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Cao DY, Zhou J, Dernell C, Chaney K, Wanat KA. Red papules associated with progressive functional decline. JAAD Case Rep 2023; 40:23-26. [PMID: 37675064 PMCID: PMC10477733 DOI: 10.1016/j.jdcr.2023.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Affiliation(s)
- David Y. Cao
- School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jessica Zhou
- School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Carl Dernell
- School of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Keri Chaney
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Karolyn A. Wanat
- Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
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2
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Davis JW, Auerbach A, Crothers BA, Lewin E, Lynch DT, Teschan NJ, Schmieg JJ. Intravascular Large B-Cell Lymphoma. Arch Pathol Lab Med 2022; 146:1160-1167. [PMID: 34979566 DOI: 10.5858/arpa.2021-0165-ra] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Intravascular large B-cell lymphoma (IVLBCL) is a rare hematopathologic entity, posing both a clinical and histologic challenge for diagnosis. Numerous pitfalls can hinder making the diagnosis. OBJECTIVE.— To summarize recent developments in literature pertaining to IVLBCL and point out key pitfalls pathologists should be prepared to encounter. DATA SOURCES.— Literature review via PubMed search and hospital (Darnall Medical Library) resources. CONCLUSIONS.— The 3 primary pitfalls of IVLBCL include masking of IVLBCL, mimicry by IVLBCL, and mimicry of IVLBCL. These scenarios illustrate the importance of histologic pattern recognition and subsequent usage of immunohistochemistry, especially in context of a clinical history that may be noncharacteristic.
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Affiliation(s)
- Joshua W Davis
- From Clinical and Anatomic Pathology Residency Program, Walter Reed National Military Medical Center, Bethesda, Maryland (Davis)
| | - Aaron Auerbach
- The Joint Pathology Center, Silver Spring, Maryland (Auerbach, Crothers, Schmieg III)
| | - Barbara A Crothers
- The Joint Pathology Center, Silver Spring, Maryland (Auerbach, Crothers, Schmieg III)
| | - Eleanor Lewin
- the Department of Pathology, Women & Infants Hospital, Providence, Rhode Island (Lewin)
| | - David T Lynch
- and the Department of Pathology, Brooke Army Medical Center, Fort Sam Houston, Texas (Lynch, Teschan)
| | - Nathan J Teschan
- and the Department of Pathology, Brooke Army Medical Center, Fort Sam Houston, Texas (Lynch, Teschan)
| | - John J Schmieg
- The Joint Pathology Center, Silver Spring, Maryland (Auerbach, Crothers, Schmieg III)
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3
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Rozenbaum D, Tung J, Xue Y, Hoang MP, Kroshinsky D. Skin biopsy in the diagnosis of intravascular lymphoma: A retrospective diagnostic accuracy study. J Am Acad Dermatol 2021; 85:665-670. [PMID: 31541748 DOI: 10.1016/j.jaad.2019.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 08/26/2019] [Accepted: 09/09/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The yield of skin biopsies in the evaluation of intravascular lymphoma (IVL) is largely unknown in Western patients. Most data supporting this test come from Asian populations, in which both prevalence and disease presentation seem to differ. OBJECTIVE To determine the yield and diagnostic properties of skin biopsy in the evaluation of IVL. METHODS We reviewed skin biopsy pathology reports of 50 patients being evaluated for IVL to calculate the diagnostic yield of this test. An additional 6 patients, who underwent skin biopsies after the diagnosis of IVL was made by other means, were included to calculate the sensitivity and specificity of our index test. RESULTS Skin biopsy samples were positive for 5 of the 50 patients being investigated for IVL. Sensitivity was 50% and specificity was 100%. LIMITATIONS Only pathology reports containing IVL as an indication for the biopsy were retrieved. This might have excluded patients in whom the disease was considered but was not deemed likely enough to be listed as the indication for the test, inflating our estimative of skin biopsy yield. CONCLUSION A relatively high diagnostic yield was found in the evaluation of IVL among patients with a diverse presentation in a Western hospital.
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Affiliation(s)
| | - Joe Tung
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Yun Xue
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Mai P Hoang
- Harvard Medical School, Boston, Massachusetts; Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniela Kroshinsky
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.
