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Han Y, Li Q, Wang D, Peng L, Huang T, Ou C, Yang K, Wang J. Case Report: Intravascular Large B-Cell Lymphoma: A Clinicopathologic Study of Four Cases With Review of Additional 331 Cases in the Literature. Front Oncol 2022; 12:883141. [PMID: 35646671 PMCID: PMC9135977 DOI: 10.3389/fonc.2022.883141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare and highly malignant non-Hodgkin B-cell lymphoma with uncommon clinical presentation and poor prognosis. The diagnostic pitfall of IVLBCL is mainly due to the fact that subtle histological changes could be easily overlooked, in addition to its rare occurrence, non-specific and variable clinical presentations, and the absence of significant mass lesions. The purpose of this study is to further explore the clinicopathologic and molecular features of IVLBCL to ensure an accurate diagnosis of this entity. Here, we retrospectively present the data of the four new cases and the literature cases. The age ranged from 23 to 92, with a medium age of 67 and a male-to-female ratio of 1:1. The clinical manifestations are extremely variable, including fever, night sweats, weight loss, anemia, thrombocytopenia, unexplained hypoxemia, impaired consciousness, and skin lesions, as well as the extremely low levels of serum albumin, high levels of serum lactate dehydrogenase (LDH), soluble interleukin-2 receptor (sIL2R), and ferritin. Morphologically, 99.9% of cases showed a selective growth pattern with large, atypical lymphocytes within the lumen of small blood vessels. In addition, vast majority of cases were positive for CD20, CD79a, PAX5, MUM1, and BCL6, and a subset of cases expressed BCL2 and CD5, whereas CD3 and CD10 were typically negative. Ki-67 proliferative index ranged from 20% to 100%. To sum up, we have conducted comprehensive case reports, to the best of our knowledge, this is the largest reported cohort of IVLBCL cases. Comprehensive assessments and more IVLBCL cases are required for early diagnosis and prompt treatment.
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Affiliation(s)
- Yingying Han
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
- Department of Pathology, School of Basic Medicine, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Qingjiao Li
- Department of Pathology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Dan Wang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
- Department of Pathology, School of Basic Medicine, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lushan Peng
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
- Department of Pathology, School of Basic Medicine, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Tao Huang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
- Department of Pathology, School of Basic Medicine, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Chunlin Ou
- Department of Pathology, School of Basic Medicine, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Keda Yang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
- Department of Pathology, School of Basic Medicine, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Junpu Wang, ; Keda Yang,
| | - Junpu Wang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
- Department of Pathology, School of Basic Medicine, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Junpu Wang, ; Keda Yang,
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Manesh M, Henry R, Gallagher S, Greas M, Sheikh MR, Zielsdorf S. Hodgkin lymphoma masquerading as perforated gallbladder adenocarcinoma: A case report. World J Gastrointest Surg 2021; 13:1279-1284. [PMID: 34754395 PMCID: PMC8554726 DOI: 10.4240/wjgs.v13.i10.1279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/24/2021] [Accepted: 08/30/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are several case reports of acute cholecystitis as the initial presentation of lymphoma of the gallbladder; all reports describe non-Hodgkin lymphoma or its subtypes on histopathology of the gallbladder tissue itself. Interestingly, there is no description in the literature of Hodgkin lymphoma causing hilar lymphadenopathy, inevitably presenting as ruptured cholecystitis with imaging mimicking gallbladder adenocarcinoma.
CASE SUMMARY A 48-year-old man with a past medical history of diabetes mellitus presented with progressive abdominal pain, jaundice, night sweats, weakness, and unintended weight loss for one month. Work-up revealed a mass in the region of the porta hepatis causing obstructions of the cystic and common hepatic ducts, gallbladder rupture, as well as retroperitoneal lymphadenopathy. The clinical picture and imaging findings were suspicious for locally advanced gallbladder adenocarcinoma causing ruptured cholecystitis and cholangitis, with metastases to retroperitoneal lymph nodes. Minimally invasive techniques, including endoscopic duct brushings and percutaneous lymph node biopsy, were inadequate for tissue diagnosis. Therefore, this case required exploratory laparotomy, open cholecystectomy, and periaortic lymph node dissection for histopathological assessment and definitive diagnosis. Hodgkin lymphoma was present in the lymph nodes while the gallbladder specimen had no evidence of malignancy.
