies. Patients’ age ranged from 56 to 84. CNS involvement was present in two cases—in both patients, the CNS involvement showed an extravascular pattern with confluent sheet-like formation. PCR analysis confirmed that in one case the systemic intravascular and CNS extravascular components were clonally identical. Conclusions In a small case series of IVLBCL, we observed that CNS involvement by IVLBCL often has an extravascular morphology, but is clonally identical to the intravascular counterpart by PCR analysis. As IVLBCL can have a rapidly progressing poor outcome, it should be kept in the differential diagnoses for patients presenting with lymphoma of the CNS. The presence of extravascular growth patterns in the CNS should not exclude IVLBCL as a diagnosis.
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Affiliation(s)
- Kate Poropatich
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dave Dittmann
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Yi-Hua Chen
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kirtee Raparia
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kristy Wolniak
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Juehua Gao
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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158
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Su DW, Pasch W, Costales C, Siddiqi I, Mohrbacher A. Asian-variant intravascular large B-cell lymphoma. Proc (Bayl Univ Med Cent) 2017; 30:186-189. [PMID: 28405077 DOI: 10.1080/08998280.2017.11929579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare and deadly malignancy involving the growth of lymphoma cells within vessel lumina of all organ types. IVLBCL is further divided into the hemophagocytic Asian variant and a classical Western variant. Both variants are difficult to diagnose by imaging, and although diagnostic criteria have been developed to guide workup, histopathological examination remains imperative. Treatment of IVLBCL remains difficult given the high mortality of the disease, but rituximab has emerged as a promising therapeutic option when combined with various cytotoxic regimens. The two main variants of IVLBCL generally manifest in their respective Asian or Western populations, and crossover between ethnicities is rare. We present the second described case of Asian-variant IVLBCL in an African American individual.
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Affiliation(s)
- Derrick W Su
- Jane Anne Nohl Division of Hematology (Su, Mohrbacher) and the Hematopathology Section, Department of Pathology (Pasch, Costales), Norris Comprehensive Cancer Center and Hospital, University of Southern California, Los Angeles, California
| | - Whitney Pasch
- Jane Anne Nohl Division of Hematology (Su, Mohrbacher) and the Hematopathology Section, Department of Pathology (Pasch, Costales), Norris Comprehensive Cancer Center and Hospital, University of Southern California, Los Angeles, California
| | - Cristina Costales
- Jane Anne Nohl Division of Hematology (Su, Mohrbacher) and the Hematopathology Section, Department of Pathology (Pasch, Costales), Norris Comprehensive Cancer Center and Hospital, University of Southern California, Los Angeles, California
| | - Imran Siddiqi
- Jane Anne Nohl Division of Hematology (Su, Mohrbacher) and the Hematopathology Section, Department of Pathology (Pasch, Costales), Norris Comprehensive Cancer Center and Hospital, University of Southern California, Los Angeles, California
| | - Ann Mohrbacher
- Jane Anne Nohl Division of Hematology (Su, Mohrbacher) and the Hematopathology Section, Department of Pathology (Pasch, Costales), Norris Comprehensive Cancer Center and Hospital, University of Southern California, Los Angeles, California
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159
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Uchiyama T, Nakamine H, Morita K, Itami H, Nakai T, Takano M, Takeda M, Hatakeyama K, Takahama J, Tanase Y, Kobayashi H, Ohbayashi C. Intravascular Large B-Cell Lymphoma Coexisting with an Ovarian Carcinoma. J Clin Exp Hematop 2017; 56:59-63. [PMID: 27334860 DOI: 10.3960/jslrt.56.59] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We report an incidental case of intravascular large B-cell lymphoma (IVLBCL) coexisting with an ovarian carcinoma in a 76-year-old woman. She visited our hospital with difficulty in defecation. Magnetic resonance imaging and computerized tomography scan revealed a solid and cystic mass probably arising from the left ovary. Gross examination of the tumor obtained by an exploratory surgery showed a solid area in a simple cyst. The ovarian tumor was diagnosed as a high-grade serous carcinoma (HGSC). Early in the post-operative course, this patient developed fever of unknown origin with central nervous system manifestations. Magnetic resonance imaging of the brain showed multiple space-occupying lesions. When we reviewed the histological sections, atypical lymphocytes were found in the lumina of small vessels of almost the entire ovary. These cells were positive for CD20 and CD79a by immunohistochemistry. A diagnosis of IVLBCL coexisting with HGSC was finally made. Although radiation therapy for brain lesions was performed and rituximab was administered, she died two months after the operation. To the best of our knowledge, this is the first case of IVLBCL incidentally identified in HGSC through microscopic examination. This case serves to create awareness of the rare event where IVLBCL may involve the ovary of patients who also have carcinoma in the organ.
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160
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Lampe K, Rudnick JC, Leendertz F, Bleyer M, Mätz-Rensing K. Intravascular T-cell lymphoma in a patas monkey ( Erythrocebus patas). Primate Biol 2017; 4:39-46. [PMID: 32110691 PMCID: PMC7041513 DOI: 10.5194/pb-4-39-2017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 02/13/2017] [Indexed: 11/11/2022] Open
Abstract
A 9-year-old female captive patas monkey (Erythrocebus patas) presented with poor general condition, inability to stand,
petechiae, anaemia, thrombocytopenia, and leukocytosis. Due to poor response
to treatment, the animal was euthanized 16 days later. Postmortem
examination revealed hemorrhages in several organs and bilateral cerebral
infarctions. Histologically, prominent accumulations of large neoplastic
lymphocytes in cerebral and meningeal blood vessels were demonstrated within
the lesions and in other organs (e.g., bone marrow, ovary, intestine).
Immunohistochemically, neoplastic cells expressed CD3 and Ki-67. PCR
revealed a lymphocryptovirus (LCV) infection, while Epstein–Barr nuclear
antigen 2 (EBNA2) could not be demonstrated within neoplastic cells by means
of immunohistochemistry. Based on the pathological findings, an
intravascular lymphoma (IVL) of T-cell origin was diagnosed. To the authors'
knowledge, this is the first report on this rare entity in a nonhuman
primate.
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Affiliation(s)
- Karen Lampe
- Pathology Unit, German Primate Center, Leibniz-Institute for Primate Research, Kellnerweg 4, 37077 Göttingen, Germany
| | | | | | - Martina Bleyer
- Pathology Unit, German Primate Center, Leibniz-Institute for Primate Research, Kellnerweg 4, 37077 Göttingen, Germany
| | - Kerstin Mätz-Rensing
- Pathology Unit, German Primate Center, Leibniz-Institute for Primate Research, Kellnerweg 4, 37077 Göttingen, Germany
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161
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Rajyaguru DJ, Bhaskar C, Borgert AJ, Smith A, Parsons B. Intravascular large B-cell lymphoma in the United States (US): a population-based study using Surveillance, Epidemiology, and End Results program and National Cancer Database. Leuk Lymphoma 2017; 58:1-9. [PMID: 28278725 DOI: 10.1080/10428194.2017.1287363] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
A population-based study of intravascular large B-cell lymphoma (IVLBCL) in the US was conducted to determine incidence, demographic and clinical characteristics, prognostic factors, and survival compared with diffuse large B-cell lymphoma not otherwise specified (DLBCL NOS). In the years 2000-2013, the age-adjusted incidence rate of IVLBCL was 0.095 (case/1,000,000). The incidence of IVLBCL increased significantly from 2000 to 2013 (annual percentage change = 9.84, p = 0.002). We identified 344 patients with IVLBCL. The median age at diagnosis was 70 years. The median 1, 3, and 5-year OS rates for IVLBCL were 66.2, 51.8, and 46.3%, respectively. After propensity matching, the 5-year overall survival of IVLBCL was comparable to DLBCL NOS (46.4 versus 46.5%, p = 0.53). On multivariate analysis advanced age, advanced stage and having Medicaid or Medicare insurance predicted worse OS, whereas female gender and use of radiation therapy predicted better OS.