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4
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A poisoned cherry: Migratory cutaneous intravascular large B-cell lymphoma with subsequent systemic nodal lymphoma. JAAD Case Rep 2020; 6:1336-1338. [PMID: 33299917 PMCID: PMC7701892 DOI: 10.1016/j.jdcr.2020.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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5
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Liu Y, Ma Y, Zhou H, Zhou X, Shao J. Analysis of clinicopathological features and prognostic factors of non-Hodgkin's intravascular large B-cell lymphoma. Oncol Lett 2020; 20:43. [PMID: 32802165 DOI: 10.3892/ol.2020.11908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 05/07/2020] [Indexed: 12/14/2022] Open
Abstract
Non-Hodgkin's intravascular large B-cell lymphoma is a highly invasive extranodal lymphoma. The proliferating tumor cells invade the small vessels and capillaries of different organs. The clinical symptoms are atypical, there is lack of specificity, and the molecular and biological behaviors are not clear, thus, the present study aimed to improve the current understanding of non-Hodgkin's intravascular large B-cell lymphoma (IVL) and provide an accurate basis for clinical treatment and prognosis, by retrospectively analyzing and summarizing the clinicopathological features, immunohistochemical findings and molecular characteristics of 17 patients with IVL. The Kaplan-Meier method and log rank test were implemented to determine survival outcomes. Fisher's exact test was used to determine the association between clinicopathological features and the expression levels of Ki-67, c-Myc, B-cell lymphoma 6 (Bcl-6) and B-cell lymphoma 2 (Bcl-2), while multivariate Cox regression analysis was performed to identify the independent risk factors that affect the survival rates of patients with IVL. P<0.05 was considered to indicate a statistically significant difference. Among the 17 patients with IVL, 13 cases (76.47%) occurred in the adrenal gland and four cases (23.53%) occurred on the skin demonstrated positive IgH gene rearrangement. FISH analysis indicated that cleavage of the c-Myc gene was closely associated with sex, hypertension status and tumor size, while cleavage of the Bcl-6 gene was closely associated with tumor size parameters. Overall, the results suggest that the Ki-67 proliferation index is an independent risk factor for the prognosis (survival time) of patients with IVL.
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Affiliation(s)
- Ying Liu
- Department of Oncology, Pathology and Dermatology, Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
| | - Yue Ma
- Department of Urology, Mianyang Central Hospital, Mianyang, Sichuan 621000, P.R. China
| | - Huihui Zhou
- Department of Oncology, Pathology and Dermatology, Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
| | - Xiuzhi Zhou
- School of Basic Medical Sciences, Binzhou Medical University, Yantai, Shandong 264003, P.R. China
| | - Juan Shao
- Department of Oncology, Pathology and Dermatology, Yantai Yuhuangding Hospital of Qingdao University, Yantai, Shandong 264000, P.R. China
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6
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7
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Intravascular Colonization of Kaposi Sarcoma: Expanding the Spectrum of Specific Infiltrates of B-Cell Chronic Lymphocytic Leukemia. Am J Dermatopathol 2019; 41:940-944. [PMID: 31268930 DOI: 10.1097/dad.0000000000001481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
B-cell chronic lymphocytic leukemia (CLL), a low-grade malignancy consisting of CD5(+), CD23(+), and CD43(+) small B lymphocytes, is the most frequent leukemia in the western world. Patients with CLL may exhibit skin changes characterized by histopathologic evidence of infiltration by atypical B lymphocytes, also known as "specific cutaneous infiltrates of CLL"; in addition, CLL is known to be associated with an increased risk of second cancers, including Kaposi sarcoma (KS). The combination of KS and CLL within the same cutaneous biopsy specimen has only rarely been described. We report a peculiar case of KS occurring in a patient with CLL, in which histopathological evaluation of KS lesions revealed prominent accumulation of CLL lymphocytes within neoplastic vascular spaces. We believe that our findings represent a novel example of intravascular colonization of vascular neoplasms by neoplastic lymphoid cells, further expanding the evergrowing spectrum of specific cutaneous infiltrates of CLL.
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8
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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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9
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Hope CB, Pincus LB. Primary cutaneous B-cell lymphomas with large cell predominance-primary cutaneous follicle center lymphoma, diffuse large B-cell lymphoma, leg type and intravascular large B-cell lymphoma. Semin Diagn Pathol 2016; 34:85-98. [PMID: 28065463 DOI: 10.1053/j.semdp.2016.11.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In this review, we present clinical features and detailed histopathologic, immunologic, and molecular information regarding primary cutaneous follicle center lymphoma and primary cutaneous diffuse large B-cell lymphoma, leg type which together represent two of the three most common types of primary cutaneous B-cell lymphoma recognized in the current WHO classification system.1,2 Overall, B-cell lymphomas represent 19-27% of primary cutaneous lymphomas in most large European and American studies3-6 and together, primary cutaneous follicle center lymphoma and primary cutaneous diffuse large B-cell lymphoma, leg type account for approximately 2/3 to ¾ of these cases.5,7-11 Both subtypes can contain a high content of large B-lymphocytes, although most cases of primary cutaneous follicle center lymphomas exhibit a range in cell size and cytology. Intravascular large B-cell lymphoma, a less commonly-encountered EBV-negative primary cutaneous B-cell lymphoma composed of large cells, will be more briefly discussed in this report as well.