CONCLUSION This clinical scenario highlights the importance of histopathological assessment in diagnosing gallbladder malignancy in a patient with gallbladder perforation and a grossly positive positron emission tomography/computed tomography scan. For both gallbladder adenocarcinoma and Hodgkin lymphoma, medical and surgical therapies must be tailored to the specific disease entity in order to achieve optimal long-term survival rates.
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Affiliation(s)
- Michelle Manesh
- Department of Surgery, University of Southern California, Los Angeles, CA 90033, United States
| | - Reynold Henry
- Department of Surgery, University of Southern California, Los Angeles, CA 90033, United States
| | - Shea Gallagher
- Department of Surgery, University of Southern California, Los Angeles, CA 90033, United States
| | - Michael Greas
- Department of Pathology, University of Southern California, Los Angeles, CA 90033, United States
| | - Mohd Raashid Sheikh
- Department of Surgery, University of Southern California, Los Angeles, CA 90033, United States
| | - Shannon Zielsdorf
- Department of Surgery, University of Southern California, Los Angeles, CA 90033, United States
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Kusunoki R, Fujishiro H, Yoshimura M, Sawada K, Suemitsu S, Kataoka M, Fujiwara A, Tsukano K, Kotani S, Yamanouchi S, Tanaka M, Miyaoka Y, Miyake T, Kohge N, Imaoka T, Ohnuma H, Ishihara S, Kinoshita Y. Intravascular Large B-cell Lymphoma Mimicking Hepatobiliary Infection: A Case Report and Literature Review. Intern Med 2019; 58:1885-1889. [PMID: 31257276 PMCID: PMC6663525 DOI: 10.2169/internalmedicine.1995-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) frequently involves the hepatobiliary system, but its clinical course and pathophysiology are still not fully known. We herein describe a case of IVLBCL mimicking acute hepatobiliary infection. An 85-year-old woman was admitted because of fever and epigastric pain, and she was diagnosed to have acute acalculous cholecystitis based on gallbladder wall thickening with fluid collection. The gallbladder swelling regressed within several days, and areas of intrahepatic hypoperfusion appeared. Inflammation continued despite treatment with antibiotics, and she died within 21 days. An autopsy examination revealed IVLBCL. IVLBCL can present as acute cholecystitis with an improvement in the imaging findings and the presence of a subsequent liver mass.
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Affiliation(s)
- Ryusaku Kusunoki
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Hirofumi Fujishiro
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Misaki Yoshimura
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Kiyoka Sawada
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Shinsuke Suemitsu
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Masatoshi Kataoka
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Aya Fujiwara
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Kousuke Tsukano
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Satoshi Kotani
- Department of Endoscopy, Shimane Prefectural Central Hospital, Japan
| | - Satoshi Yamanouchi
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Masaki Tanaka
- Department of Endoscopy, Shimane Prefectural Central Hospital, Japan
| | - Youichi Miyaoka
- Department of Endoscopy, Shimane Prefectural Central Hospital, Japan
| | - Tatsuya Miyake
- Department of Hepatology, Shimane Prefectural Central Hospital, Japan
| | - Naruaki Kohge
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Tomonori Imaoka
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Hideyuki Ohnuma
- Department of Pathology, Shimane Prefectural Central Hospital, Japan
| | - Shunji Ishihara
- Department of Internal Medicine 2, Shimane University School of Medicine, Japan
| | - Yoshikazu Kinoshita
- Department of Internal Medicine 2, Shimane University School of Medicine, Japan
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