[Intravascular large B cell lymphoma: a case series of three patients and update]

Renal Intravascular Large B-cell Lymphoma: A Case Report and Review of the Literature

We herein report the case of a 52-year-old woman who consulted us because of a 2-month history of a fever, anorexia and weight loss. A physical examination was unremarkable. The blood count showed mild anemia and lymphopenia, and lactate dehydrogenase was elevated. Creatinine clearance was normal and proteinuria was undetectable. CT showed enlarged kidneys. A bone marrow biopsy was normal. PET-CT showed an intense uptake of ¹⁸fluorodeoxyglucose in both kidneys. A kidney biopsy provided the diagnosis of intravascular large B-cell lymphoma (IVLBCL). Kidney-limited IVLBCL without an impairment in the renal function or proteinuria has not been described. We analyzed the 38 published cases of IVLBCL involving the kidney to describe the main features of this entity.

[Macrophage activation syndrome as the presenting manifestation of intravascular lymphoma]

INTRODUCTION

Intravascular large B cell lymphoma is a neoplastic cell proliferation leading to the occlusion of the lumen of small vessels. This is a rare haematological malignancy, which is difficult to diagnose because of a heterogeneous clinical presentation.

CASE REPORT

We report a 62-year-old man who presented a macrophage activation syndrome as the presenting manifestation of an intravascular lymphoma. This association is frequently marked by a greater severity and clinical care requires an early and appropriate treatment.

CONCLUSION

Due to the polymorphism and the systemic presentation of intravascular large B cell lymphoma, the internist may be confronted with this disease, which is considered to be more severe if associated with a macrophage activation syndrome. Awareness of the intravascular large B cell lymphoma is important because the prognosis depends on the rapidity of the initiation of chemotherapy associated with rituximab.

[Lymphoma and arteries: peri- or intravascular?]

PURPOSE

Lymphoma is a polymorphous disease that does not spare arteries. Arterial involvement may be perivascular or intravascular, with different prognostic and therapeutic implications.

PATIENTS AND METHODS

We present here one case of perivascular lymphoma and another case of intravascular lymphoma in order to highlight the specific features of each type.

RESULTS

The first patient was a woman who presented a pseudo-aneurysmal anterior iliac artery due to a non-Hodgkin lymphoma with subsequent bilateral pyelocalyceal distension. The second patient was a man who developed intravascular lymphomatosis expressed by an aneurysm of the common femoral then the primitive iliac artery.

CONCLUSION

The distinction between perivascular and intravascular arterial involvement is based on a range of features and is essential for an optimal care of patients with lymphoma.