1
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Tomkins O, Lunn MP. Recent insights into haematology and peripheral nerve disease. Curr Opin Neurol 2024; 37:461-466. [PMID: 38861221 DOI: 10.1097/wco.0000000000001291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
PURPOSE OF REVIEW The association between clonal haematological disorders and peripheral nerve disease is recognized. Paraproteinaemic phenomena are the most common mechanism, but direct neural lymphomatous infiltration is seen and can be challenging to diagnose. Traditional and novel anticancer therapies have neuropathic side effects. RECENT FINDINGS Novel studies using sensitive techniques are refining the incidence of peripheral neuropathy in patients with a monoclonal gammopathy, and the pathogenesis of IgM Peripheral neuropathy (PN) and POEMS syndrome. Recent series give insight into the characteristics and diagnostic challenges of patients with neurolymphomatosis and amyloid light chain amyloidosis. There is an increasing repertoire of effective anticancer drugs in haematological oncology, but chemotherapy-related neuropathy remains a common side effect. SUMMARY This review of the current literature focuses on recent updates and developments for the paraproteinaemic neuropathies, and the evaluation, diagnosis and treatment of peripheral nerve disease due to high-grade and low-grade lymphomas and lymphoproliferative disorders.
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Affiliation(s)
- Oliver Tomkins
- Department of Haematology, University College London Hospitals NHS Foundation Trust
| | - Michael P Lunn
- Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK
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2
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Thiotepa-based high-dose chemotherapy with autologous stem cell transplantation for neurolymphomatosis. Int J Hematol 2023:10.1007/s12185-023-03544-8. [PMID: 36689064 DOI: 10.1007/s12185-023-03544-8] [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: 09/13/2022] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 01/24/2023]
Abstract
Neurolymphomatosis (NL) is a rare clinical entity characterized by lymphomatous infiltration of the peripheral nervous system. According to recent retrospective data, consolidative high-dose chemotherapy (HDC) with autologous stem cell transplantation (ASCT) may be beneficial for NL. However, few reports to date have discussed optimal conditioning regimens. Herein, we report two cases of NL in patients with relapsed intravascular large B-cell lymphoma who received consolidative thiotepa-containing HDC-ASCT. Case 1: A 56-year-old woman who relapsed 2 months after the first complete remission (CR) and underwent ASCT. Case 2: A 65-year-old woman who relapsed 8 months after the first CR and underwent ASCT. Both patients engrafted. Time to neutrophil engraftment was 10 and 12 days after HDC-ASCT, and CR was sustained for 26 and 18 months, respectively, as of the last follow-up. Although there is little evidence supporting the utility of thiotepa-based HDC-ASCT in patients with NL, the results of this case report suggest that further studies are warranted to determine its efficacy in this setting.
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Abstract
Though metastasis and malignant infiltration of the peripheral nervous system is relatively rare, physicians should have a familiarity with their presentations to allow for prompt diagnosis and initiation of treatment. This article will review the clinical presentations, diagnostic evaluation, and treatment of neoplastic involvement of the cranial nerves, nerve roots, peripheral nerves, and muscle. Due to the proximity of the neural structure traversing the skull base, metastasis to this region results in distinctive syndromes, most often associated with breast, lung, and prostate cancer. Metastatic involvement of the nerve roots is uncommon, apart from leptomeningeal carcinomatosis and bony metastasis with resultant nerve root damage, and is characterized by significant pain, weakness, and numbness of an extremity. Neoplasms may metastasize or infiltrate the brachial and lumbosacral plexuses resulting in progressive and painful sensory and motor deficits. Differentiating neoplastic involvement from radiation-induced injury is of paramount importance as it dictates treatment and prognosis. Neurolymphomatosis, due to malignant lymphocytic infiltration of the cranial nerves, nerve roots, plexuses, and peripheral nerves, deserves special attention given its myriad presentations, often mimicking acquired demyelinating neuropathies.
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4
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Tanaka Y, Momose S, Takayanagi N, Tabayashi T, Tokuhira M, Tamaru JI, Kizaki M. Rapid deterioration of intravascular large B-cell lymphoma with mass formation in the trigeminal nerve and multiple organ infiltration: An autopsy case report. J Clin Exp Hematop 2021; 62:41-45. [PMID: 34840206 PMCID: PMC9010497 DOI: 10.3960/jslrt.21013] [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: 12/04/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare lymphoma characterized by the selective growth of lymphoma cells within the lumen of vessels. We describe the case of a 69-year-old male who presented with marked pain in the left facial region. Gadolinium-enhanced magnetic resonance imaging revealed a swollen left trigeminal nerve (TN) and positron emission tomography/computed tomography demonstrated fluorodeoxyglucose-only uptake at the same site. The patient had high serum lactate dehydrogenase and soluble interleukin-2 receptor levels. As random skin biopsy and bone marrow biopsy detected no abnormal pathogenesis, open biopsy of the TN was performed, revealing diffuse large B-cell lymphoma (DLBCL). However, ground glass opacities rapidly developed in both lung fields with severe respiratory failure. The patient died of progressive disease before the initiation of chemotherapy. Postmortem examination revealed widespread lymphoma cells in the lumen of vessels in multiple organs, including the lungs, excluding the bone marrow and skin. Lymphoma cells formed a mass in the TN and left lumbar plexus. A diagnosis of IVLBCL was made based on the postmortem pathological analysis. DLBCL of abnormal sites, such as the peripheral nervous system, should be considered in cases of IVLBCL as a differential diagnosis.
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Affiliation(s)
- Yuka Tanaka
- Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Shuji Momose
- Department of Pathology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Natsuko Takayanagi
- Department of Pathology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Takayuki Tabayashi
- Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Michihide Tokuhira
- Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Jun-Ichi Tamaru
- Department of Pathology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Masahiro Kizaki
- Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
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5
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Porzionato A, Pelletti G, Barzon L, Contran M, Emmi A, Arminio A, Macchi V, De Caro R. Intravascular large B-cell lymphoma affecting multiple cranial nerves: A histopathological study. Neuropathology 2021; 41:396-405. [PMID: 34541718 PMCID: PMC9293035 DOI: 10.1111/neup.12767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/23/2021] [Accepted: 05/31/2021] [Indexed: 12/16/2022]
Abstract
Intravascular large B‐cell lymphoma (IVLBCL) is a rare form of lymphomas with poor prognosis, characterized by atypical lymphocytes selectively growing within the lumen of small or medium‐sized vessels. Here, we report a case of intracerebral IVLBCL in a 54‐year‐old man who died three months after symptom onset. The diagnosis was made by postmortem pathological examination, based on the identification of multiple ischemic lesions, with small or medium‐sized vessels filled with malignant B‐cells, in the cerebral hemispheres, cerebellum, midbrain, and medulla oblongata, including the external cuneate nucleus and trigeminal spinal tract nucleus. Apart from necrotic lesions, specific histopathological search for occluded vessels in the other brain stem structures permitted identification of significant involvement of the cuneate nucleus, solitary tract nucleus, hypoglossal nucleus, and inferior olivary complex. Small vessels affected by IVLBCL were also found in the trunks of the oculomotor, trigeminal, glossopharyngeal, vagal, and hypoglossal nerves. These histopathological findings were consistent with some cranial nerve symptoms/signs ascertained during hospitalization, such as diplopia, dysphonia, and asymmetry/hypomotility of the palatal veil. The case study presented here reports novel insights on radiological, anatomical, and clinical correlations of the IVLBCL, including the possible involvement of nuclei and trunks of multiple cranial nerves. The reported findings may help clinicians in the early identification of this rapidly progressive disease that can be easily misdiagnosed, through integrated neuroradiological, neurological and neuropathological approaches.
