201
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Jacobs C, Graham ID, Makarski J, Chassé M, Fergusson D, Hutton B, Clemons M. Clinical practice guidelines and consensus statements in oncology--an assessment of their methodological quality. PLoS One 2014; 9:e110469. [PMID: 25329669 PMCID: PMC4201546 DOI: 10.1371/journal.pone.0110469] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 09/22/2014] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Consensus statements and clinical practice guidelines are widely available for enhancing the care of cancer patients. Despite subtle differences in their definition and purpose, these terms are often used interchangeably. We systematically assessed the methodological quality of consensus statements and clinical practice guidelines published in three commonly read, geographically diverse, cancer-specific journals. Methods Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. METHODS Consensus statements and clinical practice guidelines published between January 2005 and September 2013 in Current Oncology, European Journal of Cancer and Journal of Clinical Oncology were evaluated. Each publication was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) rigour of development and editorial independence domains. For assessment of transparency of document development, 7 additional items were taken from the Institute of Medicine's standards for practice guidelines and the Journal of Clinical Oncology guidelines for authors of guidance documents. FINDINGS Thirty-four consensus statements and 67 clinical practice guidelines were evaluated. The rigour of development score for consensus statements over the three journals was 32% lower than that of clinical practice guidelines. The editorial independence score was 15% lower for consensus statements than clinical practice guidelines. One journal scored consistently lower than the others over both domains. No journals adhered to all the items related to the transparency of document development. One journal's consensus statements endorsed a product made by the sponsoring pharmaceutical company in 64% of cases. CONCLUSION Guidance documents are an essential part of oncology care and should be subjected to a rigorous and validated development process. Consensus statements had lower methodological quality than clinical practice guidelines using AGREE II. At a minimum, journals should ensure that that all consensus statements and clinical practice guidelines adhere to AGREE II criteria. Journals should consider explicitly requiring guidelines to declare pharmaceutical company sponsorship and to identify the sponsor's product to enhance transparency.
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Affiliation(s)
- Carmel Jacobs
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian D. Graham
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute and University of Ottawa, Department of Medicine, Ottawa, Ontario, Canada
| | | | - Michaël Chassé
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dean Fergusson
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute and University of Ottawa, Department of Medicine, Ottawa, Ontario, Canada
| | - Brian Hutton
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark Clemons
- Division of Medical Oncology, The Ottawa Hospital Cancer Centre and Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute and University of Ottawa, Department of Medicine, Ottawa, Ontario, Canada
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202
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Dziewanowski K, Drozd R, Parczewski M, Klinke M. Multiorgan transplantation from a deceased donor with intravascular diffuse large B-cell lymphoma: transmission of the disease and results of treatment. Clin Transplant 2014; 28:1080-3. [DOI: 10.1111/ctr.12417] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Krzysztof Dziewanowski
- Nephrology-Transplant Center; Department of the Regional Public Hospital in Szczecin; Szczecin Poland
| | - Radosław Drozd
- Nephrology-Transplant Center; Department of the Regional Public Hospital in Szczecin; Szczecin Poland
| | - Miłosz Parczewski
- Department of Infectious Diseases; Pomeranian Medical University; Szczecin Poland
| | - Małgorzata Klinke
- Nephrology-Transplant Center; Department of the Regional Public Hospital in Szczecin; Szczecin Poland
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203
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Patel SS, Aasen GA, Dolan MM, Linden MA, McKenna RW, Rudrapatna VK, Trottier BJ, Drawz SM. Early Diagnosis of Intravascular Large B-Cell Lymphoma: Clues From Routine Blood Smear Morphologic Findings. Lab Med 2014; 45:248-52; quiz e93. [DOI: 10.1309/lmsveokln18m5xtv] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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204
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Ha JM, Kim E, Lee WJ, Hwang JW, Yune S, Ko YH, Choi JY, Kim SJ, Kim WS. Unusual manifestation of intravascular large B-cell lymphoma: severe hypercalcemia with parathyroid hormone-related protein. Cancer Res Treat 2014; 46:307-11. [PMID: 25038766 PMCID: PMC4132453 DOI: 10.4143/crt.2014.46.3.307] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Accepted: 04/04/2013] [Indexed: 11/21/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of non-Hodgkin lymphoma. It usually presents with nonspecific symptoms, such as fever, rather than with overt lymphadenopathy. Reports of hypercalcemia, as the initial presentation of IVLBCL, are limited in the literature, despite it being a well-known complication of various solid cancers. We present a 68-year-old male with severe hypercalcemia and increased levels of serum parathyroid hormone-related protein. He was diagnosed with IVLBCL, involving the bone marrow and spleen, and was successfully treated with rituximab-containing chemotherapy. A few previous case reports have shown hypercalcemia in patients with IVLBCL. Much like our case, previous cases with hypercalcemia had advanced diseases, including bone marrow invasion. Although it was an extremely rare manifestation of IVLBCL, we suggest that IVLBCL should be a part of the differential diagnosis in patients with unexplained hypercalcemia. Therefore, an active work-up might be recommended, including positron emission tomography/ computed tomography scan and bone marrow examination, which may be useful for early diagnosis.
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Affiliation(s)
- Jung Min Ha
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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205
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Kanazawa Y, Hagiwara N, Matsuo R, Arakawa S, Ago T, Kitazono T. [Case of intravascular large B-cell lymphoma (IVLBCL) with central nervous system symptoms diagnosed by renal biopsy]. Rinsho Shinkeigaku 2014; 54:484-8. [PMID: 24990832 DOI: 10.5692/clinicalneurol.54.484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 60-year-old man was admitted to our hospital complaining of fever, headache and vertigo. Neurological examination on admission showed mild ataxic gait. Brain magnetic resonance imaging showed linear high intensity in the left parietal lobe on diffusion-weighted imaging (DWI) and laboratory data revealed elevated serum lactate dehydrogenase and soluble interleukin-2 receptor. Although intravascular lymphoma was suspected from these findings, bone marrow and skin biopsies were negative. Two months later, he presented with sensory disturbance of the left upper limb, and new lesions in the right frontal and bilateral parietal lobes were detected on DWI. A systemic evaluation showed multiple low-density lesions in the bilateral kidneys on computed tomography. Based on the results of a renal biopsy, we made a histological diagnosis of intravascular large B-cell lymphoma (IVLBCL). As IVLBCL is quite rare and often has a poor prognosis, a systemic evaluation to determine the proper biopsy site is needed for early diagnosis.