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Affiliation(s)
| | | | | | - Angela Smith
- b Gundersen Lutheran Medical Foundation , La Crosse , WI , USA
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162
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Dedhia PH, Lopez K, Reddy A, McHugh JB, Langer E, Miller BS. Intravascular Large B-Cell Lymphoma Presenting As Thyroid, Adrenal And Mesenteric Nodules. AACE Clin Case Rep 2017. [DOI: 10.4158/ep161228.cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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163
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Nakamura S, Kagawa K, Sumitani R, Uemura M, Takahashi M, Iwasa M, Fujii S, Miki H, Abe M. Primary CD30-positive Diffuse Large B-cell Lymphoma in the Superior Vena Cava. Intern Med 2017; 56:2043-2047. [PMID: 28768978 PMCID: PMC5577084 DOI: 10.2169/internalmedicine.56.8203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Primary superior vena cava lymphoma originating from the endothelium of a large vein is very rare. A 70-year-old man was admitted to the hospital; computed tomography showed a tumor limited to the inside of the superior vena cava, completely occluding the vessel. A transjugular biopsy confirmed the diagnosis of diffuse large B-cell lymphoma, which was diffusely positive for CD30. Rituximab monotherapy followed by five courses of R-CHOP chemotherapy induced a complete remission. There was no recurrence after two years. The pathophysiology of lymphoma derived from large vessels may be different from intravascular large B-cell lymphoma, which usually involves small vessels.
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MESH Headings
- Aged
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biopsy
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Humans
- Ki-1 Antigen/analysis
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Neoplasm Recurrence, Local/drug therapy
- Prednisone/therapeutic use
- Remission Induction
- Rituximab
- Superior Vena Cava Syndrome/etiology
- Tomography, X-Ray Computed
- Vena Cava, Superior
- Vincristine/therapeutic use
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Affiliation(s)
- Shingen Nakamura
- Department of Hematology, Endocrinology and Metabolism, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
| | - Kumiko Kagawa
- Department of Hematology, Endocrinology and Metabolism, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
| | - Ryohei Sumitani
- Department of Hematology, Endocrinology and Metabolism, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
| | - Munenori Uemura
- Department of Hematology, Endocrinology and Metabolism, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
| | - Mamiko Takahashi
- Department of Hematology, Endocrinology and Metabolism, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
| | - Masami Iwasa
- Department of Hematology, Endocrinology and Metabolism, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
| | - Shiro Fujii
- Department of Hematology, Endocrinology and Metabolism, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
| | - Hirokazu Miki
- Division of Transfusion Medicine and Cell Therapy, Tokushima University Hospital, Japan
| | - Masahiro Abe
- Department of Hematology, Endocrinology and Metabolism, Institute of Biomedical Sciences, Tokushima University Graduate School, Japan
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164
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Takeshige T, Harada N, Sekimoto Y, Kanemaru R, Tsutsumi T, Matsuno K, Shiota S, Masuda A, Gotoh A, Asahina M, Uekusa T, Takahashi K. Pulmonary Intravascular Large B-cell Lymphoma (IVLBCL) Disguised as an Asthma Exacerbation in a Patient with Asthma. Intern Med 2017; 56:1885-1891. [PMID: 28717087 PMCID: PMC5548684 DOI: 10.2169/internalmedicine.56.7613] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A 62-year-old man with asthma presented with a 1-month history of wheezing and exertional dyspnea. Although the wheezing symptoms disappeared after systemic corticosteroid therapy, the exertional dyspnea and hypoxemia did not improve. A diagnosis of intravascular large B-cell lymphoma (IVLBCL) with pulmonary involvement was suspected because of the increased serum lactic dehydrogenase (LDH) and soluble interleukin-2 receptor (sIL-2R) level, increased alveolar-arterial oxygen difference (AaDO2), decreased pulmonary diffusing capacity for carbon monoxide (DLCO) and scintigraphic, computed tomography (CT) and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)-CT findings. The patient was diagnosed as having IVLBCL with pulmonary involvement based on a pathological analysis of a random skin biopsy and a transbronchial lung biopsy. IVLBCL should be considered in patients with symptoms of asthma that are refractory to corticosteroid treatment.
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Affiliation(s)
- Tomohito Takeshige
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Norihiro Harada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Yasuhito Sekimoto
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Ryota Kanemaru
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Takeo Tsutsumi
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Kei Matsuno
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Satomi Shiota
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Azuchi Masuda
- Department of Hematology, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Akihiko Gotoh
- Department of Hematology, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Miki Asahina
- Department of Human Pathology, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Toshimasa Uekusa
- Department of Pathology, Labour Health and Welfare Organization Kanto Rosai Hospital, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
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165
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Autologous hematopoietic stem cell transplantation for intravascular large B-cell lymphoma: the European Society for Blood and Marrow Transplantation experience. Bone Marrow Transplant 2016; 52:650-652. [PMID: 27991887 DOI: 10.1038/bmt.2016.339] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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166
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Prats-Martín C, Franco-Macías E, Morales-Camacho RM, Pérez O, Vargas MT, de la Cruz Vicente F, Borrero JJ, Bernal R, Pérez-Simón JA. Intravascular lymphoma: look through the small vessels. Ann Hematol 2016; 96:517-519. [PMID: 27838775 DOI: 10.1007/s00277-016-2874-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 10/28/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Concepción Prats-Martín
- UGC de Hematología, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Universidad de Sevilla, Seville, Spain. .,Department of Hematology, University Hospital Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Universidad de Sevilla, Seville, Spain.