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Affiliation(s)
- Andrea Porzionato
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Guido Pelletti
- Section of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luisa Barzon
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Martina Contran
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Aron Emmi
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Angelo Arminio
- Section of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Veronica Macchi
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Raffaele De Caro
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
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6
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Sommer C, Carroll AS, Koike H, Katsuno M, Ort N, Sobue G, Vucic S, Spies JM, Doppler K, Kiernan MC. Nerve biopsy in acquired neuropathies. J Peripher Nerv Syst 2021; 26 Suppl 2:S21-S41. [PMID: 34523188 DOI: 10.1111/jns.12464] [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: 09/25/2020] [Revised: 06/02/2021] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
A diagnosis of neuropathy can typically be determined through clinical assessment and focused investigation. With technological advances, including significant progress in genomics, the role of nerve biopsy has receded over recent years. However, making a specific and, in some cases, tissue-based diagnosis is essential across a wide array of potentially treatable acquired peripheral neuropathies. When laboratory investigations do not suggest a definitive diagnosis, nerve biopsy remains the final step to ascertain the etiology of the disease. The present review highlights the utility of nerve biopsy in confirming a diagnosis, while further illustrating the importance of a tissue-based diagnosis in relation to treatment strategies, particularly when linked to long-term immunosuppressive therapies.
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Affiliation(s)
- Claudia Sommer
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Antonia S Carroll
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia.,Westmead Clinical School, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Neurology and Neurophysiology, St Vincent's Hospital, The University of NSW, Sydney, New South Wales, Australia
| | - Haruki Koike
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nora Ort
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Gen Sobue
- Brain and Mind Research Center, Nagoya University, Nagoya, Japan.,Aichi Medical University, Nagakute, Japan
| | - Steve Vucic
- Westmead Clinical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Judith M Spies
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kathrin Doppler
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Matthew C Kiernan
- Brain and Mind Centre, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia.,Department of Neurology, Royal Prince Alfred Hospital, The University of Sydney, Camperdown, New South Wales, Australia
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7
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Abstract
Paraproteinaemic neuropathies comprise a heterogeneous group of neuro-haematological conditions with some distinct neurological, haematological and systemic phenotypes. The spectrum of disease varies from mild to severe, indolent to rapidly progressive and from small fibre sensory involvement to dramatic sensorimotor deficits. The haematological association may be overlooked, resulting in delayed treatment, disability, impaired quality of life and increased mortality. However, the presence of an irrelevant benign paraprotein can sometimes lead to inappropriate treatment. In this review, we outline our practical approach to paraproteinaemic disorders, discuss the utility and limitations of diagnostic tests and the distinctive clinical phenotypes and touch on the complex multidisciplinary management approaches.
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Affiliation(s)
- Antonia S Carroll
- Brain and Mind Centre, The University of Sydney, Sydney, New South Wales, Australia.,National Hospital for Neurology and Neurosurgery, London, UK
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8
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Jeong J, Kim SW, Sung DH. Neurolymphomatosis: a single-center experience of neuromuscular manifestations, treatments, and outcomes. J Neurol 2020; 268:851-859. [PMID: 33098033 DOI: 10.1007/s00415-020-10202-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 05/30/2023]
Abstract
OBJECTIVES Neurolymphomatosis (NL) is a disease characterized by the infiltration of malignant lymphocytes into the peripheral nervous system. We report clinical features, radiographic findings, modes of treatment, and outcomes of patients with NL. METHODS We retrospectively investigated patients with NL. We extracted data, including clinical features, magnetic resolution imaging (MRI), 18F-fludeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scans, cerebrospinal fluid cytology findings, the results of electrodiagnostic studies, as well as patient treatments and outcomes. RESULTS Ten NL patients were identified. All patients reported pain/paresthesia and weakness in the affected area. The MRI scans were abnormal in eight out of nine patients with an enhancement of the spinal nerve root, plexus, peripheral nerve trunk, and cranial nerve. The FDG PET/CT scans were positive in all patients. Radiculopathy or radiculoplexopathy was the most common electrodiagnostic finding. Neurological improvement was observed in only three patients. The condition of the nine patients who underwent multimodality treatments for cancer eventually deteriorated and the patients died. CONCLUSIONS NL should be considered in the differential diagnosis of any type of neuropathy in patients with lymphoma. Because it could be confused with other neuropathies in lymphoma and various musculoskeletal diseases, a high index of suspicion and familiarity with clinical manifestation of NL are key. FDG PET/CT was the most sensitive diagnostic imaging modality to detect relevant neural invasion. The root within the spinal neural foramen was the most frequently affected neural structure. Early diagnosis of this rare neurologic manifestation of lymphoma may improve treatment outcomes.
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Affiliation(s)
- Jisun Jeong
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Sun Woong Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Duk Hyun Sung
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Ilwon-ro, Gangnam-gu, Seoul, 06351, Korea.