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Affiliation(s)
- Yuka Kanazawa
- Division of Cerebrovascular Medicine, Kyushu Rosai Hospital
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206
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Fonkem E, Lok E, Robison D, Gautam S, Wong ET. The natural history of intravascular lymphomatosis. Cancer Med 2014; 3:1010-24. [PMID: 24931821 PMCID: PMC4303169 DOI: 10.1002/cam4.269] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 04/21/2014] [Accepted: 04/28/2014] [Indexed: 11/21/2022] Open
Abstract
Intravascular lymphomatosis (IVL) is a rare and clinically devastating form of extranodal B-cell non-Hodgkin's lymphoma. We performed a comprehensive analysis of the literature on IVL's published between 1959 and 2011 and evaluated the natural history as well as identified prognostic and predictive factors in patients. Nonparametric two-tailed Mann–Whitney U-test and Mantel–Cox log rank test were used to evaluate the survival intervals and prognostic factors. Multivariate analysis of variance (MANOVA) and chi-squared statistics were carried out to examine treatment-related predictive factors. Of the 740 patients with IVL, 651 (88%) had a diagnosis of B-cell lymphoma, 45 (6%) with T-cell lymphoma, and 12 patients (2%) with NK cell lymphoma. Central nervous system (CNS) IVL had the highest proportion of postmortem diagnosis, 250 (60%) compared to 21 (8%) of skin, 28 (11%) of bone marrow (BM) and spleen, and 17 (7%) of lung IVL's. Age <70 years (P = 0.0073), non-CNS site of initial diagnosis (P = 0.0014), lactate dehydrogenase (LDH) <700 (P = 0.0112), and rituximab treatment (P < 0.0001) were favorable prognostic factors. Gender, ethnicity, hemoglobin, BM biopsy, and the type of imaging studies used were not significant. Rituximab and doxorubicin treatment worked significantly better in patients with age >71 and LDH >577 compared to nonrituximab, nondoxorubicin regimens (MANOVA 2 degrees of freedom, P = 0.0345), with a median time from treatment to death of 20.0 (95% confidence interval [CI] 14.0–N/A, n = 14) months versus 2.0 (95%CI 0.5–N/A, n = 5) (χ2 = 4.7, P = 0.0304). Patients with CNS IVL relapsed primarily in the CNS (88%) while same-organ relapse occurred less frequently in skin (23%), BM and spleen (50%) and lung (20%) IVL's. Our results indicate that IVL is primarily a disease of B-lymphoma cells. Timely diagnosis and treatment with rituximab-based chemotherapy improve patient survival. The pattern of recurrence is different between CNS IVL and IVL's in other organs.
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Affiliation(s)
- Ekokobe Fonkem
- Brain Tumor Center and Neuro-Oncology Unit, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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207
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Cheah CY, Seymour JF, Dickinson M. Ongoing challenge of optimal patient selection for CNS prophylaxis in patients with non-Hodgkin lymphoma. Int J Hematol Oncol 2014. [DOI: 10.2217/ijh.14.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
SUMMARY CNS relapse is a devastating and frequently lethal complication in patients with lymphoma, and selecting patients to receive CNS-directed prophylaxis is a common and frequently challenging decision for the clinician. Histologic subtype, anatomic location, molecular and clinical risk factors may all be used to stratify patients for CNS risk. In this paper we focus on these issues and attempt to provide practical guidance for the clinician in selecting which patients with lymphoma may benefit from CNS prophylaxis.
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Affiliation(s)
- Chan Yoon Cheah
- Department of Haematology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - John F Seymour
- Department of Haematology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Michael Dickinson
- Department of Haematology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
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208
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Colavolpe C, Ebbo M, Trousse D, Khibri H, Franques J, Chetaille B, Coso D, Ouvrier MJ, Gastaud L, Guedj E, Schleinitz N. FDG-PET/CT is a pivotal imaging modality to diagnose rare intravascular large B-cell lymphoma: case report and review of literature. Hematol Oncol 2014; 33:99-109. [PMID: 24850057 DOI: 10.1002/hon.2140] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 02/13/2014] [Accepted: 03/05/2014] [Indexed: 12/14/2022]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) remains a diagnostic challenge, because of non-specific findings on clinical, laboratory, and imaging studies. We present a case in which 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography was particularly useful to suspect the diagnosis, to detect unexpected locations, to guide contributive biopsy, and to assess the response to treatment. In case of initial negative results, FDG-PET should be repeated in the course of clinical evolution. In the presence of neurological or hormonal symptoms without brain magnetic resonance imaging abnormality, FDG-PET brain slices could depict additional pituitary and/or brain hypermetabolisms. We discuss the potential interests of FDG-PET in IVLBCL by a literature review.
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Affiliation(s)
| | - Mikael Ebbo
- Department of Internal Medicine, CHU Conception, Marseille, France
| | | | - Hajar Khibri
- Department of Internal Medicine, CHU Conception, Marseille, France
| | | | - Bruno Chetaille
- Department of Bio-pathology, Institut Paoli-Calmettes, Marseille, France
| | - Diane Coso
- Department of Onco-hematology, Institut Paoli-Calmettes, Marseille, France
| | | | - Lauris Gastaud
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Eric Guedj
- Department of Nuclear Medicine, CHU Timone, Marseille, France
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209
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Akpinar TS, Ozkok A, Batu D, Sarihan I, Kose M, Tascioglu C. Isolated renal intravascular lymphoma: a case report and review of the literature. Ren Fail 2014; 36:1125-8. [PMID: 24826874 DOI: 10.3109/0886022x.2014.918829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a very rare subtype of extranodal large B-cell lymphoma. It may involve various organ systems such as skin, liver, lung or kidney. Isolated kidney involvement of IVLBCL is also very rare. Herein we report a very rare case of isolated renal IVLBCL presented with fever of unknown origin, acute kidney injury and nephrotic syndrome. Diagnosis was suspected with isolated high renal (18)F fluorodeoxyglucose uptake in positron emission tomography and confirmed with renal biopsy. Complete remission was obtained with combined chemotherapy including rituximab. We reviewed the English literature in terms of IVLBCL with renal involvement and we could only find 16 such cases. Accordingly, fever, AKI and nephritic syndrome are the most common presenting symptoms in renal intravascular lymphoma.
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Affiliation(s)
- Timur Selcuk Akpinar
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University , Istanbul , Turkey , and
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210
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Panda AK, Malik S. CNS intravascular lymphoma: an underappreciated cause of rapidly progressive dementia. BMJ Case Rep 2014; 2014:bcr-2014-203772. [PMID: 24722717 DOI: 10.1136/bcr-2014-203772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Intravascular lymphoma is a rare subtype of extranodal large cell non-Hodgkin's lymphoma that is usually seen in the elderly. It can occasionally present with neurological symptoms in the form of dementia, focal neurological deficit and seizure. Diagnosis is difficult because of non-specific clinical manifestation. We report a case of a 38-year-old woman presenting with rapidly progressive dementia and seizure. MRI of the brain showed bilateral diffuse involvement of cortex and subcortical white matter. Brain biopsy disclosed the aetiological confirmation of intravascular B-cell lymphoma. The patient was treated with monthly cyclophosphamide, doxorubicin, vincristine and prednisolone regimen, but unfortunately, she died after two chemotherapy cycles. So, high index of suspicion is warranted to diagnose and treat the condition early to have a better outcome.