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Affiliation(s)
- Charity B Hope
- Department of Pathology, University of California San Francisco, USA
| | - Laura B Pincus
- Department of Pathology, University of California San Francisco, USA; Department of Dermatology, University of California San Francisco, USA.
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10
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Ishida M, Hodohara K, Yoshida T, Okabe H. Intravascular large B-cell lymphoma colonizing in senile hemangioma: a case report and proposal of possible diagnostic strategy for intravascular lymphoma. Pathol Int 2011; 61:555-7. [DOI: 10.1111/j.1440-1827.2011.02697.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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11
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Ishida M, Hotta M, Hodohara K, Okabe H. A case of intravascular large B-cell lymphoma colonizing in senile hemangioma. J Cutan Pathol 2010; 38:251-3. [DOI: 10.1111/j.1600-0560.2010.01633.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Wahie S, Dayala S, Husain A, Summerfield G, Hervey V, Langtry JAA. Cutaneous features of intravascular lymphoma. Clin Exp Dermatol 2010; 36:288-91. [DOI: 10.1111/j.1365-2230.2010.03934.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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13
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Ardighieri L, Lonardi S, Vermi W, Medicina D, Cerroni L, Facchetti F. Intralymphatic atypical T-cell proliferation in a cutaneous hemangioma. J Cutan Pathol 2010; 37:497-503. [DOI: 10.1111/j.1600-0560.2009.01327.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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[Intravascular lymphoma revealed by generalized arborescent telangiectasia and repeated venous thrombosis]. Ann Dermatol Venereol 2008; 135:397-401. [PMID: 18457728 DOI: 10.1016/j.annder.2007.11.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Accepted: 11/09/2007] [Indexed: 11/21/2022]
Abstract
BACKGROUND Intravascular lymphoma is a rare form of non-Hodgkin's lymphoma characterized by proliferation of lymphoid cells within the lumen of small veins, small arteries and capillaries. CASE REPORT A 79-year-old man presented with repeated superficial venous thrombosis of the lower limbs associated with diffuse telangiectasia of the trunk, upper arms and thighs but with normal epidermis. Screening for thrombophilia and neoplasm were negative. The patient subsequently developed abdominal pain, lower-limb oedema, deterioration in performance status and rapidly increasing telangiectasia with the appearance of generalized oedematous cutaneous induration. Increased LDH and anaemia were observed without other blood count anomalies. Intravascular lymphoma was diagnosed on a skin biopsy with telangiectasia and oedema. After eight courses of treatment with rituximab-CHOP the outcome was good. DISCUSSION A few telangiectasias associated with nodules or infiltrated plaques are often a clinical manifestation of intravascular lymphoma. The dermatological presentation described here is interesting for two reasons: on the one hand, telangiectasias were initially isolated in normal epidermis without any infiltration for more than one year and, on the other hand, the skin infiltration seen subsequently was very extensive and marked. Moreover, although microthrombi are frequent in small and medium-sized blood vessels, thrombosis of large vessels is rarely described in intravascular lymphoma.
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Satzger I, Völker B, Kofahl-Krause D, Ganser A, Kapp A, Gutzmer R. [Intravascular lymphoma: two case reports demonstrating the heterogeneity of the disease]. Hautarzt 2008; 60:131-6. [PMID: 18654750 DOI: 10.1007/s00105-008-1583-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Intravascular lymphoma (IVL) is a rare subtype of extranodal large-B-cell lymphoma, histologically characterized by accumulation of clonal lymphocytes in small vessels of different organs. Overall survival is usually poor. The clinical manifestations are highly variable, depending on the involved organs. Cutaneous and neurological involvement is frequent; the cutaneous symptoms are heterogeneous with erythema, erythematous papules and plaques, generalized telangiectases and lesions resembling panniculitis or Kaposi sarcoma. IVL may also be limited to the skin; this entity is included the current classifications. We present here two patients with two different variants of IVL. One showed only skin involvement with panniculitis-like induration and responded well to therapy with Rituximab-CHOP (Rituximab plus Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone). The other patient had distinctive cutaneous and neurological symptoms which did not respond to therapy. By means of these two patients, we present the heterogeneity of IVL and discuss current aspects of diagnosis and treatment.