| | - Emilio Franco-Macías
- UGC de Neurociencias, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Universidad de Sevilla, Seville, Spain
| | - Rosario M Morales-Camacho
- UGC de Hematología, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Universidad de Sevilla, Seville, Spain
| | - Olga Pérez
- UGC de Hematología, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Universidad de Sevilla, Seville, Spain
| | - M Teresa Vargas
- UGC de Hematología, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Universidad de Sevilla, Seville, Spain
| | - Fátima de la Cruz Vicente
- UGC de Hematología, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Universidad de Sevilla, Seville, Spain
| | - Juan J Borrero
- UGC de Anatomía Patológica, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Universidad de Sevilla, Seville, Spain
| | - Ricardo Bernal
- UGC de Hematología, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Universidad de Sevilla, Seville, Spain
| | - José A Pérez-Simón
- UGC de Hematología, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS)/CSIC/Universidad de Sevilla, Seville, Spain
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167
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Pattison DA, Hofman MS, Bazargan A, Colman P, Hicks RJ. Intense focal pituitary FDG uptake due to intravascular large B-cell lymphoma in pyrexia of unknown origin. Am J Hematol 2016; 91:1167-1168. [PMID: 27387341 DOI: 10.1002/ajh.24469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 07/05/2016] [Indexed: 11/06/2022]
Affiliation(s)
- David A. Pattison
- Centre for Cancer Imaging, Peter MacCallum Cancer Centre; Melbourne Australia
| | - Michael S. Hofman
- Centre for Cancer Imaging, Peter MacCallum Cancer Centre; Melbourne Australia
- Department of Medicine; University of Melbourne; Melbourne Australia
| | - Ali Bazargan
- Department of Haematology; St Vincent's Hospital; Fitzroy Australia
| | - Peter Colman
- Department of Medicine; University of Melbourne; Melbourne Australia
- Department of Diabetes & Endocrinology; Royal Melbourne Hospital; Parkville Australia
| | - Rodney J. Hicks
- Centre for Cancer Imaging, Peter MacCallum Cancer Centre; Melbourne Australia
- Department of Medicine; University of Melbourne; Melbourne Australia
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168
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A Case of De Novo CD5+ Disseminated Intravascular Large B-Cell Lymphoma Presenting as Multiorgan Failure. Case Rep Hematol 2016; 2016:6239416. [PMID: 27777803 PMCID: PMC5061938 DOI: 10.1155/2016/6239416] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 09/14/2016] [Indexed: 11/17/2022] Open
Abstract
Intravascular large B-cell lymphoma is an extremely rare extranodal lymphoma that proliferates in the lumen of the blood vessels while sparing the organ parenchyma. It usually presents with CNS and skin involvement. A 65-year-old Caucasian female presented with fevers and chills of 3-4 months' duration. Bone marrow biopsy done 3 months prior showed no significant myelodysplasia or lymphoid aggregates. The patient later died due to multiorgan failure. A bone marrow biopsy showed 20–30% CD5+ B cells consistent with infiltrative large B-cell lymphoma. An autopsy performed revealed diffuse intravascular invasion by lymphoma cells. Multiorgan involvement by intravascular B-cell lymphoma is very rare. Based on our literature review and to the best of our knowledge, there are only 5 case reports describing the presentation of this lymphoma with multiorgan failure. The immunophenotypic studies performed revealed that our patient had de novo CD5+ intravascular large B-cell lymphoma which is known to be aggressive with very poor prognosis. Although it is an extremely rare lymphoma, it should be considered as a potential cause of multiorgan failure when no other cause has been identified. A prompt tissue diagnosis and high-dose chemotherapy followed by ASCT can sometimes achieve remission.
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169
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Wang J, Ding W, Gao L, Yao W, Chen M, Zhao S, Liu W, Zhang W. High Frequency of Bone Marrow Involvement in Intravascular Large B-Cell Lymphoma. Int J Surg Pathol 2016; 25:118-126. [PMID: 27553679 DOI: 10.1177/1066896916665203] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of diffuse large B-cell lymphoma. Thirteen cases of IVLBCL with a median age of 56 years were analyzed retrospectively. Nonspecific symptoms such as fever and hepatosplenomegaly were the most common manifestations, and the bone marrow was usually involved in 8/13 (61.5%) cases. All tumors expressed CD20, and 12/13 (92.3%) of the tumors exhibited a nongerminal center phenotype by Hans algorithm. CD5 was expressed in 3/12 (25%) of the tumors. MYC was negative in all cases, and BCL2 was positive in 10/12 (83.3%) cases. Cytogenetic analysis revealed 5 cases that did not have rearrangements in either the MYC or the BCL2 gene. No association with Epstein-Barr virus was found. Seven of 11 patients received chemotherapy. The median survival time was 6 months. Patients with hemophagocytic syndrome had poor prognoses. Our study demonstrates that IVLBCL has a poor clinical outcome with a high frequency of bone marrow involvement and that the MYC gene may not play an important role in the poor prognosis of IVLBCL.
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Affiliation(s)
- Jianchao Wang
- 1 West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wenshuang Ding
- 1 West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Limin Gao
- 1 West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wenqing Yao
- 1 West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Min Chen
- 1 West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Sha Zhao
- 1 West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Weiping Liu
- 1 West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wenyan Zhang
- 1 West China Hospital, Sichuan University, Chengdu, Sichuan, China
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170
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High-Resolution Vessel Wall MRI. Clin Neuroradiol 2016; 27:105-108. [DOI: 10.1007/s00062-016-0529-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 07/11/2016] [Indexed: 12/14/2022]
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171
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Saito T, Matsuya T, Takahashi C, Kaneta K, Ohishi Y, Uehara J, Hashimoto M, Honma M, Ishida-Yamamoto A. Cutaneous variant of intravascular large B-cell lymphoma in a Japanese patient: An occult lesion localized in a solitary angiolipoma. J Dermatol 2016; 44:e28-e29. [PMID: 27422850 DOI: 10.1111/1346-8138.13504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Takefumi Saito
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | - Taisuke Matsuya
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | - Chiaki Takahashi
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | - Kazuhiro Kaneta
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | - Yasushi Ohishi
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | - Jiro Uehara
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | - Makoto Hashimoto
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
| | - Masaru Honma
- Department of Dermatology, Asahikawa Medical University, Asahikawa, Japan
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172
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Aggressive Lymphomas Diagnosed in the Bone Marrow: Two Illustrative Cases. Indian J Hematol Blood Transfus 2016; 32:125-9. [PMID: 27408373 DOI: 10.1007/s12288-015-0520-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 02/18/2015] [Indexed: 10/23/2022] Open
Abstract
Lymphomas with subtle patterns in the marrow can be a diagnostic challenge, unless a high index of suspicion is maintained. We present two patients with aggressive lymphomas who presented with cytopenias and the subsequent bone marrow examinations yielded surprising results. These cases highlight the potential usefulness of a bone marrow examination in the diagnosis of lymphomas in the absence of nodal or other tissue specimens.
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173
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Hall JM, Meyers N, Andrews J. Hemophagocytosis-Related (Asian Variant) Intravascular Large B-Cell Lymphoma in a Hispanic Patient: A Case Report Highlighting a Micronodular Pattern in the Spleen. Am J Clin Pathol 2016; 145:727-35. [PMID: 27247375 DOI: 10.1093/ajcp/aqw027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES We report a case of hemophagocytosis-related (Asian variant) intravascular large B-cell lymphoma (IVLBCL) in a patient of Western origin initially diagnosed by splenectomy with diffuse large B-cell lymphoma (DLBCL) with a micronodular pattern. The clonal relationship between these two DLBCL subtypes is also investigated. METHODS Hemophagocytosis-related (Asian variant) IVLBCL was identified at autopsy in a 62-year-old Hispanic woman, in North America, following an antemortem diagnosis of massive splenic involvement by DLBCL with a micronodular pattern, a feature not expected of IVLBCL. RESULTS These two apparently distinct lymphoma types demonstrated similar immunophenotypic profiles and IgH gene rearrangements of identical size suggesting a clonal relationship. The 2008 WHO classification system describes IVLBCL in the spleen as having a sinusoidal pattern. CONCLUSIONS Our observations provide the first molecular genetic support for a seemingly underrecognized micronodular pattern of IVLBCL in the spleen and further support the proposal of a "mixed variant" of IVLBCL with concomitant "intravascular" and "solid" phases of disease.