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Affiliation(s)
- Akhila Kumar Panda
- Department of Neurology, Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India
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211
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Ho CWG, Mantoo S, Lim CH, Wong CY. Synchronous invasive ductal carcinoma and intravascular large B-cell lymphoma of the breast: a case report and review of the literature. World J Surg Oncol 2014; 12:88. [PMID: 24708809 PMCID: PMC3985532 DOI: 10.1186/1477-7819-12-88] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 03/30/2014] [Indexed: 12/14/2022] Open
Abstract
Primary breast lymphomas (PBLs) represent less than 1% of all breast malignancies. Intravascular large B-cell lymphoma (ILBCL) is a rare, aggressive form of extranodal lymphoma. Breast involvement has only been described in the literature once previously. ILBCL is characterized by the proliferation of tumour cells within the lumen of small vessels of involved organs, resulting in their eventual occlusion. Clinical features are often vague, diagnosis is difficult and delayed, and prognosis is usually poor. We report the first ever case of synchronous ILBCL and invasive ductal carcinoma (IDC) of the breast in a patient presenting with pyrexia of unknown origin and altered mental status who underwent modified radical mastectomy and subsequent chemotherapy, and review the literature regarding intravascular large B-cell lymphoma, PBLs and synchronous carcinomas and lymphomas of the breast.
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Affiliation(s)
- Christopher Wei Guang Ho
- Department of General Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
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212
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213
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Brunt EM, Gouw ASH, Hubscher SG, Tiniakos DG, Bedossa P, Burt AD, Callea F, Clouston AD, Dienes HP, Goodman ZD, Roberts EA, Roskams T, Terracciano L, Torbenson MS, Wanless IR. Pathology of the liver sinusoids. Histopathology 2014; 64:907-20. [PMID: 24393125 DOI: 10.1111/his.12364] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The hepatic sinusoids comprise a complex of vascular conduits to transport blood from the porta hepatis to the inferior vena cava through the liver. Under normal conditions, portal venous and hepatic artery pressures are equalized within the sinusoids, oxygen and nutrients from the systemic circulation are delivered to the parenchymal cells and differentially distributed throughout the liver acini, and proteins of liver derivation are carried into the cardiac/systemic circulation. Liver sinusoid structures are lined by endothelial cells unique to their location, and Kupffer cells. Multifunctional hepatic stellate cells and various immune active cells are localized within the space of Disse between the sinusoid and the adjacent hepatocytes. Flow within the sinusoids can be compromised by physical or pressure blockage in their lumina as well as obstructive processes within the space of Disse. The intimate relationship of the liver sinusoids to neighbouring hepatocytes is a significant factor affecting the health of hepatocytes, or transmission of the effects of injury within the sinusoidal space. Pathologists should recognize several patterns of injury involving the sinusoids and surrounding hepatocytes. In this review, injury, alterations and accumulations within the liver sinusoids are illustrated and discussed.
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Affiliation(s)
- Elizabeth M Brunt
- Department of Pathology and Immunology, Washington University, School of Medicine, St Louis, MO, USA
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214
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Arima H, Inoue D, Tabata S, Matsushita A, Imai Y, Ishikawa T, Takahashi T. Simultaneous thrombosis of the mesenteric artery and vein as a novel clinical manifestation of intravascular large B-cell lymphoma. Acta Haematol 2014; 132:108-11. [PMID: 24525901 DOI: 10.1159/000356682] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 09/23/2013] [Indexed: 01/23/2023]
Abstract
A 79-year-old man with a 2-month history of fever and weight loss was admitted to our hospital because of an acute abdomen. Abdominal CT scans showed marked sectional thickening and edema of the small intestine. On laparotomy, a 16-cm section of the small intestine was ischemic and necrotic; therefore, segmentectomy of the intestine was performed. A thrombus was noted at the stump of the mesenteric artery branch. Histopathological analysis of the resected intestine revealed fibrin thrombi in both mesenteric arteries and veins. Furthermore, a cluster of large, abnormal lymphoid cells bordering the intima of most branches of the mesenteric veins and small vessels was observed. Immunohistochemical analysis revealed that these abnormal cells were positive for CD20, leading to a diagnosis of intravascular large B-cell lymphoma (IVLBCL). The patient was successfully treated with standard R-CHOP chemotherapy; however, the lymphoma recurred in the central nervous system 18 months after the initial diagnosis, and the patient died. Simultaneous thrombosis of the mesenteric artery and vein is unusual as a clinical manifestation of IVLBCL. However, IVLBCL should be taken into consideration when ischemic disorders of unknown cause, accompanied by fever of unknown origin, are encountered.
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Affiliation(s)
- Hiroshi Arima
- Departments of Hematology and Clinical Immunology, Shinko Hospital, Kobe, Japan
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215
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García-Muñoz R, Rubio-Mediavilla S, Robles-de-Castro D, Muñoz A, Herrera-Pérez P, Rabasa P. Intravascular large B cell lymphoma. Leuk Res Rep 2014; 3:21-3. [PMID: 24596677 PMCID: PMC3939386 DOI: 10.1016/j.lrr.2013.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 12/04/2013] [Accepted: 12/08/2013] [Indexed: 12/24/2022] Open
Abstract
Intravascular large B cell lymphoma (IVBCL) is a rare type of extranodal large B cell lymphoma characterized by selective growth of lymphoma cells within the microvasculature. We present an illustrative case of intravascular B cell lymphoma suspected by the presence of a very small monoclonal B cell population identified by immunophenotype and polymerase chain reaction in bone marrow. The diagnosis was confirmed by skin biopsy.
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Affiliation(s)
| | | | | | - Aura Muñoz
- Hematology Service, Hospital San Pedro, Logroño, La Rioja, Spain
| | | | - Pilar Rabasa
- Hematology Service, Hospital San Pedro, Logroño, La Rioja, Spain
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216
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Khan MS, McCubbin M, Nand S. Intravascular Large B-Cell Lymphoma: A Difficult Diagnostic Challenge. J Investig Med High Impact Case Rep 2014; 2:2324709614526702. [PMID: 26425595 PMCID: PMC4528864 DOI: 10.1177/2324709614526702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Case Presentation. A 69-year-old Hispanic male, with a past history of diabetes and coronary disease, was admitted for fever, diarrhea, and confusion of 4 weeks duration. Physical examination showed a disoriented patient with multiple ecchymoses, possible ascites, and bilateral scrotal swelling. Hemoglobin was 6.7, prothrombin time (PT) 21.4 seconds with international normalized ratio 2.1, partial thromboplastin time (PTT) 55.6 seconds, fibrin split 10 µg/L, and lactate dehydrogenase (LDH) 1231 IU/L. Except for a positive DNA test for Epstein–Barr virus (EBV) infection, extensive diagnostic workup for infections, malignancy, or a neurological cause was negative. Mixing studies revealed a nonspecific inhibitor of PT and PTT but Factor VIII levels were normal. The patient was empirically treated with antibiotics but developed hypotension and died on day 27 of admission. At autopsy, patient was found to have intravascular diffuse large B-cell lymphoma involving skin, testes, lung, and muscles. The malignant cells were positive for CD20, CD791, Mum-1, and Pax-5 and negative for CD3, CD5, CD10, CD30, and Bcl-6. The malignant cells were 100% positive for Ki-67. Discussion. Intravascular large cell B-cell lymphoma (IVLBCL) is rare form of diffuse large B-cell lymphoma and tends to proliferate within small blood vessels, particularly capillaries and postcapillary venules. The cause of its affinity for vascular bed remains unknown. In many reports, IVLBCL was associated with HIV, HHV8, and EBV infections. The fact that our case showed evidence of EBV infection lends support to the association of this diagnosis to viral illness. The available literature on this subject is scant, and in many cases, the diagnosis was made only at autopsy. The typical presentation of this disorder is with B symptoms, progressive neurologic deficits, and skin findings. Bone marrow, spleen, and liver are involved in a minority of patients. Nearly all patients have elevated LDH, and about 65% are anemic. About 20% have hepatic and renal dysfunction. The treatment consists of systemic chemotherapy with cyclophosphamide, doxorubicin, vincristine, prednisone plus rituximab (CHOP-R) and central nervous system prophylaxis. Retrospective data suggests that, with treatment, 51% to 82% of the patients achieve a complete remission and 27% to 56% are alive at 2-year follow-up. Conclusion. IVLBCL is a difficult diagnosis to make as the disease remains confined to the vascular lumen. It may be associated with certain viral illnesses, and this association needs to be explored further. It is important to consider this diagnosis in the appropriate settings because patients may achieve durable remissions with therapy.