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Affiliation(s)
- I Satzger
- Klinik und Poliklinik für Dermatologie und Venerologie, Medizinische Hochschule Hannover, Hauttumorzentrum Hannover (HTZH), Ricklinger Strasse 5, Hannover, Germany.
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16
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Pallure V, Dandurand M, Stoebner PE, Habib F, Colonna G, Meunier L. [Intravascular B-cell lymphoma with febrile inflammatory lymphoedema of the lower limbs and lower back]. Ann Dermatol Venereol 2008; 135:299-303. [PMID: 18420078 DOI: 10.1016/j.annder.2007.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Accepted: 07/20/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Intravascular lymphomas are diffuse large-cell lymphomas belonging to a group of high-grade non-Hodgkin's lymphomas and are generally of phenotype B. They are rare and carry a severe prognosis. Clinical polymorphism is dominated by neurological and cutaneous involvement. PATIENTS AND METHODS We report the case of an 80-year-old woman with cutaneous intravascular B-cell lymphoma as revealed by an isolated episode of febrile bilateral inflammatory lymphoedema. Following combined chemotherapy with rituximab and mini-CHOP (cyclophosphamide, adriamycin, oncovin and prednisone), complete remission was obtained rapidly, with no relapse at two years. DISCUSSION Diagnosis of these tumours is rendered difficult by the clinical polymorphism and multifocal nature of lymphocytic proliferations. In the present case, diagnosis was based on histology results since presentation of the disease in the form of bilateral inflammatory oedema of the lower limbs is not sufficient to establish lymphoma. Combined rituximab and polychemotherapy comprising a CHOP regimen appears to yield the best results.
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Affiliation(s)
- V Pallure
- Service de dermatologie, groupe hospitalo-universitaire Carémeau, rue du Professeur-Robert-Debré, 30900 Nîmes, France
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Shimizu I, Ichikawa N, Yotsumoto M, Sumi M, Ueno M, Kobayashi H. Asian variant of intravascular lymphoma: aspects of diagnosis and the role of rituximab. Intern Med 2007; 46:1381-6. [PMID: 17827836 DOI: 10.2169/internalmedicine.46.0066] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The Asian variant of intravascular lymphoma (AIVL) is a rare non-Hodgkin's lymphoma, characterized by hemophagocytic syndrome and the absence of neurological abnormality or skin lesions, which are typical features of classical IVL. The purpose of this study was to describe the characteristics and outcomes of AIVL patients. PATIENTS AND METHODS We conducted a retrospective chart review of AIVL patients who were admitted to our institution between January 1999 and December 2006. RESULTS Eight patients met the criteria. All patients presented with typical clinical features, including fever, hepatosplenomegaly, and cytopenia. The median time from onset to diagnosis was 4 weeks (range 2-12). Pathological diagnoses were made by bone marrow biopsy in three patients, transjugular liver biopsy in two patients, splenectomy in two patients, and percutaneous liver biopsy in one patient. All patients were treated with CHOP-like chemotherapy and rituximab was administered in five patients. Six patients achieved complete response, one achieved partial response, and two patients had central nervous system (CNS) relapse. Among the five patients treated with rituximab, four are still alive, with a median follow-up of 28 months. CONCLUSION A CHOP-like regimen with rituximab may be effective for AIVL cases, but, as in classical IVL, CNS prophylaxis should be considered.
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MESH Headings
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Agents/therapeutic use
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Asian People
- Central Nervous System Neoplasms/drug therapy
- Central Nervous System Neoplasms/secondary
- Cyclophosphamide/therapeutic use
- Doxorubicin/therapeutic use
- Female
- Humans
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Prednisolone/therapeutic use
- Retrospective Studies
- Rituximab
- Vascular Neoplasms/diagnosis
- Vascular Neoplasms/drug therapy
- Vascular Neoplasms/pathology
- Vincristine/therapeutic use
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Affiliation(s)
- Ikuo Shimizu
- Department of Hematology, Nagano Red Cross Hospital.
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18
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Abstract
PURPOSE OF REVIEW There has been confusion and debate regarding the definition, terminology, and optimal treatment of the different types of primary cutaneous B-cell lymphomas. This review presents the new World Health Organization-European Organization for the Research and Treatment of Cancer classification for cutaneous lymphomas; describes clinicopathologic, immunophenotypic, and genetic features of the different types of cutaneous B-cell lymphomas in this classification; and discusses current views on treatment of these lymphomas. RECENT FINDINGS The three main types of cutaneous B-cell lymphomas in this new classification are primary cutaneous marginal zone B-cell lymphoma, primary cutaneous follicle center lymphoma, and primary cutaneous large B-cell lymphoma (leg type). Primary cutaneous marginal zone B-cell and primary cutaneous follicle center lymphoma are indolent types with an excellent prognosis that should be treated primarily with nonaggressive therapies. Primary cutaneous large B-cell lymphoma (leg type) is an aggressive lymphoma that should be treated primarily with aggressive chemotherapy. SUMMARY The World Health Organization-European Organization for the Research and Treatment of Cancer classification will contribute to uniform diagnosis, management, and treatment of patients with cutaneous B-cell lymphoma and will prevent patients with indolent types of the disease from being treated inappropriately with systemic chemotherapy.