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Affiliation(s)
- Jordan M Hall
- From the San Antonio Military Medical Center, Fort Sam Houston, TX
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174
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Shimada K, Shimada S, Sugimoto K, Nakatochi M, Suguro M, Hirakawa A, Hocking TD, Takeuchi I, Tokunaga T, Takagi Y, Sakamoto A, Aoki T, Naoe T, Nakamura S, Hayakawa F, Seto M, Tomita A, Kiyoi H. Development and analysis of patient-derived xenograft mouse models in intravascular large B-cell lymphoma. Leukemia 2016; 30:1568-79. [PMID: 27001523 DOI: 10.1038/leu.2016.67] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 02/11/2016] [Accepted: 03/04/2016] [Indexed: 12/31/2022]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a distinct disease entity with the peculiar characteristic that tumor cells proliferate within vessels. Despite recent advances in understanding the disease from clinical aspects, the underlying pathogenesis remains unknown. Here we demonstrate analyses of IVLBCL biology using four xenograft mouse models established from primary IVLBCL samples. In all four models, the main characteristic of IVLBCL tumor cell proliferation within vessels was retained. Time-lapse engraftment analyses revealed that the tumor cells initially engrafted and proliferated in the sinusoids and vessels in the liver and then engrafted and proliferated in multiple organs. Intriguingly, serial passage of tumor cells from the adrenal gland of a transplanted mouse developed from primary patient bone marrow cells into a second mouse showed that the tumor cells mainly distributed into the adrenal gland in the second mouse, implying the existence of clonal selection and/or evolution at engraftment of a specific organ. Gene expression profiling analyses demonstrated that the gene set associated with cell migration was enriched for normal peripheral blood B cells, indicating that inhibition of cell migration might be involved in IVLBCL pathogenesis. In conclusion, the mouse xenograft models described here are essential tools for uncovering IVLBCL biology.
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Affiliation(s)
- K Shimada
- Institute for Advanced Research, Nagoya University, Nagoya, Japan.,Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - S Shimada
- Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya, Japan
| | - K Sugimoto
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Fujii Memorial Research Institute, Otsuka Pharmaceutical Co., Ltd, Otsu, Japan
| | - M Nakatochi
- Center for Advanced Medicine and Clinical Research, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - M Suguro
- Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - A Hirakawa
- Center for Advanced Medicine and Clinical Research, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - T D Hocking
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - I Takeuchi
- Department of Computer Science/Scientific and Engineering Simulation, Nagoya Institute of Technology, Nagoya, Japan
| | - T Tokunaga
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Hematology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - Y Takagi
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - A Sakamoto
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - T Aoki
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - T Naoe
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Department of Hematology, National Hospital Organization, Nagoya Medical Center, Nagoya, Japan
| | - S Nakamura
- Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya, Japan
| | - F Hayakawa
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - M Seto
- Division of Molecular Medicine, Aichi Cancer Center Research Institute, Nagoya, Japan.,Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - A Tomita
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - H Kiyoi
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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175
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Iioka F, Honjo G, Misaki T, Toda Y, Izumi K, Kamoda Y, Nagai Y, Akasaka T, Kitamura K, Nakagwa M, Fukutsuka K, Okumura A, Ohno H. A unique subtype of diffuse large B-cell lymphoma primarily involving the bone marrow, spleen, and liver, defined by fluorodeoxyglucose-positron emission tomography combined with computed tomography. Leuk Lymphoma 2016; 57:2593-602. [DOI: 10.3109/10428194.2016.1154959] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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176
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Abstract
Epstein-Barr virus (EBV) infection is a common feature of B cell lymphoproliferative disorders (LPDs), including diffuse large B cell lymphoma. Approximately 10 % of DLBCLs are EBV-positive, with the highest incidence in immunocompromised and elderly patients. Here, we review the clinical, genetic, and pathologic characteristics of DLBCL and discuss the molecular role of EBV in lymphoma tumorigenesis. Using EBV-positive DLBCL of the elderly as a model, we describe the key features of EBV-positive DLBCL. Studies of EBV-positive DLBCL of the elderly demonstrate that EBV-positive DLBCL has a distinct biology, related to both viral and host factors. The pathogenic mechanisms noted in EBV-positive DLBCL of the elderly, including enhanced NFκB activity, are likely to be a generalizable feature of EBV-positive DLBCL. Therefore, we review how this information might be used to target the EBV or its host response for the development of novel treatment strategies.
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177
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Cha MJ, Lee KS, Hwang HS, Kim TJ, Kim TS, Kim BT, Ko YH, Shim YM. Pulmonary Intravascular Lymphomatosis: Clinical, CT, and PET Findings, Correlation of CT and Pathologic Results, and Survival Outcome. Radiology 2016; 280:602-10. [PMID: 26943231 DOI: 10.1148/radiol.2016151706] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To describe clinical, computed tomographic (CT), and positron emission tomographic (PET) features, correlation of CT and pathologic results, and survival of patients with pulmonary intravascular lymphomatosis. Materials and Methods The institutional review board approved this retrospective study with waiver of patient consent. Forty-two patients with pulmonary intravascular lymphomatosis were identified, 11 (26%) of whom showed lung involvement. CT features were correlated with histopathologic results. Clinical and survival outcomes were compared between patients with and those without pulmonary involvement by adopting the χ(2), Student t, or Kaplan-Meier analysis with log-rank tests. Results At clinical presentation, all 11 patients showed B symptoms (systemic symptoms of fever, night sweats, and weight loss), 10 had respiratory and four had neurologic symptoms, and two had skin lesions. Patients received cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy with (n = 5) or without (n = 6) rituximab, and seven (64%) patients died. Patients with lung involvement showed reduced overall and recurrence-free survival (median; 10.8 and 18.9 months, respectively) compared with those without lung involvement (median, 18.4 and 31.0 months, respectively) (P = .338 and .065, respectively). The most common CT abnormality was bilateral ground-glass opacity (GGO, n = 10), with increased fluorodeoxyglucose uptake at PET/CT (seven of seven patients). GGO correlated histopathologically with the expanded alveolar septal vasculatures and perivascular spaces filled with neoplastic lymphoid cells. Conclusion Pulmonary intravascular lymphomatosis appeared as bilateral GGO on CT images, with increased fluorodeoxyglucose uptake on PET/CT images. GGO on CT images correlated with the area of expanded alveolar septae because of distended vessels filled with neoplastic lymphoid cells. (©) RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Min Jae Cha
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| | - Kyung Soo Lee
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| | - Hye Sun Hwang
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| | - Tae Jung Kim
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| | - Tae Sung Kim
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| | - Byung-Tae Kim
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| | - Young-Hyeh Ko
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
| | - Young Mog Shim
- From the Department of Radiology and Center for Imaging Science (M.J.C., K.S.L., H.S.H., T.J.K., T.S.K.), Department of Nuclear Medicine (B.T.K.), Department of Pathology (Y.H.K.), and Department of Thoracic Surgery (Y.M.S.), Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea
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178
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Kaneyuki D, Komeno Y, Yoshimoto H, Yoshimura N, Iihara K, Ryu T. Intestinal Intravascular Large B-cell Lymphoma Mimicking Ulcerative Colitis with Secondary Membranoproliferative Glomerulonephritis. Intern Med 2016; 55:2475-81. [PMID: 27580553 DOI: 10.2169/internalmedicine.55.6737] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 47-year-old woman with ulcerative colitis (UC) was admitted to our hospital for renal dysfunction and progressive anemia. Colonoscopy revealed intestinal lesions and pathological findings showed intravascular large B-cell lymphoma (IVLBCL). According to the polymerase chain reaction analysis of sequential rectal specimens, we concluded that she suffered from intestinal BCL, not UC. After chemotherapy, her renal function progressed to nephrotic syndrome. The pathological findings of renal biopsy specimens indicated membranoproliferative glomerulonephritis (MPGN). Chemotherapy was continued and led to the remission of BCL and MPGN. We herein describe the first case of intestinal IVLBCL mimicking UC with secondary MPGN.