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Affiliation(s)
- Maria S Khan
- The Ohio State University Medical Center, Columbus Ohio
| | | | - Sucha Nand
- Loyola University Medical Center, Maywood, Illinois
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217
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Kutane Lymphome. MEDIKAMENTÖSE TUMORTHERAPIE IN DER DERMATO-ONKOLOGIE 2014. [PMCID: PMC7122836 DOI: 10.1007/978-3-642-24837-5_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Kutane Lymphome (cutaneous lymphomas: CL) umfassen die Gruppe der kutanen T-Zell-Lymphome (cutaneous T-cell lymphomas: CTCL), kutanen B-Zell-Lymphome (cutaneous B-cell lymphomas: CBCL) und die sog. hämatodermischen Neoplasien (HN). CL gehören zur Gruppe der Non-Hodgkin-Lymphome (NHL) und stellen in der Subgruppe der extranodalen NHL die zweithäufigste Gruppe hinter den gastrointestinalen Lymphomen dar (Jaffe et al. 2009). Man unterscheidet zwischen primären und sekundären CL. Primäre CL
haben ihren Ursprung in der Haut und bleiben in der Regel darauf auch längere Zeit beschränkt, während sekundäre LymphomekutaneCL kutane Manifestationen von primär nodalen oder extranodalen Lymphomen darstellen (Willemze 2005). Die primären CL unterscheiden sich hinsichtlich klinischem Verlauf, Therapieoptionen und Prognose erheblich von nodalen und extrakutanen Lymphomen. So zeigen z. B. die primär kutanen CD30+ Lymphome einen gutartigen Verlauf, wogegen die nodalen Varianten als aggressiv eingestuft werden. Da die CL zumeist weniger aggressiv sind, werden sie weniger aggressiv behandelt.
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218
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Hong JY, Kim HJ, Ko YH, Choi JY, Jung CW, Kim SJ, Kim WS. Clinical features and treatment outcomes of intravascular large B-cell lymphoma: a single-center experience in Korea. Acta Haematol 2014; 131:18-27. [PMID: 24021554 DOI: 10.1159/000351060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 03/24/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Clinical features and treatment outcomes of intravascular large B-cell lymphoma (IVLBCL) have rarely been reviewed due to its rarity and pathologic obscurity. METHODS We analyzed 20 patients who were pathologically diagnosed with IVLBCL at the Samsung Medical Center. RESULTS Initial manifestations were nonspecific, such as fever with cytopenia, elevated serum lactate dehydrogenase and hypoalbuminemia. Hemophagocytosis was frequent and bone marrow was the most common site of pathologic diagnosis in our series. Hepatosplenomegaly, pleural effusion and ground-glass opacity in the lungs were also commonly found, and positron emission tomography imaging showed increased (18)F-fluorodeoxyglucose uptake in the involved organs. All patients received CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) or rituximab-CHOP. The median overall survival (OS) was 38.9 months (95% confidence interval 6.7-71.1). Rituximab-containing chemotherapy compared to chemotherapy alone resulted in higher 3-year OS (71.4 and 25.0%; p = 0.027). Patients with hemophagocytosis had a poorer 3-year OS compared to patients without hemophagocytosis (29.6 and 75%; p = 0.046). Prognostic factor analysis showed the association of pleural effusion with worse OS (p = 0.002). CONCLUSIONS Treatment with rituximab-containing chemotherapy can improve the treatment outcome of IVLBCL. Pleural effusion may be a poor prognostic factor in patients with IVLBCL.
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Affiliation(s)
- Jung Yong Hong
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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219
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An elderly lady with Fever of unknown etiology and severe pulmonary hypertension: intravascular lymphoma-an elusive diagnosis. Case Rep Med 2013; 2013:153798. [PMID: 24454389 PMCID: PMC3880734 DOI: 10.1155/2013/153798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 10/12/2013] [Accepted: 11/25/2013] [Indexed: 12/22/2022] Open
Abstract
Pulmonary hypertension (PH) associated with malignancy, especially adenocarcinoma, is a well-known entity and is included in group V of the WHO classification. Intravascular lymphoma is a rare type of diffuse large B cell lymphoma, characterized by selective intravascular growth of malignant lymphocytes, aggressive behavior, and often a fatal course. Most of the time, diagnosis is postmortem due to the rarity and the protean manifestations of the disease. We present a rare case of an elderly patient presenting with severe pulmonary hypertension, fever of unknown etiology (FUO), and lymphadenopathy. Extensive evaluation searching for the etiology of her FUO and PH was noncontributory. The diagnosis of intravascular lymphoma was finally reached by the performance of a random abdominal fat pad biopsy and the patient was started on immunochemotherapy. She continues the follow up after 6 cycles of R-CHOP with no further febrile episodes and steady improvement in exercise tolerance.
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220
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Intravascular large B cell lymphoma presenting as cholecystitis: diagnostic challenges persist. Ann Hematol 2013; 93:1259-60. [PMID: 24288109 DOI: 10.1007/s00277-013-1963-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 11/08/2013] [Indexed: 12/17/2022]
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221
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Huprikar NA, Kurtz MT, Mount CA. Massive splenomegaly and lymphopenia: a unique case of obstructive shock. BMJ Case Rep 2013; 2013:bcr-2013-201643. [PMID: 24172780 DOI: 10.1136/bcr-2013-201643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We present a patient with intravascular large B-cell lymphoma (IVLBCL)-induced obstructive shock. This case represents a unique presentation of the disease, while highlighting the difficulty of establishing the diagnosis. Although there was a high clinical suspicion for a lymphomatous process, the obstructive shock component of the patient's presentation was perplexing. It was not until the autopsy reports demonstrated lymphocytes within the pulmonary vasculature that the clinical picture of altered mental status, weight loss and obstructive shock were unified to the diagnosis of intravascular large B-cell lymphoma.