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9
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Keddie S, Nagendran A, Cox T, Bomsztyk J, Jaunmuktane Z, Brandner S, Manji H, Rees JH, Ramsay AD, Rossor A, D'Sa S, Reilly MM, Carr AS, Lunn MP. Peripheral nerve neurolymphomatosis: Clinical features, treatment, and outcomes. Muscle Nerve 2020; 62:617-625. [PMID: 32786031 DOI: 10.1002/mus.27045] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 07/28/2020] [Accepted: 08/09/2020] [Indexed: 11/10/2022]
Abstract
This series characterises nine patients with neurohistopathologically proven peripheral nerve neurolymphomatosis. A search of the hospital neuropathology database from 2002 to 2019 identified biopsy proven cases. Clinical data, investigation modalities, treatments, and outcomes were collated. Median age at neuropathy onset was 47 y, the neuropathy commonly as the initial lymphoma disease manifestation. Most (8/9) presented with painful asymmetrical sensory disturbance, with additional cranial nerve involvement in three. Neurophysiology typically demonstrated multiple axonal mononeuropathies. Cerebrospinal fluid protein was often raised (6/8). Magnetic resonance imaging suggested peripheral nerve infiltration in 6/9 and positron emission tomography CT in 4/9. Bone marrow biopsy was abnormal in 6/8. Treatment involved systemic or intrathecal chemotherapy and radiotherapy. Median survival was 23 mo. Neurolymphomatosis is a rare but important cause of neuropathy, particularly in those lacking systemic evidence of lymphoma as correct aggressive treatment can prolong survival. Nerve biopsy is essential to classify lymphoma type and rule out alternatives.
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Affiliation(s)
- Stephen Keddie
- Centre for Neuromuscular Disease, Department of Neuromuscular Diseases, UCL Institute of Neurology, and National Hospital of Neurology and Neurosurgery, London, UK.,Neuroimmunology and CSF Laboratory, Institute of Neurology, National Hospital for Neurology and Neurosurgery, University College London NHS Foundation Trust, London, UK
| | - Arjuna Nagendran
- Centre for Neuromuscular Disease, Department of Neuromuscular Diseases, UCL Institute of Neurology, and National Hospital of Neurology and Neurosurgery, London, UK
| | - Tom Cox
- Centre for Neuromuscular Disease, Department of Neuromuscular Diseases, UCL Institute of Neurology, and National Hospital of Neurology and Neurosurgery, London, UK
| | - Joshua Bomsztyk
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Zane Jaunmuktane
- Division of Neuropathology, National Hospital of Neurology and Neurosurgery, UCL Hospitals NHS Foundation Trust, London, UK
| | - Sebastian Brandner
- Division of Neuropathology, National Hospital of Neurology and Neurosurgery, UCL Hospitals NHS Foundation Trust, London, UK
| | - Hadi Manji
- Centre for Neuromuscular Disease, Department of Neuromuscular Diseases, UCL Institute of Neurology, and National Hospital of Neurology and Neurosurgery, London, UK
| | - Jeremy H Rees
- Department of Neuro-Oncology, National Hospital of Neurology and Neurosurgery, London, UK
| | - Alan D Ramsay
- Haematopathology Unit, Department of Cellular Pathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alexander Rossor
- Centre for Neuromuscular Disease, Department of Neuromuscular Diseases, UCL Institute of Neurology, and National Hospital of Neurology and Neurosurgery, London, UK
| | - Shirley D'Sa
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mary M Reilly
- Centre for Neuromuscular Disease, Department of Neuromuscular Diseases, UCL Institute of Neurology, and National Hospital of Neurology and Neurosurgery, London, UK
| | - Aisling S Carr
- Centre for Neuromuscular Disease, Department of Neuromuscular Diseases, UCL Institute of Neurology, and National Hospital of Neurology and Neurosurgery, London, UK
| | - Michael P Lunn
- Centre for Neuromuscular Disease, Department of Neuromuscular Diseases, UCL Institute of Neurology, and National Hospital of Neurology and Neurosurgery, London, UK.,Neuroimmunology and CSF Laboratory, Institute of Neurology, National Hospital for Neurology and Neurosurgery, University College London NHS Foundation Trust, London, UK
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10
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Matsue K, Abe Y, Narita K, Kobayashi H, Kitadate A, Miura D, Takeuchi M, Takeuchi K. Bone marrow infiltration pattern in patients with intravascular large B-cell lymphoma diagnosed by random skin biopsy. EJHAEM 2020; 1:281-285. [PMID: 35847692 PMCID: PMC9175664 DOI: 10.1002/jha2.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 12/14/2022]
Abstract
We retrospectively analyzed bone marrow (BM) infiltration pattern in consecutive 30 intravascular large B-cell lymphoma (IVLBCL) patients diagnosed by random skin biopsy (RSB). BM infiltration of lymphoma was observed in 18 patients (60.0%), including five patients with the intrasinusoidal pattern with minimal extravasation, eight patients with the mixed of intrasinusoidal and scattered/interstitial or nodular infiltration, and five patients with the nodular/diffuse pattern. Twelve patients were negative for lymphoma infiltration. BM histology of patients with IVLBCL were diverse and frequently discordant with those of other site of IVLBCL lesions. BM biopsy had a poorer diagnostic performance for detecting intravascular features.
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Affiliation(s)
- Kosei Matsue
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Yoshiaki Abe
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Kentaro Narita
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Hiroki Kobayashi
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Akihiro Kitadate
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Daisuke Miura
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Masami Takeuchi
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Kengo Takeuchi
- Division of PathologyThe Cancer InstituteJapanese Foundation for Cancer ResearchTokyoJapan
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11
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12
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Nishikawara M, Kawakami T, Sakai H, Kawakami F, Nishina S, Uehara T, Ishida F, Nakazawa H. Magnetic Resonance Imaging-negative, Rituximab-resistant Neurolymphomatosis as a Paradoxical Presentation of Relapsed Primary Adrenal Lymphoma. Intern Med 2020; 59:1437-1443. [PMID: 32132335 PMCID: PMC7332632 DOI: 10.2169/internalmedicine.4085-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Primary adrenal lymphoma (PAL) is rare and known to have a predilection for central nervous system (CNS) relapse. A 70-year-old man with a 2-year history of primary aldosteronism presented because of a fever. He was hypotensive, and his adrenal glands were unequivocally enlarged. PAL was diagnosed. Despite showing an initial response to immunochemotherapy, progressive paralysis ensued. Magnetic resonance imaging findings were negative, and rituximab was ineffective. His debilitated condition hindered further chemotherapy. A postmortem examination revealed lymphoma relapse in the systemic peripheral nerves. The sequential presentation of two rare lymphomas implies that PAL might have a predilection for not only the CNS but also peripheral nerves.