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Affiliation(s)
- Daisuke Kaneyuki
- Department of Hematology, Japan Community Healthcare Organization (JCHO) Tokyo Yamate Medical Center, Japan
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179
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Shigematsu Y, Matsuura M, Nishimura N, Tsuyama N, Takeuchi K, Terui Y, Takeshima N, Hatake K. Intravascular Large B-cell Lymphoma of the Bilateral Ovaries and Uterus in an Asymptomatic Patient with a t(11;22)(q23;q11) Constitutional Translocation. Intern Med 2016; 55:3169-3174. [PMID: 27803414 PMCID: PMC5140869 DOI: 10.2169/internalmedicine.55.6578] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of extranodal diffuse large B-cell lymphoma, which is characterized by the intravascular growth of lymphoma cells, aggressive behavior, and an often fatal course. Patients with IVLBCL are usually symptomatic. Although any organ may be involved, localized lesions in the bilateral ovaries and uterus are extremely rare. We experienced a rare case of IVLBCL involving the bilateral ovaries and uterus in an asymptomatic patient with a t(11;22)(q23;q11) constitutional balanced translocation. Its association with the disease remains unknown. Even in asymptomatic situations, IVLBCL is possible, and the uterus and ovaries can be involved.
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MESH Headings
- Diagnosis, Differential
- Female
- Humans
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Ovarian Neoplasms/diagnosis
- Ovarian Neoplasms/diagnostic imaging
- Ovarian Neoplasms/genetics
- Ovarian Neoplasms/pathology
- Positron Emission Tomography Computed Tomography
- Translocation, Genetic
- Uterine Neoplasms/diagnosis
- Uterine Neoplasms/diagnostic imaging
- Uterine Neoplasms/genetics
- Uterine Neoplasms/pathology
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Affiliation(s)
- Yasuyuki Shigematsu
- Division of Hematology Oncology, The Cancer Institute Hospital, Japanese Foundation of Cancer Research, Japan
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180
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Usuda D, Arahata M, Temaru R, Iinuma Y, Kanda T, Hayashi S. Autopsy-Proven Intravascular Lymphoma Presenting as Rapidly Recurrent Strokes. Case Rep Oncol 2016; 9:148-53. [PMID: 27065845 PMCID: PMC4821140 DOI: 10.1159/000444632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We present a 79-year-old Japanese woman diagnosed with cerebral infarction. In spite of enough antiplatelet and anticoagulant therapy, she presented rapidly recurrent strokes three times for 3 months. Magnetic resonance imaging showed progression of bilateral cerebral infarcts, and chest-abdominal computed tomography showed multiple bilateral nodular lesions in the lung and multiple tumor lesions in the liver. Autopsy revealed diagnosis of intravascular lymphoma (IVL). This case indicates that IVL is rare and usually goes undiagnosed until time of autopsy because of its protean neurological manifestations; hence, it should be considered as a possible etiology if multiple strokes occur in a short period of time.
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Affiliation(s)
- Daisuke Usuda
- Department of Infectious Diseases, Kanazawa Medical University, Uchinada, Japan
- Department of Community Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan
- *Daisuke Usuda Department of Infectious Diseases, Kanazawa Medical University 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa-ken 920-0293 (Japan) E-Mail
| | - Masahisa Arahata
- Department of Internal Medicine, Nanto Municipal Hospital, Nanto, Japan
| | - Rie Temaru
- Department of Internal Medicine, Nanto Municipal Hospital, Nanto, Japan
| | - Yoshitsugu Iinuma
- Department of Infectious Diseases, Kanazawa Medical University, Uchinada, Japan
| | - Tsugiyasu Kanda
- Department of Community Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan
| | - Shinichi Hayashi
- Department of Diagnostic Pathology, Toyama University Hospital, Toyama, Japan
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181
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Adler NR, Sia CSB, Polchleb C, Jane S, Aung AK. Intravascular large B cell lymphoma with haemophagocytic syndrome: a double lethal masquerade. Intern Med J 2015; 45:1310-2. [DOI: 10.1111/imj.12931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 07/05/2015] [Accepted: 08/02/2015] [Indexed: 11/30/2022]
Affiliation(s)
- N. R. Adler
- Department of General Medicine; Alfred Hospital; Melbourne Victoria Australia
| | - C. S. B. Sia
- Department of General Medicine; Alfred Hospital; Melbourne Victoria Australia
| | - C. Polchleb
- Department of General Medicine; Alfred Hospital; Melbourne Victoria Australia
| | - S. Jane
- Department of Haematology; Alfred Hospital; Melbourne Victoria Australia
- Monash University; Melbourne Victoria Australia
| | - A. K. Aung
- Department of General Medicine; Alfred Hospital; Melbourne Victoria Australia
- Deparment of Infectious Diseases; Alfred Hospital; Melbourne Victoria Australia
- Monash University; Melbourne Victoria Australia
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182
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Tahsili-Fahadan P, Rashidi A, Cimino PJ, Bucelli RC, Keyrouz SG. Neurologic manifestations of intravascular large B-cell lymphoma. Neurol Clin Pract 2015; 6:55-60. [PMID: 26918203 DOI: 10.1212/cpj.0000000000000185] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Intravascular large B-cell lymphoma is a rare subtype of large B-cell lymphoma that affects various organs including the nervous system. The diagnosis is challenging and frequently made at autopsy. RECENT FINDINGS We report 5 cases with an array of neurologic manifestations. All patients were initially evaluated for alternative diagnoses. Three patients were diagnosed at autopsy, one with brain biopsy, and another with muscle biopsy. Muscle was involved in all 3 patients who had muscle tissue available for analysis. SUMMARY Our observations suggest that random open muscle biopsy may present a high-yield, less invasive option for the diagnosis of this disorder.
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Affiliation(s)
- Pouya Tahsili-Fahadan
- Department of Neurology (PT-F, RCB, SGK), Divisions of General Neurology (PT-F/RCB), Neuromuscular Disorders (RCB), Cerebrovascular Diseases (SGK), and Neurological Critical Care (SGK), Division of Oncology (AR), and Department of Pathology and Immunology, Division of Neuropathology (PJC), Washington University School of Medicine, St. Louis, MO
| | - Armin Rashidi
- Department of Neurology (PT-F, RCB, SGK), Divisions of General Neurology (PT-F/RCB), Neuromuscular Disorders (RCB), Cerebrovascular Diseases (SGK), and Neurological Critical Care (SGK), Division of Oncology (AR), and Department of Pathology and Immunology, Division of Neuropathology (PJC), Washington University School of Medicine, St. Louis, MO
| | - Patrick J Cimino
- Department of Neurology (PT-F, RCB, SGK), Divisions of General Neurology (PT-F/RCB), Neuromuscular Disorders (RCB), Cerebrovascular Diseases (SGK), and Neurological Critical Care (SGK), Division of Oncology (AR), and Department of Pathology and Immunology, Division of Neuropathology (PJC), Washington University School of Medicine, St. Louis, MO
| | - Robert C Bucelli
- Department of Neurology (PT-F, RCB, SGK), Divisions of General Neurology (PT-F/RCB), Neuromuscular Disorders (RCB), Cerebrovascular Diseases (SGK), and Neurological Critical Care (SGK), Division of Oncology (AR), and Department of Pathology and Immunology, Division of Neuropathology (PJC), Washington University School of Medicine, St. Louis, MO
| | - Salah G Keyrouz
- Department of Neurology (PT-F, RCB, SGK), Divisions of General Neurology (PT-F/RCB), Neuromuscular Disorders (RCB), Cerebrovascular Diseases (SGK), and Neurological Critical Care (SGK), Division of Oncology (AR), and Department of Pathology and Immunology, Division of Neuropathology (PJC), Washington University School of Medicine, St. Louis, MO
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183
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Persistent Altered Mental Status in a Patient With Human Immunodeficiency Virus. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2015. [DOI: 10.1097/ipc.0000000000000301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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184
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Özsan N, Sarsık B, Yılmaz AF, Şimşir A, Dönmez A. Intravascular large B-cell lymphoma diagnosed on prostate biopsy: a case report. Turk J Haematol 2015; 31:403-7. [PMID: 25541658 PMCID: PMC4454057 DOI: 10.4274/tjh.2013.0090] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a very rare type of non-Hodgkin lymphoma, usually affecting elderly patients and characterized by selective infiltration of neoplastic cells within blood vessels' lumina. IVLBCL diagnosed with prostatic involvement is extremely rare. We report a patient of 65 years old, having mostly neurological complaints but diagnosed with IVLBCL upon histopathological examination of transurethral prostate resection material, which revealed large neoplastic cell infiltration totally limited within the lumens of small vessels. By immunohistochemistry, neoplastic cell infiltration was positive with MUM1, bcl-6, and bcl-2 and negative with ALK1, CD10, and CD30, with a high Ki-67 proliferation index. CD34 and CD31 staining showed expression in endothelial cells, highlighting the intravascular nature of neoplastic infiltrate. The patient unfortunately refused to receive treatment and died of the disease 8 months after the diagnosis. IVLBCL, though very rare, should be considered in differential diagnosis of all organ biopsies with intravascular infiltration. Further improvements in the understanding of the pathogenesis and biology of this rare type of lymphoma are mandatory.