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Affiliation(s)
- Nikhil Anand Huprikar
- Department of Internal Medicine, Madigan Army Medical Center, Tacoma, Washington, USA
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222
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Ponzoni M, Ferreri AJM. Intravascular large B cell lymphoma: widespread but not everywhere. Acta Haematol 2013; 131:16-7. [PMID: 24021531 DOI: 10.1159/000354817] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 06/29/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Maurilio Ponzoni
- Pathology Unit, Ospedale San Raffaele Scientific Institute, Milan, Italy
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223
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Deckert M, Brunn A, Montesinos-Rongen M, Terreni MR, Ponzoni M. Primary lymphoma of the central nervous system--a diagnostic challenge. Hematol Oncol 2013; 32:57-67. [PMID: 23949943 DOI: 10.1002/hon.2087] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 06/24/2013] [Indexed: 01/20/2023]
Abstract
Primary lymphoma of the central nervous system is a distinct diffuse large B-cell lymphoma confined to the nervous system. Whereas classical cases can be classified easily, differential diagnosis can be a challenge in particular in patients who had received treatment prior to biopsy. In the differential diagnosis, other tumours and inflammatory diseases of autoimmune and infectious aetiology need to be considered.
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Affiliation(s)
- Martina Deckert
- Department of Neuropathology, University Hospital of Cologne, Cologne, Germany
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224
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Berger MD, Banz Y, Pabst T. Pitfalls in the diagnosis of intravascular large B-cell lymphoma. Eur J Haematol 2013; 91:563-4. [DOI: 10.1111/ejh.12162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Martin D. Berger
- Department of Medical Oncology; University Hospital of Berne; Switzerland
| | - Yara Banz
- Institute of Pathology; University of Berne; Switzerland
| | - Thomas Pabst
- Department of Medical Oncology; University Hospital of Berne; Switzerland
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225
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Abstract
We describe three cases of intravascular lymphoma B with different clinical presentation: one case of a cutaneous variant and two cases with surrenal and cutaneous localisation. All patients are in complete remission after chemotherapy alone or after chemotherapy and autologous stem cells transplantation. The review of the literature as well as our cases specify the interest of an aggressive chemotherapy with autologous of peripheral stem cells if it was possible.
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226
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Wakim JJ, Levenson BM, Mathews D, Naina HV. Management of an unusual case of intravascular large B-cell lymphoma of the penis, prostate, and bones with CNS relapse. J Clin Oncol 2013; 31:e288-90. [PMID: 23650410 DOI: 10.1200/jco.2012.46.6003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Jad J Wakim
- Division of Hematology and Oncology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390, USA
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227
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Wang T, Ghaffar H, Grin A. Intravascular large B-cell lymphoma presenting with fulminant pseudomembranous colitis. Pathol Res Pract 2013; 209:323-6. [DOI: 10.1016/j.prp.2013.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 02/27/2013] [Accepted: 03/14/2013] [Indexed: 10/27/2022]
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228
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McKelvie PA, Wools C, Roberts L, Cook M. Intravascular large B-cell lymphoma occurring 25 years after treatment of ALK-positive anaplastic large cell lymphoma. Leuk Lymphoma 2013; 54:2745-7. [DOI: 10.3109/10428194.2013.786071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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229
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Chuffart M, Stephan A, Comoz F, Salaun V, Baldolli A, Reman O, Verneuil L. [Intravascular large B-cell lymphoma]. Ann Dermatol Venereol 2013; 140:328-30. [PMID: 23567238 DOI: 10.1016/j.annder.2013.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Accepted: 02/05/2013] [Indexed: 11/24/2022]
Affiliation(s)
- M Chuffart
- Service de dermatologie, CHU, 14, avenue Georges-Clémenceau, 14033 Caen, France.
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230
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The histological and biological spectrum of diffuse large B-cell lymphoma in the World Health Organization classification. Cancer J 2013; 18:411-20. [PMID: 23006945 DOI: 10.1097/ppo.0b013e31826aee97] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Diffuse large B-cell lymphomas (DLBCLs) are aggressive B-cell lymphomas that are clinically, pathologically, and genetically diverse, in part reflecting the functional diversity of the B-cell system. The focus in recent years has been toward incorporation of clinical features, morphology, immunohistochemistry, and ever evolving genetic data into the classification scheme. The 2008 World Health Organization classification reflects this complexity with the addition of several new entities and variants. The discovery of distinct subtypes by gene expression profiling heralded a new era with a focus on pathways of transformation as well as a promise of more targeted therapies, directed at specific pathways. Some DLBCLs exhibit unique clinical characteristics with a predilection for specific anatomic sites; the anatomic site often reflects underlying biological distinctions. Recently, the spectrum of Epstein-Barr virus (EBV)-driven B-cell proliferations in patients without iatrogenic or congenital immunosuppression has been better characterized; most of these occur in patients of advanced age and include Epstein-Barr virus (EBV)-positive large B-cell lymphoma of the elderly. Human herpesvirus 8 is involved in the pathogenesis of primary effusion lymphoma, which can present as a "solid variant." Two borderline categories were created; one deals with tumors at the interface between classic Hodgkin lymphoma and DLBCL. The second confronts the interface between Burkitt lymphoma and DLBCL, so-called "B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and Burkitt lymphoma" in the 2008 classification. Most cases harbor both MYC and BCL2 translocations and are highly aggressive. Another interesting entity is anaplastic lymphoma kinase-positive DLBCL, which renders itself potentially targetable by anaplastic lymphoma kinase inhibitors. Ongoing investigations at the genomic level, with both exome and whole-genome sequencing, are sure to reveal new pathways of transformation in the future.
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231
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Murakami J, Shimizu Y. Hepatic manifestations in hematological disorders. Int J Hepatol 2013; 2013:484903. [PMID: 23606974 PMCID: PMC3626309 DOI: 10.1155/2013/484903] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 02/11/2013] [Accepted: 02/11/2013] [Indexed: 12/17/2022] Open
Abstract
Liver involvement is often observed in several hematological disorders, resulting in abnormal liver function tests, abnormalities in liver imaging studies, or clinical symptoms presenting with hepatic manifestations. In hemolytic anemia, jaundice and hepatosplenomegaly are often seen mimicking liver diseases. In hematologic malignancies, malignant cells often infiltrate the liver and may demonstrate abnormal liver function test results accompanied by hepatosplenomegaly or formation of multiple nodules in the liver and/or spleen. These cases may further evolve into fulminant hepatic failure.