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Affiliation(s)
- Mayuka Nishikawara
- Division of Hematology, Department of Internal Medicine, Shinshu University School of Medicine, Japan
| | - Toru Kawakami
- Division of Hematology, Department of Internal Medicine, Shinshu University School of Medicine, Japan
| | - Hitoshi Sakai
- Division of Hematology, Department of Internal Medicine, Shinshu University School of Medicine, Japan
| | - Fumihiro Kawakami
- Division of Hematology, Department of Internal Medicine, Shinshu University School of Medicine, Japan
| | - Sayaka Nishina
- Division of Hematology, Department of Internal Medicine, Shinshu University School of Medicine, Japan
| | - Takeshi Uehara
- Department of Diagnostic Pathology, Shinshu University School of Medicine, Japan
| | - Fumihiro Ishida
- Division of Hematology, Department of Internal Medicine, Shinshu University School of Medicine, Japan
- Department of Biomedical Laboratory Medicine, Shinshu University School of Medicine, Japan
| | - Hideyuki Nakazawa
- Division of Hematology, Department of Internal Medicine, Shinshu University School of Medicine, Japan
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13
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Matsue K, Abe Y, Narita K, Kobayashi H, Kitadate A, Takeuchi M, Miura D, Takeuchi K. Diagnosis of intravascular large B cell lymphoma: novel insights into clinicopathological features from 42 patients at a single institution over 20 years. Br J Haematol 2019; 187:328-336. [PMID: 31267524 PMCID: PMC6900202 DOI: 10.1111/bjh.16081] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/13/2019] [Indexed: 01/06/2023]
Abstract
This study aimed to clarify the comprehensive clinical, laboratory, pathological and imaging features of intravascular large B‐cell lymphoma (IVLBCL) using data on 42 IVLBCL patients diagnosed at our hospital over the past 20 years. The majority of patients were diagnosed via random skin biopsy (29/42, 69·0%) followed by bone marrow biopsy alone (8/42, 19·0%). Characteristic features included persistent fever (41/42, 97·6%), decreased performance status (≥2) (100%), hypoxaemia (32/40, 80·0%), impaired consciousness (19/42, 45·2%), hypoalbuminemia (42/42, 100%) and extreme elevation of lactate dehydrogenase and soluble interleukin 2 receptor levels. Brain magnetic resonance imaging showed abnormal findings in 32/37 patients (86·4%). Hyperintense lesion in the pons was a peculiar finding that was unrelated to the neurological deficits. Positron emission tomography‐computed tomography revealed a high incidence of bone marrow (26/34, 76·5%), spleen (19/34, 55·9%) and adrenal gland (9/34, 26·5%) involvement. Neurolymphomatosis was noted in 6 patients during the course of the disease. About 60% of IVLBCL patients in whom in vivo diagnosis was possible survived more than 5 years with combination chemotherapy. Our observations provide additional insight into the diagnosis of IVLBCL and indicate that early disease recognition via random skin biopsy combined with imaging, enables in vivo diagnosis of the disease and improved survival for many patients.
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Affiliation(s)
- Kosei Matsue
- Division of Haematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, Chiba, Japan
| | - Yoshiaki Abe
- Division of Haematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, Chiba, Japan
| | - Kentaro Narita
- Division of Haematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, Chiba, Japan
| | - Hiroki Kobayashi
- Division of Haematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, Chiba, Japan
| | - Akihiro Kitadate
- Division of Haematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, Chiba, Japan
| | - Masami Takeuchi
- Division of Haematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, Chiba, Japan
| | - Daisuke Miura
- Division of Haematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, Chiba, Japan
| | - Kengo Takeuchi
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
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14
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Zhang Y, Zhu TN, Sun J, Zhong DR, Zhang W, Zhou DB. [Clinical characteristics of intravascular large B cell lymphoma: a single-center retrospective study]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 39:1004-1009. [PMID: 30612402 PMCID: PMC7348217 DOI: 10.3760/cma.j.issn.0253-2727.2018.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
目的 提高对血管内大B细胞淋巴瘤(IVLBCL)的认识。 方法 回顾性分析北京协和医院自2010年1月至2016年6月收治的12例IVLBCL患者的临床资料。 结果 ①12例患者中,男6例,女6例,中位年龄为58.5(32~76)岁。临床表现:发热最为常见(10/12),其次为呼吸系统症状(咳嗽、呼吸困难、胸腔积液等,6/12)、噬血细胞综合征(6/12)、神经系统症状(1/12);所有患者均有LDH升高(367~1 700 U/L)、铁蛋白升高(805~1 527 µg/L)、结外器官受累(肺6例,骨髓3例,脑2例,软脑膜、肾上腺、副鼻窦、胆囊、甲状腺各1例)。②组织病理特征:光镜下可见分布于小血管内的单个或小簇状淋巴瘤细胞,毛细血管或血窦结构得以保留,免疫组化显示CD20、CD79a等B淋巴细胞标志阳性。③疗效及预后:11例患者接受CHOP或R-CHOP方案化疗,其总反应率为90.1%,完全缓解率为66.7%。患者平均随访20(1~40)个月,中位生存期及中位无进展生存期尚未达到。单因素Cox回归分析未能发现年龄、分期、IPI等临床参数与预后相关。 结论 IVLBCL临床罕见,出现肺部受累比例高,肺活检有较高阳性率;R-CHOP方案目前仍是最主要的治疗方案。
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Affiliation(s)
- Y Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
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15
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Sato S, Teshima S, Nakamura N, Ohtake T, Kikuchi J, Kishi H, Nomura K, Kurose N, Masaki Y, Tamaru JI. Intravascular large B-cell lymphoma involving large blood vessels, three autopsy cases. Pathol Int 2019; 69:97-103. [DOI: 10.1111/pin.12751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/05/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Shuku Sato
- Department of Hematology; Shonan Kamakura General Hospital; Kamakura Japan
- Department of Pathology; Tokai University; School of Medicine; Isehara Japan
| | - Shinichi Teshima
- Department of Pathology; Shonan Kamakura General Hospital; Kamakura Japan
| | - Naoya Nakamura
- Department of Pathology; Tokai University; School of Medicine; Isehara Japan
| | - Takayasu Ohtake
- Department of Nephrology, Immunology, and Vascular Medicine; Shonan Kamakura General Hospital; Kamakura Japan
| | - Jun Kikuchi
- Department of Pathology; Saitama Medical Center; Saitama Medical University; Saitama Japan
| | - Hirohisa Kishi
- Department of Pathology; Saitama Medical Center; Saitama Medical University; Saitama Japan
- Department of Pathology; Doai Memorial Hospital; Tokyo Japan
| | - Kyoichi Nomura
- Department of Neurology; Saitama Medical Center; Saitama Medical University; Saitama Japan
| | - Nozomu Kurose
- Department of Pathology; Kanazawa Medical University; Kanazawa Japan
| | - Yasufumi Masaki
- Department of Hematology and Immunology; Kanazawa Medical University; Kanazawa Japan
| | - Jun-ichi Tamaru
- Department of Pathology; Saitama Medical Center; Saitama Medical University; Saitama Japan
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16
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Kobayashi H, Abe Y, Miura D, Narita K, Kitadate A, Takeuchi M, Matsue K. Limited efficacy of high-dose methotrexate in patients with neurolymphomatosis. Int J Hematol 2019; 109:286-291. [PMID: 30604318 DOI: 10.1007/s12185-018-02586-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/26/2018] [Accepted: 12/26/2018] [Indexed: 11/29/2022]
Abstract
Neurolymphomatosis (NL) is a rare manifestation of non-Hodgkin lymphoma, in which malignant cells infiltrate the peripheral nerves. Most patients are treated with high-dose methotrexate (HD-MTX)-based systemic chemotherapy regimens similar to patients with central nervous system lymphoma. However, because NL is rare, the efficacy of HD-MTX is largely unknown. We reviewed medical records of patients diagnosed with NL over the past 10 years and identified 18 patients. The underlying hematological malignancy was diffuse large B-cell lymphoma (DLBCL) in 10 patients (55.6%), intravascular large B-cell lymphoma in six (33.3%), and other types in two patients. Ten patients were treated with HD-MTX-based systemic chemotherapy; the response rates with and without HD-MTX-based chemotherapy were 100% (n = 10) and 85.7% (n = 6), respectively (P = 0.41). The median progression-free and overall survival rates of patients with versus without HD-MTX treatment were 6.4 vs. 8.5 months (P = 0.97) and 13.5 vs. 8.5 months (P = 0.63), respectively. Despite the initial favorable responses, rapid disease recurrence was observed in most patients administered HD-MTX-based chemotherapy. Our observations suggest that HD-MTX-based chemotherapy may have insufficient efficacy against NL, and that other therapeutic approaches are required to improve the outcomes of patients with this rare disease.