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Affiliation(s)
- Nazan Özsan
- Ege University Faculty of Medicine, Department of Pathology, İzmir, Turkey. E-ma-il:
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185
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Bae J, Lim HK, Park HY. Imaging findings for intravascular large B-cell lymphoma of the liver. Clin Mol Hepatol 2015; 21:295-9. [PMID: 26523272 PMCID: PMC4612291 DOI: 10.3350/cmh.2015.21.3.295] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 10/29/2013] [Accepted: 10/30/2013] [Indexed: 12/14/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of extranodal diffuse large B-cell lymphoma that most commonly involves the central nervous system and skin. To our knowledge, no state-of-the art imaging findings have been reported for hepatic IVLBCL in the English literature. We report the first case of hepatic involvement of IVLBCL along with a literature review.
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Affiliation(s)
- Jungmin Bae
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Keun Lim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ha Young Park
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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186
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Hasegawa J, Hoshino J, Suwabe T, Hayami N, Sumida K, Mise K, Ueno T, Sawa N, Wake A, Ohashi K, Fujii T, Honda K, Takaichi K, Ubara Y. Characteristics of Intravascular Large B-Cell Lymphoma Limited to the Glomerular Capillaries: A Case Report. Case Rep Nephrol Dial 2015; 5:173-9. [PMID: 26351627 PMCID: PMC4555212 DOI: 10.1159/000437296] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A 65-year-old woman was admitted to our hospital for the evaluation of rapidly progressive renal dysfunction with serum creatinine of 2.7 mg/dl and urinary protein of 1.5 g daily. C-reactive protein (CRP) was 0.1 mg/dl. Kidney-limited intravascular large B-cell lymphoma (IVL) localized to the glomerular capillaries was diagnosed because the intraglomerular cells were positive for CD20 and CD79a, while there was no positivity in the extraglomerular kidney and extrarenal organs. Treatment with rituximab, cyclophosphamide, hydroxydaunomycin, vincristine, and prednisolone was started, and the patient has since been doing well. When IVL is limited to the intraglomerular capillaries, CRP may not be elevated.
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Affiliation(s)
- Jumpei Hasegawa
- Nephrology Center, Toranomon Hospital, Tokyo, Japan ; Department of Nephrology, Ohkubo Hospital, Tokyo, Japan
| | | | | | | | | | - Koki Mise
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | | | - Naoki Sawa
- Nephrology Center, Toranomon Hospital, Tokyo, Japan
| | - Atsushi Wake
- Department of Hematology, Toranomon Hospital, Tokyo, Japan
| | - Kenichi Ohashi
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, Tokyo, Japan
| | - Kazuho Honda
- Department of Pathology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenmei Takaichi
- Nephrology Center, Toranomon Hospital, Tokyo, Japan ; Department of Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Yoshifumi Ubara
- Nephrology Center, Toranomon Hospital, Tokyo, Japan ; Department of Okinaka Memorial Institute for Medical Research, Tokyo, Japan
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187
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Xiong X, Hou S, Chen H, Zhao X, Li X, Li L, Lian K, Zhang Q. [Asian variant of intravascular large B cell lymphoma with leukemia:a case report and literature review]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2015; 36:529-31. [PMID: 26134023 PMCID: PMC7343061 DOI: 10.3760/cma.j.issn.0253-2727.2015.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Xiangle Xiong
- Department of Lymphatic Oncology, Shanxi Academy of Medical Sciences Shanxi Dayi Hospital, Taiyuan 030032,China
| | - Shuling Hou
- Department of Lymphatic Oncology, Shanxi Academy of Medical Sciences Shanxi Dayi Hospital, Taiyuan 030032,China
| | - Huishu Chen
- Department of Lymphatic Oncology, Shanxi Academy of Medical Sciences Shanxi Dayi Hospital, Taiyuan 030032,China
| | - Xiujuan Zhao
- Department of Lymphatic Oncology, Shanxi Academy of Medical Sciences Shanxi Dayi Hospital, Taiyuan 030032,China
| | - Xi Li
- Department of Lymphatic Oncology, Shanxi Academy of Medical Sciences Shanxi Dayi Hospital, Taiyuan 030032,China
| | - Li Li
- Department of Lymphatic Oncology, Shanxi Academy of Medical Sciences Shanxi Dayi Hospital, Taiyuan 030032,China
| | - Ke Lian
- Department of Lymphatic Oncology, Shanxi Academy of Medical Sciences Shanxi Dayi Hospital, Taiyuan 030032,China
| | - Qiaohua Zhang
- Department of Lymphatic Oncology, Shanxi Academy of Medical Sciences Shanxi Dayi Hospital, Taiyuan 030032,China
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188
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Kuramitsu K, Fukumoto T, Yano Y, Hirano H, Misumi T, Katayama Y, Kawano H, Yakushijin K, Zen Y, Itoh T, Ku Y. A case of intravascular lymphoma diagnosed in an explanted liver after liver transplantation. Transpl Int 2015; 28:1245-50. [DOI: 10.1111/tri.12611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 03/31/2015] [Accepted: 05/18/2015] [Indexed: 12/28/2022]
Affiliation(s)
- Kaori Kuramitsu
- Division of Hepato-biliary and Pancreatic Surgery; Department of Surgery; Kobe University; Kobe Japan
| | - Takumi Fukumoto
- Division of Hepato-biliary and Pancreatic Surgery; Department of Surgery; Kobe University; Kobe Japan
| | - Yoshihiko Yano
- Division of Gastroenterology; Department of Internal Medicine; Kobe University; Kobe Japan
| | - Hirotaka Hirano
- Division of Gastroenterology; Department of Internal Medicine; Kobe University; Kobe Japan
| | - Takuyo Misumi
- Division of Anesthesiology; Department of Surgery Related; Kobe University; Kobe Japan
| | | | - Hiroki Kawano
- Department of Hematology; Kobe University; Kobe Japan
| | - Kimikazu Yakushijin
- Division of Medical Oncology/Hematology; Department of Medicine; Kobe University; Kobe Japan
| | - Yoh Zen
- Department of Diagnostic Pathology; Kobe University; Kobe Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology; Kobe University; Kobe Japan
| | - Yonson Ku
- Division of Hepato-biliary and Pancreatic Surgery; Department of Surgery; Kobe University; Kobe Japan
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189
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Shiroshita K, Kida JI, Matsumoto K, Uemura M, Yamaoka G, Miyai Y, Haba R, Imataki O. Intravascular proliferating anaplastic lymphoma kinase-positive anaplastic large-cell lymphoma. World J Hematol 2015; 4:10-15. [DOI: 10.5315/wjh.v4.i2.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 09/20/2014] [Accepted: 03/18/2015] [Indexed: 02/05/2023] Open
Abstract
An 82-year-old Japanese man visited our emergency unit complaining of dyspnea. Laboratory data showed 15% atypical lymphocytes in peripheral blood which expressed the T-cell phenotype. Chest/abdominal computed tomography depicted hepatosplenomegaly and swelling of systemic lymph nodes. The patient died of advanced respiratory failure 5 d after the first occurrence of his dyspnea. At autopsy, the pathological features revealed a diffuse infiltration of large atypical lymphocytes to systemic organs including the spleen and lung. In immunohistochemical staining, these cells expressed CD30, TIA-1, anaplastic lymphoma kinase (ALK), CD5 and CD3. An advanced surface molecule analysis revealed a lack of CD54 (intercellular cell adhesion molecule-1) and CD56 (neural cell adhesion molecule). We observed the proliferation and infiltration of these lymphoma cells specifically at the intravascular lesions similar to intravascular lymphoma (IVL). T-cell IVL is not established as an independent clinical entity in the World Health Organization classification, and our patient’s ALK-positive T-IVL in lung appears to be the first reported case.