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Affiliation(s)
- Jun Murakami
- The Third Department of Internal Medicine, Faculty of Medicine, University of Toyama, Toyama 930-0194, Japan
| | - Yukihiro Shimizu
- Gastroenterology Unit, Takaoka City Hospital, Toyama 933-8550, Japan
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232
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Naito R, Ako J, Wada H, Ikeda N, Sugawara Y, Akaba T, Momomura SI. Pulmonary hypertension in a patient with intravascular lymphomatosis. J Cardiol Cases 2013; 7:e181-e183. [PMID: 30533158 DOI: 10.1016/j.jccase.2013.02.011] [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: 11/28/2012] [Revised: 02/18/2013] [Accepted: 02/21/2013] [Indexed: 10/27/2022] Open
Abstract
Intravascular lymphomatosis (IVL) is a rare subtype of lymphoma characterized by proliferation of lymphoma cells into small vessels. Clinical presentations of IVL are considerably varied among patients, and antemortem diagnosis is sometimes difficult. We report a 75-year-old Japanese female who presented with gradually worsening shortness of breath and pulmonary hypertension. After routine examinations, the patient was diagnosed with pulmonary artery hypertension (PH) combined with pulmonary hypertension owing to left-sided heart disease possibly due to chronic atrial fibrillation. However, a standard therapy of PH and diuretics was ineffective. In the clinical course, sustained increase in serum lactate dehydrogenase level, progressive bicytopenia, and appearance of atypical cells in her peripheral blood led to the diagnosis of IVL. The symptoms, laboratory findings and PH improved after initial chemotherapy. <Learning objective: Pulmonary artery hypertension (PH) has been focused in cardiovascular diseases and considerable progress in diagnosis and treatment was achieved. The targets of the treatment are PH and underlying causes of PH. The prevalence and frequency of the underlying causes extensively vary. However, considering that PH is a progressive and fatal disease if untreated, sufficient evaluation and optimal treatments are essential. Intravascular lymphomatosis might be considered to have a potential to cause PH.>.
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Affiliation(s)
- Ryo Naito
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Oomiya-ku, Saitama 330-8503, Japan
| | - Junya Ako
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Oomiya-ku, Saitama 330-8503, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Oomiya-ku, Saitama 330-8503, Japan
| | - Nahoko Ikeda
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Oomiya-ku, Saitama 330-8503, Japan
| | - Yoshitaka Sugawara
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Oomiya-ku, Saitama 330-8503, Japan
| | - Tomohiro Akaba
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Oomiya-ku, Saitama 330-8503, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Oomiya-ku, Saitama 330-8503, Japan
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233
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Franz M, Alfidja A, Molucon Chabrot C, Hermet E, Montoriol PF, Rosset E, Boyer L, Chabrot P. [Lymphoma and arteries: peri- or intravascular?]. ACTA ACUST UNITED AC 2013; 38:162-71. [PMID: 23473620 DOI: 10.1016/j.jmv.2013.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 01/13/2013] [Indexed: 12/24/2022]
Abstract
PURPOSE Lymphoma is a polymorphous disease that does not spare arteries. Arterial involvement may be perivascular or intravascular, with different prognostic and therapeutic implications. PATIENTS AND METHODS We present here one case of perivascular lymphoma and another case of intravascular lymphoma in order to highlight the specific features of each type. RESULTS The first patient was a woman who presented a pseudo-aneurysmal anterior iliac artery due to a non-Hodgkin lymphoma with subsequent bilateral pyelocalyceal distension. The second patient was a man who developed intravascular lymphomatosis expressed by an aneurysm of the common femoral then the primitive iliac artery. CONCLUSION The distinction between perivascular and intravascular arterial involvement is based on a range of features and is essential for an optimal care of patients with lymphoma.
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MESH Headings
- Aged
- Aneurysm/etiology
- Aneurysm/pathology
- Aneurysm, False/etiology
- Aneurysm, False/pathology
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Aorta, Abdominal/pathology
- Arterial Occlusive Diseases/etiology
- Arteritis/diagnosis
- Diagnosis, Differential
- Female
- Femoral Artery/pathology
- Fourth Ventricle/pathology
- Humans
- Hydrocephalus/etiology
- Iliac Artery/pathology
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Positron-Emission Tomography
- Recurrence
- Renal Artery Obstruction/complications
- Sarcoma/diagnosis
- Thrombosis/etiology
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Affiliation(s)
- M Franz
- Service de Radiologie B, Pôle de Radiologie, CHU Gabriel-Montpied, 58 rue Montalembert, BP 69, 63003 Clermont-Ferrand cedex 1, France.
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234
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Renjen PN, Khan NI, Gujrati Y, Kumar S. Intravascular large B-cell lymphoma confirmed by brain biopsy: a case report. BMJ Case Rep 2013; 2013:bcr-2012-007990. [PMID: 23420723 DOI: 10.1136/bcr-2012-007990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Intravascular lymphoma (IVL) is a rare variant of non-Hodgkin's lymphoma characterised by neoplastic lymphoid cells growing inside the lumina of medium and small vessels. The diversity of clinical presentation owing to the possibility of its occurrence in any organ often makes it a challenging diagnosis. We present an intriguing case of intravascular large B-cell central nervous system (CNS) lymphoma in which the patient presented with a non-specific neurological symptom and had no systemic symptoms or dermatological manifestations. The patient deteriorated rapidly after presentation and succumbed to multi-organ failure within 2 weeks of admission.
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235
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Diffuse large B-cell lymphoma. Crit Rev Oncol Hematol 2013; 87:146-71. [PMID: 23375551 DOI: 10.1016/j.critrevonc.2012.12.009] [Citation(s) in RCA: 282] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 12/04/2012] [Accepted: 12/20/2012] [Indexed: 12/14/2022] Open
Abstract
Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoid malignancy in adults accounting for 31% of all NHL in Western Countries. Following, morphological, biological and clinical studies have allowed the subdivision of DLBCLs into morphological variants, molecular and immunophenotypic subgroups and distinct disease entities. However, a large number of cases still remain biologically and clinically heterogeneous, for which there are no clear and accepted criteria for subclassification; these are collectively termed DLBCL, not otherwise specified (NOS). DLBCL-NOS occurs in adult patients, with a median age in the seventh decade, but the age range is broad, and it may also occur in children. Clinical presentation, behaviour and prognosis are variable, depending mainly of the extranodal site when they arise. These malignancies present in localized manner in approximately 20% of patients. Disseminated extranodal disease is less frequent, and one third of patients have systemic symptoms. Overall, DLBCLs are aggressive but potentially curable malignancies. Cure rate is particularly high in patients with limited disease with a 5-year PFS ranging from 80% to 85%; patients with advanced disease have a 5-year PFS ≈ 50%. The International Prognostic Index (IPI) and age adjusted IPI (aaIPI) are the benchmarks of DLBCL prognosis. First-line treatment for patients with DLBCL is based on the individual IPI score and age, and three major subgroups should be considered: elderly patients (>60 years, aaIPI=0-3); young patients with low risk (<60 years, aaIPI=0-1); young patients with high risk (<60 years, aaIPI=2-3). The combination of the anti-CD20 monoclonal antibody rituximab and CHOP chemotherapy, every 14 or 21 days, is the standard treatment for DLBCL patients. Recent randomized trials suggest that high-dose chemotherapy supported by autologous stem cell transplant (HDC/ASCT) should not be used as upfront treatment for young high-risk patients outside prospective clinical trials. HDC/ASCT is actually recommended in young patients who did not achieve CR after first-line chemotherapy. Consolidation radiotherapy should be reserved to patients with bulky disease who did not achieve CR after immunochemotherapy. Patients with high IPI score, which indicates increased LDH serum level and the involvement of more than one extranodal site, and patients with involvement of certain extranodal sites (a.e., testes and orbit) should receive CNS prophylaxis as part of first-line treatment. HDC/ASCT should be considered the standard therapy for DLBCL patients with chemotherapy-sensitive relapse. Overall results in patients who cannot be managed with HDC/ASCT due to age or comorbidity are disappointing. New effective and less toxic chemotherapy drugs or biological agents are also worth considering for this specific and broad group of patients. Several novel agents are undergoing evaluation in DLBCL; among other, immunomodulating agents (lenalidomide), m-TOR inhibitors (temsirolimus and everolimus), proteasome inhibitors (bortezomib), histone deacetylase inhibitors (vorinostat), and anti-angiogenetic agents (bevacizumab) are being investigated in prospective trials.