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Affiliation(s)
- Hiroki Kobayashi
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan.
| | - Yoshiaki Abe
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan
| | - Daisuke Miura
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan
| | - Kentaro Narita
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan
| | - Akihiro Kitadate
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan
| | - Masami Takeuchi
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan
| | - Kosei Matsue
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa, Chiba, 296-8602, Japan
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17
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Suzuki Y, Sakakibara A, Shimada K, Shimada S, Ishikawa E, Nakamura S, Kato S, Takahara T, Asano N, Satou A, Kohno K. Immune evasion-related extranodal large B-cell lymphoma: A report of six patients with neoplastic PD-L1-positive extranodal diffuse large B-cell lymphoma. Pathol Int 2019; 69:13-20. [PMID: 30601579 DOI: 10.1111/pin.12742] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/22/2018] [Indexed: 01/12/2023]
Abstract
We identified six patients with Epstein-Barr virus (EBV)-negative extranodal diffuse large B-cell lymphoma (DLBCL) and immunohistochemical expression of PD-L1 on their tumor cells by examining 283 DLBCL cases with the PD-L1 SP142 clone between 2015 and 2017. They consisted of two men and four women with a median age of 71 years, and were examined in an autopsy (n = 1) and biopsies from the adrenal gland (n = 2), skin (n = 1), pelvic cavity (n = 1), and kidney (n = 1). All showed a monomorphic population of large transformed B-cells leading to diagnoses of DLBCL with two intravascular large B-cell lymphoma (IVLBCL) and one de novo CD5+ type and were featured by an invariable immunephenotype: CD3-, CD20+, BCL-2+, and MUM1+. In addition, CD5 and CD10 were each detected in one case. All cases expressed PD-L1 on >10% to >90% of tumor cells, which was confirmed with two other PD-L1 antibodies (E1J2J and 28-8). Three untreated patients had a rapid, lethal clinical course within 7 months after diagnosis; while, the remaining three achieved complete remission after treatment and were alive at the last follow-up. We suggest immune evasion-related extranodal large B-cell lymphoma should be recognized beyond the currently identified entities of IVLBCL and de novo CD5+ DLBCL.
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Affiliation(s)
- Yuka Suzuki
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Ayako Sakakibara
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Kazuyuki Shimada
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoko Shimada
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Eri Ishikawa
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan.,Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Seiichi Kato
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Taishi Takahara
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan
| | - Naoko Asano
- Department of Clinical Laboratory, Nagano Prefectural Shinshu Medical Center, Suzaka, Japan
| | - Akira Satou
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan
| | - Kei Kohno
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
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18
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Abe Y, Usui Y, Narita K, Takeuchi M, Matsue K. Concomitant subcutaneous intravascular lymphoma lesions in a patient with cardiac diffuse large B-cell lymphoma: is intravascular lymphoma a distinct clinical entity? Int J Hematol 2018; 108:637-639. [PMID: 30196477 DOI: 10.1007/s12185-018-2532-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 11/25/2022]
Abstract
We describe a patient who presented with large cardiac diffuse large B-cell lymphoma (DLBCL) and adrenal masses. The patient also had subcutaneous intravascular lymphoma lesions which were detected by random skin biopsy. Although ambiguous, minimal extravascular location of lymphoma cells is permitted for the diagnosis of intravascular large B-cell lymphoma (IVLBCL) in the WHO definition, a number of rare cases have been reported as having concomitant tumours in other organs, such as the adrenal gland, brain, and penis. We assume that IVLBCL might be a peculiar feature of DLBCL characterised by preferential localisation of lymphoma cells within the capillaries rather than a distinct disease entity of DLBCL.
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Affiliation(s)
- Yoshiaki Abe
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa-shi, Chiba, 296-8602, Japan
| | - Yoshiaki Usui
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa-shi, Chiba, 296-8602, Japan
| | - Kentaro Narita
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa-shi, Chiba, 296-8602, Japan
| | - Masami Takeuchi
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa-shi, Chiba, 296-8602, Japan
| | - Kosei Matsue
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa-shi, Chiba, 296-8602, Japan.