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190
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Aggressive B-cell lymphomas: a review and practical approach for the practicing pathologist. Adv Anat Pathol 2015; 22:168-80. [PMID: 25844675 DOI: 10.1097/pap.0000000000000065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Recent advances in diffuse large B-cell lymphoma are changing the way pathologists approach, diagnose, and report on this heterogeneous group of lymphomas. The purpose of this review is to provide a practical yet comprehensive approach to diffuse large B-cell lymphoma and aggressive B-cell lymphomas that can be used and easily interpreted by pathologists at all levels of training. It will address important concepts and current testing modalities which provide important prognostic information for the clinician when considering appropriate chemotherapeutic regimens for each patient's lymphoma diagnosis. It will also provide some insights into recently reported signaling pathways and molecular alterations and their contribution to lymphomagenesis and how identifying these abnormalities may provide future potential therapeutic targets for these aggressive lymphomas.
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191
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192
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Intravascular large B-cell lymphoma presenting as cauda equina syndrome and showing aberrant cytokeratin expression: a diagnostic challenge. Pathology 2015; 46:241-4. [PMID: 24614706 DOI: 10.1097/pat.0000000000000089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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193
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Sreedharanunni S, Sachdeva MUS, Malhotra P, Ahluwalia J, Naseem S, Prakash G, Khadwal A, Sharma P, Kumar N, Varma N, Varma S, Das R. Role of blood and bone marrow examination in the diagnosis of mature lymphoid neoplasms in patients presenting with isolated splenomegaly. ACTA ACUST UNITED AC 2015; 20:530-7. [PMID: 25760312 DOI: 10.1179/1607845415y.0000000005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Mature lymphoid neoplasms presenting with 'prominent splenomegaly without significant lymphadenopathy' are uncommon and pose unique diagnostic challenges as compared to those associated with lymphadenopathy. Their descriptions in the literature are largely limited to a few case series. We analyzed the spectrum of these lymphomas diagnosed by peripheral blood (PB) and/or bone marrow (BM) examination. METHODS Over a period of 6 years, 75 patients were diagnosed with a lymphoma from PB/BM who had presented with predominant splenomegaly. Their clinical and laboratory records including PB and BM morphology; immunophenotyping using multi-parametric flow-cytometry and immunohistochemistry were reviewed. Wherever indicated, an extended panel of immunohistochemistry (IHC) was performed on BM biopsies for accurate sub-classification. RESULTS AND DISCUSSION The commonest lymphomas were hairy cell leukemia (HCL) (32%) and splenic marginal zone lymphoma (SMZL) (24%). Others included diffuse large B cell lymphoma (8%), chronic lymphocytic leukemia/small lymphocytic lymphoma (8%), mantle cell lymphoma (2.7%), and follicular lymphoma (1.3%), all of which usually presents with lymphadenopathy. SMZL was the commonest lymphoma among females and those with massive splenomegaly and lymphocytosis; while HCL was commonest in patients with pancytopenia. SMZL commonly presented with lymphocytosis; however, 22% of them also presented with pancytopenia. CONCLUSION The high diagnostic efficacy of PB and BM examination using flow-cytometry and immunohistochemistry in confirming and sub-classifying splenic lymphomas suggests that a thorough hematological evaluation should always precede a diagnostic splenectomy. Immunohistochemistry remains the best modality to identify sparse or intra-sinusoidal infiltration on BM biopsy and is particularly useful in patients with fibrotic marrows and pancytopenia.
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MESH Headings
- Adolescent
- Adult
- Aged
- Bone Marrow/pathology
- Diagnosis, Differential
- Female
- Flow Cytometry
- Humans
- Immunohistochemistry
- Immunophenotyping
- Leukemia, Hairy Cell/diagnosis
- Leukemia, Hairy Cell/pathology
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukocytes, Mononuclear/pathology
- Lymphatic Diseases/diagnosis
- Lymphatic Diseases/pathology
- Lymphocytosis/diagnosis
- Lymphocytosis/pathology
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, Follicular/diagnosis
- Lymphoma, Follicular/pathology
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Mantle-Cell/diagnosis
- Lymphoma, Mantle-Cell/pathology
- Male
- Middle Aged
- Pancytopenia/diagnosis
- Pancytopenia/pathology
- Retrospective Studies
- Splenic Neoplasms/diagnosis
- Splenic Neoplasms/pathology
- Splenomegaly/diagnosis
- Splenomegaly/pathology
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194
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Fragasso A, Mannarella C, Ciancio A, Scarciolla O. Peripheral blood hemophagocytosis in an unusual lymphoma. Clin Case Rep 2015; 3:11-3. [PMID: 25678965 PMCID: PMC4317203 DOI: 10.1002/ccr3.124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 08/21/2014] [Accepted: 03/06/2014] [Indexed: 12/14/2022] Open
Abstract
We describe a patient with fever, pancytopenia, and hepato-splenomegaly associated with the finding of neoplastic lymphoid cells and histiocytes with hemophagocytosis in the peripheral smear; the diagnostic features were suggestive for a biological overlap between a large B-cell lymphoma with intravascular involvement and the Asian variant of intravascular B-cell lymphoma.