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Affiliation(s)
- Rein Willemze
- Leiden University Medical Center, Department of Dermatology, Leiden, The Netherlands.
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Ponzoni M, Ferreri AJM. Intravascular lymphoma: a neoplasm of 'homeless' lymphocytes? Hematol Oncol 2006; 24:105-12. [PMID: 16721900 DOI: 10.1002/hon.776] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Intravascular lymphoma (IVL) is an extremely rare form of non-Hodgkin lymphoma characterized by almost exclusive growth of neoplastic lymphocytes within blood vessel lumen. IVL is morphologically characterized in most instances by large cells with B-cell lineage. IVL is an aggressive and usually disseminated disease that predominantly affects elderly patients, resulting in poor PS, B-symptoms, anemia, and high lactate dehydrogenase serum level. The brain and skin are the most commonly involved sites; nodal disease is rare. Survival after conventional chemotherapy is disappointing, with a relevant impact of diagnostic delay and lethal complications. Notwithstanding these results, IVL limited to the skin (cutaneous variant) is a favorable presentation with distinctive clinical characteristics. Moreover, differences in clinical presentation with Eastern Countries IVL cases, mostly associated with hemophagocytic syndrome, do exist. Intensive combinations containing drugs with higher central nervous system bioavailability are needed in cases with brain involvement; the role of high-dose chemotherapy with autologous stem cell transplantation should be investigated in younger patients with unfavorable features. The present review will discuss the most recent acquisitions related either to diagnosis and immunophenotypic/biologic characteristics as well as clinical/therapeutic issues of IVL.
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Affiliation(s)
- Maurilio Ponzoni
- Pathology Unit, San Raffaele H Scientific Institute, Milan, Italy.
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Abstract
Intravascular lymphoma (IVL) is a rare subtype of extranodal diffuse large B-cell lymphoma with a distinct presentation. Anatomically the disease is characterized by the proliferation of clonal lymphocytes within small vessels with relative sparing of the surrounding tissue. The clinical symptoms of the disease are dependent on the specific organ involvement, which most often includes the central nervous system and skin. Because of the various modes of presentation and the rarity of IVL, the diagnosis is often made postmortem. The diagnosis is almost exclusively made by surgical biopsy of a suspected site of involvement. Advances in imaging and immunohistochemistry have led to increasing antemortem diagnosis of this lymphoma. Although some patients with this disease may be curable with aggressive therapy, further research into novel treatment strategies is needed to improve outcome. Some potential insights into future therapies may be drawn from the small amount of basic science literature relevant to this entity. This review provides a concise, up-to-date summary of IVL.
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Affiliation(s)
- Dan Zuckerman
- Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
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21
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Kuo TT, Chen MJ, Kuo MC. Cutaneous Intravascular NK-cell Lymphoma: Report of a Rare Variant Associated With Epstein-Barr Virus. Am J Surg Pathol 2006; 30:1197-201. [PMID: 16931967 DOI: 10.1097/01.pas.0000213263.99973.09] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Intravascular lymphoma (IVL) is a rare variant of non-Hodgkin lymphoma with a predilection for skin and brain. Except a few cases of T-cell lineage, most of the reported cases were large B-cell lymphomas. We encountered a case of cutaneous IVL in a 71-year-old woman presenting with multiple erythematous patches and nodules on her trunk and extremities. The intravascular large cells showed an immunophenotype of CD3epsilon(+);, CD5(-), CD20(-), CD30(-), CD56(+), and TIA-1(+). The lymphoma cells were also positive for Epstein-Barr virus by Epstein-Barr virus-encoded RNA in situ hybridization test and the T-cell receptor gene was germline. This IVL differs from nasal type NK/T-cell lymphoma only by its intravascular nature. Only 3 cases of intravascular NK-cell lymphoma have been reported before. Because this variant is extremely rare, our case is documented and compared with the 3 previously reported cases.
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Affiliation(s)
- Tseng-tong Kuo
- Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kwei San, Taoyuan, Taiwan.
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