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19
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Intravascular large B-cell lymphoma: a chameleon with multiple faces and many masks. Blood 2018; 132:1561-1567. [DOI: 10.1182/blood-2017-04-737445] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 08/01/2018] [Indexed: 12/20/2022] Open
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20
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Kobayashi M, Sakai Y, Kariya Y, Sakai H, Hineno A, Oyanagi K, Kanno H. First pathological report of a de novo CD5-positive diffuse large B-cell lymphoma patient presenting with Guillain-Barré syndrome-like neuropathy due to neurolymphomatosis. Neuropathology 2018; 38:417-421. [PMID: 29718563 DOI: 10.1111/neup.12470] [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: 12/13/2017] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 02/02/2023]
Abstract
Peripheral neuropathy occurs in approximately 5% of the patients with lymphoma. Two major causes of peripheral neuropathy associated with lymphoma are neurolymphomatosis and paraneoplastic neuropathy such as demyelinating neuropathy. The differential diagnosis between neurolymphomatosis and demyelinating neuropathy is difficult, because electrophysiological findings suggestive of demyelination are frequently observed even in patients with neurolymphomatosis. Here, we report a patient with de novo CD5-positive diffuse large B-cell lymphoma (DLBCL) who presented with Guillain-Barré syndrome (GBS)-like neuropathy. Demyelination due to paraneoplastic neuropathy was clinically suspected. However, autopsy demonstrated that the cause of the neuropathy was neurolymphomatosis. Clinical courses of neurolymphomatosis vary and neurolymphomatosis cases presenting with GBS-like neuropathy are reported. In addition, DLBCL is the most frequent histological type of malignant lymphoma that develops neurolymphomatosis. Furthermore, "CD5-positive" DLBCL may tend to develop neurolymphomatosis. If a patient with "CD5-positive" DLBCL develops peripheral neuropathy, neurolymphomatosis should be considered and imaging studies performed and, if possible, nerve tissue biopsy, regardless of clinical symptoms of the neuropathy. To our knowledge, this is the first report of a patient with de novo CD5-positive DLBCL with neurolymphomatosis who presented with GBS-like neuropathy.
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Affiliation(s)
- Mikiko Kobayashi
- Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yasuhiro Sakai
- Department of Molecular Pathology, Shinshu University Graduate School of Medicine, Matsumoto, Japan
| | - Yuta Kariya
- Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hitoshi Sakai
- Division of Hematology, Department of Internal Medicine, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akiyo Hineno
- Department of Medicine (Neurology and Rheumatology), Shinshu University School of Medicine, Matsumoto, Japan
- Intractable Disease Care Center, Shinshu University Hospital, Matsumoto, Japan
| | - Kiyomitsu Oyanagi
- Division of Neuropathology, Department of Brain Disease Research, Shinshu University School of Medicine, Matsumoto, Japan
- Brain Research Laboratory, Hatsuishi Hospital, Kashiwa, Japan
| | - Hiroyuki Kanno
- Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan
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21
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Sakakibara A, Inagaki Y, Imaoka E, Ishikawa E, Shimada S, Shimada K, Suzuki Y, Nakamura S, Satou A, Kohno K. Autopsy case report of intravascular large B-cell lymphoma with neoplastic PD-L1 expression. J Clin Exp Hematop 2018; 58:32-35. [PMID: 29415979 DOI: 10.3960/jslrt.17037] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare and clinically distinctive entity characterized by the almost exclusive growth of large cells within the lumen of blood vessels in particular capillaries. Reports of this peculiar disease, do not commonly address the PD-L1 expression on IVLBCL tumor cells. Here, we describe a 51-year-old Japanese woman who presented with rapidly progressive cognitive decline and higher brain dysfunction. CT scan and MRI revealed multiple ischemic foci in the cerebral hemispheres, ground-glass opacity in the lungs, and splenomegaly. Random skin biopsy for IVLBCL diagnosis yielded negative results. The patient experienced a rapidly deteriorating clinical course with no treatment, and died from the disease after 3 months of hospitalization. Post-mortem examination revealed systemic intravascular plugging of lymphoma cells, without mass lesions in the central nervous system or in visceral organs such as the lungs, liver, pituitary gland, ovaries, and uterus. The tumor cells were positive for CD10, CD20, BCL2, BCL6, and MUM1, but not other lineage-specific markers. Notably, the tumor cells showed strong PD-L1 expression. Our case was diagnosed as IVLBCL with neoplastic PD-L1 expression. These findings suggest that PD-L1 is associated with immune evasion of IVLBCL and may play a role in the pathogenesis and peculiar biological behavior of this unique disease. Additionally, PD-L1 may represent a possible therapeutic target for immune check-point inhibitors.
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Affiliation(s)
- Ayako Sakakibara
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital
| | | | - Eiki Imaoka
- Department of Neurosurgery, Anjo Kosei Hospital
| | - Eri Ishikawa
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital
| | - Satoko Shimada
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital
| | - Kazuyuki Shimada
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine
| | - Yuka Suzuki
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital
| | - Akira Satou
- Department of Surgical Pathology, Aichi Medical University Hospital
| | - Kei Kohno
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital
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22
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Park HJ, Shin HY, Kim SH, Jeong HN, Choi YC, Suh BC, Park KD, Kim SM. Partial Conduction Block as an Early Nerve Conduction Finding in Neurolymphomatosis. J Clin Neurol 2018; 14:73-80. [PMID: 29629543 PMCID: PMC5765259 DOI: 10.3988/jcn.2018.14.1.73] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Revised: 09/20/2017] [Accepted: 09/25/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Neurolymphomatosis is a rare manifestation of hematological malignancy and is characterized by direct infiltration of the peripheral nervous system. The objective of this study was to identify the clinical and electrophysiological features of neurolymphomatosis. METHODS We retrospectively analyzed the medical records of 13 patients with neurolymphomatosis. Seven (54%) of the patients were men, and the median age at symptom onset was 60.0 years. RESULTS The most common type of underlying malignancy was diffuse large B-cell lymphoma (69%). Twelve patients had painful asymmetric neuropathies. The median survival time after diagnosis was 7 months, and 12 patients died during the study period. Thirty-eight motor nerve conduction studies (NCSs) were performed in the affected nerves. Ten and 28 motor nerves were classified into the conduction-block and simple-axon-degeneration groups, respectively. The median time interval between symptom onset and the NCS was significantly shorter in the conduction-block group than in the simple-axon-degeneration group (p=0.032). However, no significant differences in the motor nerve conduction velocities, terminal latencies, and distal compound muscle action potential amplitudes were identified between the conduction-block and simple-axon-degeneration groups. The conduction-block group showed excessive temporal dispersion in only five of the ten NCSs (50%). Follow-up NCSs revealed that partial conduction blocks had changed into axonal degeneration patterns. CONCLUSIONS This is the first study to analyze the electrophysiological features of patients with neurolymphomatosis. Our findings showed that a partial conduction block is not rare and is an early nerve conduction abnormality in neurolymphomatosis.