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Affiliation(s)
- Alberto Fragasso
- Hematology Unit, Ospedale Madonna delle Grazie, ASM Matera, Italy
| | - Clara Mannarella
- Hematology Unit, Ospedale Madonna delle Grazie, ASM Matera, Italy
| | - Angela Ciancio
- Hematology Unit, Ospedale Madonna delle Grazie, ASM Matera, Italy
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195
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Abstract
Diffuse large B-cell lymphomas (DLBCLs) are aggressive B-cell neoplasms with considerable clinical, biologic, and pathologic diversity, in part reflecting the functional diversity of the B-cell system and multiple pathways of transformation. In recent years, the advent of new high-throughput genomic technologies has provided new insights into the biology of DLBCL, leading to the identification of distinct molecular identities and novel pathogenetic pathways. This increasing complexity had led to an expanding number of entities in the World Health Organization classification. Using a multi-modality approach, the updated 2008 classification delineated some new subgroups, including DLBCLs associated with particular age groups or specific anatomic sites, as well as two borderline categories (tumors at the interface between classical Hodgkin lymphoma and DLBCL as well as between Burkitt lymphoma and DLBCL). This article reviews the histopathologic features of the various aggressive B-cell lymphoma subtypes included in the 2008 classification, with emphasis on some of the new entities as well as areas of diagnostic challenge.
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Affiliation(s)
- Yi Xie
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Stefania Pittaluga
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Elaine S Jaffe
- Hematopathology Section, Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD.
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196
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O'Malley DP, Auerbach A, Weiss LM. Practical Applications in Immunohistochemistry: Evaluation of Diffuse Large B-Cell Lymphoma and Related Large B-Cell Lymphomas. Arch Pathol Lab Med 2015; 139:1094-107. [DOI: 10.5858/arpa.2014-0451-cp] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context
Diffuse large B-cell lymphoma is the most commonly diagnosed subtype of lymphoma worldwide. The current World Health Organization (WHO) classification includes several subtypes, based on a combination of clinical, immunohistochemical, and genetic differences. Immunohistochemical staining is essential in evaluating diffuse large B-cell lymphoma and many related large B-cell lymphomas and aggressive B-cell lymphomas.
Objective
To address different immunohistochemical features used for identification, subclassification, prognosis and in some cases, therapy, of diffuse large B-cell lymphoma and related lymphomas.
Data Sources
The information outlined in this review article is based on our experiences with routine cases, on the current WHO classification of hematopoietic and lymphoid tumors, and on a review of English-language articles published throughout 2014.
Conclusions
Features and diagnostic criteria of diffuse large B-cell lymphoma, aggressive variants of B-cell lymphomas, including Burkitt lymphoma and “double-hit” lymphomas, are discussed. Identification of cell of origin (germinal center type versus activated B-cell type) is discussed at length. Finally, practical approaches for diagnosis are discussed.
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Affiliation(s)
| | | | - Lawrence M. Weiss
- From Clarient Diagnostic Services, Aliso Viejo, California (Drs O'Malley and Weiss); and Joint Pathology Center, Silver Spring, Maryland (Dr Auerbach)
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197
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Bailly P, Diraison P, Coustans M, Lamotte N, Breuilly C. [Intravascular large B-cell lymphoma revealed by a cerebral infarct and a mesenteric ischemia]. Presse Med 2014; 44:244-7. [PMID: 25542708 DOI: 10.1016/j.lpm.2014.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/28/2014] [Accepted: 09/22/2014] [Indexed: 11/19/2022] Open
Affiliation(s)
- Pierre Bailly
- Centre hospitalier de Cornouaille, service de neurologie, 29107 Quimper cedex, France.
| | - Philippe Diraison
- Centre hospitalier de Cornouaille, service de neurologie, 29107 Quimper cedex, France
| | - Marc Coustans
- Centre hospitalier de Cornouaille, service de neurologie, 29107 Quimper cedex, France
| | - Nadège Lamotte
- Centre hospitalier de Cornouaille, service de neurologie, 29107 Quimper cedex, France
| | - Christophe Breuilly
- Centre hospitalier de Cornouaille, service de neurologie, 29107 Quimper cedex, France
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198
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Thomas CA, Guileyardo JM, Krause JR. An intravascular lymphoma with extravascular tendencies. Proc (Bayl Univ Med Cent) 2014; 27:341-3. [PMID: 25484506 DOI: 10.1080/08998280.2014.11929153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVL) is rare and characterized by selective growth of neoplastic cells within the lumina of small blood vessels. We present the case of a 69-year-old woman who died of a widespread IVL with extravascular involvement of the lymph nodes, liver, bladder, and adrenal gland. This report discusses the unique features of IVL with concurrent extravascular components.
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Affiliation(s)
- Cody A Thomas
- Department of Pathology, Baylor University Medical Center at Dallas and the Charles A. Sammons Cancer Center, Dallas, Texas
| | - Joseph M Guileyardo
- Department of Pathology, Baylor University Medical Center at Dallas and the Charles A. Sammons Cancer Center, Dallas, Texas
| | - John R Krause
- Department of Pathology, Baylor University Medical Center at Dallas and the Charles A. Sammons Cancer Center, Dallas, Texas
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199
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Sawada T, Omuro Y, Kobayashi T, Hishima T, Koizumi F, Kanemasa Y, Shimoyama T, Sasaki E, Maeda Y. Long-term complete remission in a patient with intravascular large B-cell lymphoma with central nervous system involvement. Onco Targets Ther 2014; 7:2133-6. [PMID: 25429230 PMCID: PMC4242899 DOI: 10.2147/ott.s72596] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This report describes a patient with intravascular large B-cell lymphoma (IVLBCL) with central nervous system involvement at the time of diagnosis who achieved complete remission for over 5 years in response to therapy. The patient, a 71 year-old woman, was previously healthy with the exception of taking verapamil for paroxysmal supraventricular tachycardia. She had presented with pyrexia and gradually progressive anemia. Brain magnetic resonance imaging revealed an infarct-like lesion in the pons, although no paralysis was observed. She was diagnosed with IVLBCL on the basis of random skin biopsy. After eight cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone therapy, abnormal laboratory data had normalized, and no pontine lesion was evident on magnetic resonance imaging without receiving any intrathecal chemotherapy. IVLBCL is associated with poor prognosis, particularly in patients with central nervous system involvement. Early initiation of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone therapy and drug interactions between anticancer agents and verapamil as a p-glycoprotein inhibitor were considered the possible reasons for favorable outcome in the present case.
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Affiliation(s)
- Takeshi Sawada
- Department of Chemotherapy, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yasushi Omuro
- Department of Chemotherapy, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Takeshi Kobayashi
- Department of Hematology, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Tunekazu Hishima
- Department of Pathology, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Fumiaki Koizumi
- Department of Laboratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yusuke Kanemasa
- Department of Chemotherapy, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Tatsu Shimoyama
- Department of Chemotherapy, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Eisaku Sasaki
- Department of Chemotherapy, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yoshiharu Maeda
- Department of Chemotherapy, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
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200
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Alexandrescu S, Orengo JP, Toossi S, Perry A, Treseler P, Hess C, Margeta M. CNS intravascular large cell lymphoma in a patient with autoimmune hemolytic anemia. Neuropathology 2014; 35:170-4. [DOI: 10.1111/neup.12175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 09/17/2014] [Indexed: 01/06/2023]
Affiliation(s)
- Sanda Alexandrescu
- Department of Pathology; University of California San Francisco; San Francisco California USA
| | - James P. Orengo
- Department of Neurology; University of California San Francisco; San Francisco California USA
| | - Shahed Toossi
- Department of Neurology; University of California San Francisco; San Francisco California USA
| | - Arie Perry
- Department of Pathology; University of California San Francisco; San Francisco California USA
- Department of Neurological Surgery; University of California San Francisco; San Francisco California USA
| | - Patrick Treseler
- Department of Pathology; University of California San Francisco; San Francisco California USA
| | - Christopher Hess
- Department of Radiology & Biomedical Imaging; University of California San Francisco; San Francisco California USA
| | - Marta Margeta
- Department of Pathology; University of California San Francisco; San Francisco California USA
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