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236
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Kloesel B, Vaidya R, Howard MT, Thompson CA. A unifying diagnosis for pancytopenia, fever, hypoglycemia, and lactic acidosis. Am J Hematol 2013; 88:78-81. [PMID: 22460726 DOI: 10.1002/ajh.23178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 02/15/2012] [Accepted: 02/22/2012] [Indexed: 12/17/2022]
Affiliation(s)
- Benjamin Kloesel
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55904, USA
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237
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Silent intravascular lymphoma initially manifesting as a unilateral adrenal incidentaloma. Case Rep Med 2012; 2012:849285. [PMID: 22927863 PMCID: PMC3425017 DOI: 10.1155/2012/849285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 07/16/2012] [Indexed: 11/17/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of malignant lymphoma. Although the involvement of adrenal glands in IVLBCL is often observed, primary adrenal IVLBCL is rare. Most reported cases of adrenal IVLBCL showed bilateral lesions resulting in rapidly progressive adrenal failure and poor prognosis. Here, we report a case of slowly progressive primary adrenal IVLBCL manifesting initially with unilateral adrenal incidentaloma. This case is a silent IVLBCL and shows that the enlargement of both adrenal glands can be followed.
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238
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Yu H, Chen G, Zhang R, Jin X. Primary intravascular large B-cell lymphoma of lung: a report of one case and review. Diagn Pathol 2012; 7:70. [PMID: 22716188 PMCID: PMC3449187 DOI: 10.1186/1746-1596-7-70] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 06/20/2012] [Indexed: 12/14/2022] Open
Abstract
Objective To investigate the clinicopathological features of primary intravascular large B-cell lymphoma of lung. Methods A case of primary pulmonary intravascular large B-cell lymphoma was analysed in histopathology and immunophenotype. Results The patient is a 42-year-old female who had cough for one year. Computed tomography showed ground-glass opacities and small nodules in bilateral lung fields. Histopathology demonstrated accumulation of similar sized neoplastic cells within alveolar capillaries, widening the alveolar septae. The alveolar structure sustained in part of districtions. Immunohistologically, the tumor cells were positive for CD20 and negative for CD3,CK, which were similar to the diffuse large B-cell lymphoma. Conclusions Intravascular large B-cell lymphoma is an uncommon type of non-Hodgkin’s lymphoma. Primary pulmonary presentation is even more rare. The diagnosis is based on the histopathology and immunohistochemistry. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2076991810705433.
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Affiliation(s)
- Hui Yu
- Department of Pathology, Shanghai Pulmonary Hospital Tongji University School of Medicine, Shanghai, China
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239
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Primary Central Nervous System Lymphoma. Clin Oncol (R Coll Radiol) 2012; 24:329-38. [DOI: 10.1016/j.clon.2012.02.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 02/29/2012] [Indexed: 11/23/2022]
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240
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True identity of endocapillary proliferation: a case of intravascular large B cell lymphoma diagnosed with immunohistochemical study of kidney biopsy and literature review. CEN Case Rep 2012; 1:61-68. [PMID: 28509062 DOI: 10.1007/s13730-012-0014-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 04/10/2012] [Indexed: 12/20/2022] Open
Abstract
A 78-year-old Japanese female presented with low-grade fever, malaise, and appetite loss lasting for 1 month. Upper and lower gastrointestinal endoscopy and contrast-enhanced whole-body computed tomography (CT) revealed no abnormal findings at a referring hospital. She was referred to our hospital because of bilateral leg edema and 2.5 g/day proteinuria. Serum creatinine was 0.73 mg/dl and the kidneys were not enlarged. Kidney biopsy showed marked endocapillary proliferation with mesangiolysis. Soon after the kidney biopsy, her symptoms improved spontaneously, along with decreases in lactate dehydrogenase (LDH) from 503 to 197 IU/l, C-reactive protein (CRP) from 4.47 to 0.66 mg/dl, and soluble interleukin-2 receptor (sIL-2R) from 1789 to 1001 U/ml. Thus, she was followed carefully as an outpatient. One month later, however, she presented with dysarthria and right-sided hemiparesis, and diffusion-weighted brain magnetic resonance imaging (MRI) showed multiple high-intensity areas. She also had respiratory failure, and lung perfusion scintigraphy showed multiple low blood stream areas. Suspecting some endovascular abnormality, we performed immunohistochemical staining of the kidney biopsy specimen taken previously to find that endocapillary infiltrating cells were CD20-positive B lymphocytes. The infiltrating cells were confined to the endocapillary compartment in glomeruli and peritubular capillaries. Both clinical and pathological findings led us to diagnose intravascular large B cell lymphoma (IVLBCL). Two bone marrow biopsies and random skin biopsies were performed, but no abnormality was found. The present case demonstrates that clinical course and renal biopsy findings of intravascular large B cell lymphoma may mimic other renal conditions and that the identification of cell types with immunohistochemical staining may help establish an accurate diagnosis.
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241
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Abstract
A rare type of diffuse large B-cell lymphoma, intravascular large B-cell lymphoma primarily affects the middle-aged to elderly population, with a slight predominance in men. By the time of presentation, most patients have advanced, disseminated disease, and often the diagnosis is made at autopsy. Patients may present with any of a myriad of symptoms, with any tissue potentially being infiltrated. Central nervous system and cutaneous involvement is common, as is the presence of B symptoms including fever, weight loss, and night sweats. Morphologically, growth of neoplastic cells is restricted to the lumen of small vessels. The cells are large, with 1 or more prominent nucleoli, scant cytoplasm, and frequent mitotic figures, and are commonly positive for cluster of differentiation markers 79a, 20, and 19, as well as MUM1/IRF4 and Bcl-2. Intravascular large B-cell lymphoma is aggressive, and without treatment is rapidly fatal.