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Affiliation(s)
- Hyung Jun Park
- Department of Neurology, Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Korea.,Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Ha Young Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Se Hoon Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Ha Neul Jeong
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Chul Choi
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Bum Chun Suh
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kee Duk Park
- Department of Neurology, Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Korea.
| | - Seung Min Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
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23
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Abstract
Cancer in the form of solid tumors, leukemia, and lymphoma can infiltrate and metastasize to the peripheral nervous system, including the cranial nerves, nerve roots, cervical, brachial and lumbosacral plexuses, and, rarely, the peripheral nerves. This review discusses the presentation, diagnostic evaluation, and treatment options for metastatic lesions to these components of the peripheral nervous system and is organized based on the anatomic distribution. As skull base metastases (also discussed in Chapter 14) result in cranial neuropathies, these will be covered in detail, as well as cancers that directly infiltrate the cranial nerves. Particular emphasis is placed on the clinical, imaging, and electrodiagnostic features that differentiate neoplastic plexopathies from radiation-induced plexopathies. Neurolymphomatosis, in which malignant lymphocytes invade the cranial nerves, nerve roots, brachial and lumbosacral plexuses, and peripheral nerves, is a rare manifestation of lymphoma and leukemia. Diagnoses of neurolymphomatosis are often missed or delayed given its varied presentations, resulting in poorer outcomes. Thus this disease will also be discussed in depth.
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Affiliation(s)
- Kelly G Gwathmey
- Department of Neurology, University of Virginia, Charlottesville, VA, United States.
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24
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Policeni B, Corey AS, Burns J, Conley DB, Crowley RW, Harvey HB, Hoang J, Hunt CH, Jagadeesan BD, Juliano AF, Kennedy TA, Moonis G, Pannell JS, Patel ND, Perlmutter JS, Rosenow JM, Schroeder JW, Whitehead MT, Cornelius RS. ACR Appropriateness Criteria ® Cranial Neuropathy. J Am Coll Radiol 2017; 14:S406-S420. [DOI: 10.1016/j.jacr.2017.08.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 08/14/2017] [Indexed: 01/09/2023]
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25
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Abstract
Lymphoma involvement of peripheral nerves is rare and it may mimic benign neurogenic tumors or neuropraxic injury. This study presents three patterns of presentations in four patients with neurolymphomatous involvement of their peripheral nerves. We reviewed the clinical records of four patients who underwent exploratory brachial plexus surgery (n = 1), pronator tunnel decompression (n = 1) and peripheral nerve exploration (n = 2) and subsequently found to have neurolymphomatosis (NL). Histological diagnoses were diffuse large B-cell lymphoma (n = 3) and NK/T-cell lymphoma (n = 1). NL lacks pathognomonic clinical and imaging features that aid clinicians in diagnosis. Apart from a history of lymphoma, and high clinical index of suspicion, PET-CT scans appear to be a helpful adjunct in detecting high metabolic lesions occuring in situ or systemically. Intra-operative frozen section is helpful to detect round blue cells, before final cytological diagnosis.
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Affiliation(s)
- Tun-Lin Foo
- 1 Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Ryan Yak
- 1 Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
| | - Mark E Puhaindran
- 1 Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore
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26
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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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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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Groth CL, Nevel KS, Gwathmey KG, Bafakih F, Jones DE. Splenic marginal zone lymphoma: An indolent malignancy leading to the development of neurolymphomatosis. Muscle Nerve 2016; 55:440-444. [PMID: 27625159 DOI: 10.1002/mus.25404] [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] [Accepted: 09/12/2016] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Acute neuropathic pain and weakness with a sensory level in a patient with a history of lymphoma has a broad differential diagnosis. Evaluation of such a presentation often includes MRI, neurophysiologic studies, and cerebrospinal fluid evaluation. We report a patient with splenic marginal zone lymphoma who developed acute weakness, sensory loss, and neuropathic pain due to neurolymphomatosis. METHODS Clinical evaluation, MRI of the lumbar spine, cerebrospinal fluid evaluation, electrodiagnostic (EDx) studies, and biopsy of a dorsal nerve root were undertaken. RESULTS EDx studies were consistent with an acute, acquired demyelinating sensorimotor polyradiculoneuropathy. Treatment with intravenous immunoglobulin and plasma exchange did not lead to clinical improvement. Ultimately, biopsy of a dorsal nerve root was performed and revealed neurolymphomatosis. CONCLUSION This case emphasizes that, when it can be performed safely, biopsy for suspected neurolymphomatosis is imperative for appropriate diagnosis and treatment. Muscle Nerve 55: 440-444, 2017.
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Affiliation(s)
- Christopher L Groth
- Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, Virginia, 22908, USA
| | - Kathryn S Nevel
- Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, Virginia, 22908, USA
| | - Kelly G Gwathmey
- Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, Virginia, 22908, USA
| | - Fahad Bafakih
- Department of Pathology, University of Virginia, Charlottesville, Virginia, USA
| | - David E Jones
- Department of Neurology, University of Virginia, P.O. Box 800394, Charlottesville, Virginia, 22908, USA
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Fonkem E, Dayawansa S, Stroberg E, Lok E, Bricker PC, Kirmani B, Wong ET, Huang JH. Neurological presentations of intravascular lymphoma (IVL): meta-analysis of 654 patients. BMC Neurol 2016; 16:9. [PMID: 26849888 PMCID: PMC4744383 DOI: 10.1186/s12883-015-0509-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 11/27/2015] [Indexed: 11/10/2022] Open
Abstract
Background Patients with intravascular lymphoma (IVL) frequently have neurological signs and symptoms. Prompt diagnosis and treatment is therefore crucial for their survival. However, the spectrum of neurological presentations and their respective frequencies have not been adequately characterized. Our aim is to document the spectrum of clinical symptoms and their respective frequencies and to create a clinical framework for the prompt diagnosis of IVL. Methods A comprehensive meta-analysis of 654 cases of IVL published between 1957 and 2012 was performed to provide better insight into the neurological presentations of this disease. Neurologic complications were mainly divided into central nervous system (CNS) and peripheral nervous system (PNS) presentations. Results There were no differences in occurrences of CNS IVL based on gender or geographic locations (Asian Vs non-Asian). However, most patients with CNS IVL were younger than 70 years of age (p < 0.05). Our limited data do not support the treatment efficacy of methotrexate. CNS symptoms were seen in 42 % of all cases. The most common CNS complications identified were cognitive impairment/dementia (60.9 %), paralysis (22.2 %), and seizures (13.4 %). PNS complications were seen in 9.5 % of cases. Out of these, muscle weakness (59.7 %), neurogenic bladder (37.1 %), and paresthesia (16.1 %) were the most common presentations. Conclusions CNS complications are more common among IVL patients. Out of these, dementia and seizures outnumber stroke-like presentations. Electronic supplementary material The online version of this article (doi:10.1186/s12883-015-0509-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ekokobe Fonkem
- Department of Neurosurgery, Baylor Scott & White Health, Temple, Texas, 76508, USA. .,Department of Neurology, Baylor Scott & White Health, Temple, Texas, 76508, USA.