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Affiliation(s)
- Dennis E Orwat
- Department of Pathology, Medical University of South Carolina, Charleston, 29425, USA
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242
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Raza M, Qayyum S, Raza S, Goorha S. Intravascular B-cell lymphoma: an elusive diagnosis. J Clin Oncol 2012; 30:e144-5. [PMID: 22529262 DOI: 10.1200/jco.2011.38.7720] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Muhammad Raza
- University of Tennessee Cancer Institute, Memphis, TN, USA.
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243
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Chroboczek T, Lazaro E, Greib C, Parrens M, Dilhuydi MS, Pellegrin JL, Viallard JF. [Intravascular large B cell lymphoma: a case series of three patients and update]. Rev Med Interne 2012; 33:250-8. [PMID: 22305635 DOI: 10.1016/j.revmed.2011.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 11/06/2011] [Accepted: 12/21/2011] [Indexed: 01/29/2023]
Abstract
PURPOSE Intravascular large B cell lymphoma (IVLBCL) is a rare and aggressive variant of non-Hodgkin's lymphoma, characterized by multifocal proliferation of lymphoma cells exclusively within small and medium blood vessels. IVLBCL can be systemic and quite polymorphic, which often makes it difficult to diagnose, thus delaying appropriate treatment. PATIENTS AND METHODS We report three patients of atypical IVLBCL, through the study of which we overview recent knowledge about IVLBCL. RESULTS The first patient initially presented with peripheral thrombocytopenia and splenic destruction of platelets, later completed with an interstitial pulmonary syndrome. The second patient, of African origin, we believe is the first case of a black patient with IVLBCL described in the medical literature. The third belongs to the rare group of occidental patients that present an IVLBCL associated with a hemophagocytic syndrome. CONCLUSION Intravascular large B cell lymphoma is a systemic and polymorphic disease. Awareness of this entitiy should allow rapid and appropriate management.
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Affiliation(s)
- T Chroboczek
- Service de médecine interne et maladies infectieuses, hôpital Haut-Lévèque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac cedex, France
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244
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Rogers LR. Neurovascular complications of solid tumors and hematological neoplasms. HANDBOOK OF CLINICAL NEUROLOGY 2012; 105:805-23. [PMID: 22230535 DOI: 10.1016/b978-0-444-53502-3.00025-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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245
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Abstract
This is the case of a 42-year-old female who presented with transient dizziness. Her symptoms and signs progressed to include dysarthria, ataxia and cognitive decline over 2 years, such that she was unable to care for herself. She died 4 years after first presentation without a diagnosis. Investigations revealed a normochromic normocytic anaemia. Cerebrospinal fluid was normal. Serial computed tomography brain showed a wedge-shaped frontal infarct but no progressive changes. Examination at autopsy showed discoloration of the gray and white matter of the brain and spinal cord.Microscopy of leptomeningeal and parenchymal vessels showed they were filled with atypical B lymphocytes confined to the intravascular space with multiple infarcts in the brain, cerebellum and spinal cord. A diagnosis of intravascular B cell lymphoma was made and is discussed.
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Affiliation(s)
- Jane Cryan
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland
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246
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Intravascular B-cell lymphoma with hypercalcemia as the initial presentation. Int J Hematol 2011; 94:567-70. [PMID: 22045306 DOI: 10.1007/s12185-011-0959-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 10/17/2011] [Accepted: 10/20/2011] [Indexed: 12/14/2022]
Abstract
Intravascular B-cell lymphoma (IVLBCL) is a rare subtype of extranodal diffuse large B-cell lymphoma, which is characterized by the growth of lymphoma cells within blood vessel lumina without nodular lesions, and which predominantly affects elderly patients. IVLBCL is characterized by B-symptoms and a variety of systemic symptoms due to focal obstruction of blood flow, but may be difficult to diagnose due to its peculiar intravascular localization and the lack of nodular lesions. While hypercalcemia is one of the complications of various types of cancerous diseases, it has rarely been reported as the first presentation of IVLBCL. In this report, we present the case of a 71-year-old male with IVLBCL who showed hypercalcemia accompanied by elevation of serum parathyroid hormone-related protein (PTH-rP) as the initial presentation. Interestingly, immunohistochemical staining revealed that the intravascular lymphoma cells expressed high levels of PTHrP. Six courses of immunochemotherapy, consisting of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP), and two courses of high-dose methotrexate induced complete remission (CR) and retained CR for 4 months. We also reviewed other IVBCL cases in which hypercalcemia was the initial presentation. We suggest that IVLBCL, although rare, should be considered as a possible causative in hypercalcemia of unknown underlying disease.
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247
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Isolated intraorbital intravascular large B-cell lymphoma: a case report. J Hematop 2011. [DOI: 10.1007/s12308-011-0102-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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248
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Tabata C, Tabata R. Possible prediction of underlying lymphoma by high sIL-2R/ferritin ratio in hemophagocytic syndrome. Ann Hematol 2011; 91:63-71. [DOI: 10.1007/s00277-011-1239-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Accepted: 04/12/2011] [Indexed: 11/29/2022]
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249
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Yamashita Y, Kajiura D, Tang L, Hasegawa Y, Kinoshita T, Nakamura S, Akatsuka S, Toyokuni S, Mori N. XCR1 expression and biased VH gene usage are distinct features of diffuse large B-cell lymphoma initially manifesting in the bone marrow. Am J Clin Pathol 2011; 135:556-64. [PMID: 21411777 DOI: 10.1309/ajcpctdc5py3lxbp] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A total of 29 cases of diffuse large B-cell lymphoma initially manifesting in the bone marrow (BM-DLBCL) were analyzed for V(H) gene sequence, and expression microarray of chemokines and chemokine receptors and immunohistochemical analysis were done. Seminested polymerase chain reaction (PCR) and sequencing analyses of 18 cases revealed that the V(H) gene usage in 6 cases was restricted to V(H)3-7, in 3 cases to V(H)4-34, and in 2 cases to V(H)4-39, which were all previously reported to be autoreactive. In total, 14 of 18 V(H) genes were those associated with autoimmune diseases, including V(H)3-21, V(H)3-23, and V(H)3-48. Furthermore, cDNA microarray analysis specific for chemokine and chemokine receptors revealed that chemokine receptor XCR1 expression was significantly elevated in the BM-DLBCL cases (P < .05), which was confirmed by quantitative reverse transcriptase-PCR and immunohistochemical analysis. Expression of the chemokine receptor XCR1 and frequent usage of autoreactive V(H) genes seem to be distinct characteristics of BM-DLBCL.
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250
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Intravascular lymphoma presenting as a longitudinally-extensive myelitis: Diagnostic challenges and etiologic clues. J Neurol Sci 2011; 303:146-9. [DOI: 10.1016/j.jns.2010.12.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 12/17/2010] [Indexed: 11/17/2022]
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