| | - Samantha Dayawansa
- Department of Neurosurgery, Baylor Scott & White Health, Temple, Texas, 76508, USA.
| | - Edana Stroberg
- Department of Pathology, Baylor Scott & White Health, Temple, Texas, 76508, USA.
| | - Edwin Lok
- Department of Neurology, Brain Tumor Center and Neuro-Oncology Unit, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, Massachusetts, 02215, USA.
| | - Paul C Bricker
- Department of Neurology, Baylor Scott & White Health, Temple, Texas, 76508, USA.
| | - Batool Kirmani
- Department of Neurology, Baylor Scott & White Health, Temple, Texas, 76508, USA.
| | - Eric T Wong
- Department of Neurology, Brain Tumor Center and Neuro-Oncology Unit, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, Massachusetts, 02215, USA.
| | - Jason H Huang
- Department of Neurosurgery, Baylor Scott & White Health, Temple, Texas, 76508, USA.
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Tanaka H, Yoshino K, Sakaida E, Hashimoto S, Takeda Y, Kawajiri C, Takagi T, Nakaseko C. Secondary neurolymphomatosis detected by whole-body diffusion-weighted magnetic resonance imaging: a case report. J Clin Exp Hematop 2014; 53:221-6. [PMID: 24369224 DOI: 10.3960/jslrt.53.221] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Neurolymphomatosis (NL) is a rare clinical entity defined as peripheral nervous system infiltration by lymphoma. The diagnosis is difficult and often elusive. Whole-body diffusion-weighted magnetic resonance imaging (DW MRI) was developed to enhance the detection of vaguely delineated tumors. Here, we describe the case of a 71-year-old male with secondary NL of diffuse large B-cell lymphoma (DLBCL) that was successfully detected by whole-body DW MRI. The patient was diagnosed with DLBCL extending from the ethmoidal sinus to the nasal cavity, orbital cavity, and anterior cranial fossa. Although he was administered R-THP-COP chemotherapy and the tumor remarkably decreased in size, he developed painful paresthesia and weakness in the left upper and bilateral lower extremities during treatment. Because lymphoma cells were detected in his spinal fluid, high-dose methotrexate (MTX) and weekly intrathecal MTX and cytarabine injections were administered. Test results for lymphoma cells in the spinal fluid became negative ; however, the neurological disorders progressed. Whole-body DW MRI was performed as whole-body screening and could localize NL at the left cervical and bilateral lumbar nerve roots. Both cervical spine plain MRI and enhanced computed tomography performed around the same time could not detect the cervical lesion. Our case report suggests that whole-body DW MRI is a useful diagnostic imaging procedure, especially as whole-body screening in facilities where PET/CT is not available.
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Neurolymphomatosis: a case series of clinical manifestations, treatments, and outcomes. J Neurol Sci 2014; 343:144-8. [PMID: 24928074 DOI: 10.1016/j.jns.2014.05.058] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 05/22/2014] [Accepted: 05/26/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Neurolymphomatosis (NL) is a rare clinical entity characterized by infiltration of malignant lymphocytes into the peripheral nervous system. We analyzed the clinicoradiological features, treatments, and outcomes in NL patients. METHODS We identified six patients with NL seen at The University of Texas MD Anderson Cancer Center from 01/2010 to 10/2012. We extracted clinical presentations, imagings, CSF cytology, and electrodiagnostic studies from medical records. One patient had a nerve biopsy. We defined therapy response as clinical improvement of neurological deficits. FINDINGS The mean age at onset was 57.1 years. Most were predominantly men with non-Hodgkin lymphoma. Positron emission tomography (PET) was positive in five patients. Nerve conduction demonstrated mononeuritis multiplex, plexopathy, demyelination, and axonal polyradiculoneuropathy, whereas electromyography was nonspecific. All patients received systemic chemotherapy, four intrathecal chemotherapy, and three intravenous immunoglobulin, plasma exchange or both. One patient who received intravenous immunoglobulin showed mild neurological improvement. Two patients responded, and the median overall survival was 15 months. CONCLUSIONS NL is an increasingly recognized complication of NHL and leukemia. A high clinical suspicion is necessary for correct diagnosis. In the present series, patients with leukemia had mononeuritis multiplex, whereas those with lymphoma had plexopathy. Electrodiagnosis and PET scans were useful diagnostic tools. No factors correlated with poorer prognosis. International collaborative studies will help to better determine the risk factors of NL, response to treatment and outcomes.
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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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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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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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A case of diffuse large B-cell lymphoma with localized femoral nerve palsy. Neurol Sci 2013; 35:103-4. [PMID: 23839568 DOI: 10.1007/s10072-013-1499-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 07/02/2013] [Indexed: 10/26/2022]
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Yamada S, Tanimoto A, Nabeshima A, Tasaki T, Wang KY, Kitada S, Noguchi H, Sasaguri Y. Diffuse large B-cell lymphoma presenting with neurolymphomatosis and intravascular lymphoma: a unique autopsy case with diverse neurological symptoms. Diagn Pathol 2012; 7:94. [PMID: 22888848 PMCID: PMC3449208 DOI: 10.1186/1746-1596-7-94] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 08/05/2012] [Indexed: 11/10/2022] Open
Abstract
A 78-year-old Japanese male noticed a difficulty in the beginning of standing up, followed by 7a progressive numbness of extremities with pain, Bell’s palsy, dysarthria, and difficulty in swallowing. A clinician had suspected cancer of unknown primary origin, accompanied by the diverse and elusive neurological symptoms, likely presenting as painful mononeuropathy simplex and cranial neuropathy. He developed dysbasia over weeks and died 1 month after the symptom onset. At autopsy, an ill-defined large and soft tumor mass in the right lobe of the liver with direct invasion into the right adrenal gland was observed. The left adrenal gland or right iliopsoas muscle was also involved. Microscopic findings showed a monotonous proliferation of medium-sized to large atypical lymphoid cells, which were diffusely positive for CD20 in immunohistochemistry, consistent with diffuse large B-cell lymphoma (DLBL). Furthermore, the lymphoma cells aggressively infiltrated endoneurial and subperineurial spaces not only in the peripheral nerves and plexuses, but partly in the spinal nerve roots, and intravascular spaces in various tissues. Therefore, systemic lymphoma (DLBL) complicated with neurolymphomatosis (NL) and intravascular lymphoma (IVL) was diagnosed. Very early diagnosis and treatment are necessary for the NL patients with poor prognosis.
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Affiliation(s)
- Sohsuke Yamada
- Department of Pathology and Cell Biology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan.
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