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Enzan N, Kitadate A, Kono M. Optimizing random skin biopsies: a review of techniques and indications for intravascular large B-cell lymphoma. Int J Hematol 2024; 119:619-625. [PMID: 38564093 PMCID: PMC11136846 DOI: 10.1007/s12185-024-03757-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
Intravascular large B-cell lymphoma (IVLBCL), a rare subtype of malignant lymphoma, is diagnosed by observation of intravascular proliferation of tumor cells in samples taken from affected organs. However, diagnosis of IVLBCL is usually difficult due to the lack of mass formation. IVLBCL may be fatal when the diagnosis is delayed, so an accurate early diagnosis is the key to successful treatment. Random skin biopsy (RSB), in which specimens are sampled from normal-appearing skin, has been reported as useful. However, the specific method of RSB remains controversial, with individual institutions using either the punch method or the incisional method. Research has shown that the incisional method has higher sensitivity than the punch method. We discuss whether this difference might owe to the collection of punch specimens from an insufficient depth and whether the punch method might result in false negatives. For RSB, we recommend taking specimens not only from normal-appearing skin, but also from any lesional skin, because lesions may reflect micro IVLBCL lesions. To ensure accurate diagnosis, both dermatologists and hematologists should know the proper method of RSB. This review summarizes the appropriate biopsy method and sites for RSB.
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Affiliation(s)
- Naoko Enzan
- Department of Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - Akihiro Kitadate
- Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
| | - Michihiro Kono
- Department of Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
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Lv Y, Xu L, Liu X, Wang Y. Random Skin Biopsy for Diagnosis of Intravascular Large B-Cell Lymphoma: A Case Report and Literature Review. Am J Dermatopathol 2023; 45:320-322. [PMID: 36939136 DOI: 10.1097/dad.0000000000002406] [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: 03/21/2023]
Abstract
BACKGROUND Intravascular large B-cell lymphoma (IVLBCL) is a rare, aggressive B-cell lymphoma. The heterogeneity of its clinical symptoms makes it hard to be diagnosed. The diagnosis is followed by pathological examination of affected tissues and organs including skin, central nervous system, and bone marrow. Random skin biopsy (RSB) with high sensitivity and less invasiveness becomes a common method for diagnosis in suspected patients without skin lesions. CASE REPORT We reported the case of a 67-year-old man who complained of fever, dizziness, unsteady gait, numbness in both lower extremities, and incontinence. Blood routine examination suggested elevated levels of lactate dehydrogenase. Enhanced magnetic resonance imaging of the head and thoracolumbosacral spine, next-generation sequencing in blood, cerebrospinal fluid collection, bone marrow aspiration, and positron emission tomography-computed tomography presented no evidence of solid tumors. However, there were intravascular tumor cell growth and morphosis as determined by RSB. CD20, CD79a, CD5, BCL-6, and BCL-2 were positive as tested by immunohistochemistry, and Ki-67 showed high proliferative activity. Taking the medical history as an element, the patient received a diagnosis of IVLBCL. After he completed 3 cycles of RCDOP + orelabrutinib, his general condition improved. CONCLUSION IVLBCL is an aggressive, lethal cancer that is difficult to diagnose; therefore, it is recommended for the suspected patients to receive RSB promptly and early treatment at the earliest opportunity to achieve amelioration in prognosis.
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Affiliation(s)
- Yuanjie Lv
- Department of Infection, Xinchang Hospital of Traditional Chinese Medicine, Shaoxing City, Zhejiang Province, China; and
| | - Lingen Xu
- Intensive Care Unit, Xinchang Hospital of Traditional Chinese Medicine, Shaoxing City, Zhejiang Province, China
| | - Xiaoping Liu
- Department of Infection, Xinchang Hospital of Traditional Chinese Medicine, Shaoxing City, Zhejiang Province, China; and
| | - Yaling Wang
- Intensive Care Unit, Xinchang Hospital of Traditional Chinese Medicine, Shaoxing City, Zhejiang Province, China
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MacGillivary ML, Purdy KS. Recommendations for an Approach to Random Skin Biopsy in the Diagnosis of Intravascular B-Cell Lymphoma. J Cutan Med Surg 2022; 27:44-50. [PMID: 36205174 PMCID: PMC9902969 DOI: 10.1177/12034754221130257] [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: 02/01/2023]
Abstract
Intravascular B-Cell Lymphoma (IVBCL) is a rare type of extranodal large B-cell lymphoma where clonal B-cells selectively home to and replicate in the lumen of small vessels. Random skin biopsy (RSB) of uninvolved skin is a reputable tool to diagnose this protean entity and thus dermatologists are involved in its diagnosis. A literature review was completed to derive an approach to RSB in these patients to maximize diagnostic yield of IVBCL and minimize morbidity. Based on this review, data from 27 patients where clinical signs and symptoms and results of investigations were able to be linked to a positive diagnosis of IVBCL from RSB from 11 papers from 2003 to 2021 were analyzed. Following this analysis, RSB should be considered when there are no clinical skin findings and there is an elevated lactate dehydrogenase in the absence of lymphadenopathy and presence of fever of unknown origin, thrombocytopenia, anemia, and ferritinemia. Three to four RSBs from the thigh, abdomen and/or posterior upper arm should be performed via either incisional or telescoping punch biopsies and should include senile/cherry angioma(s) if present. If RSB results in a diagnosis of IVBCL, hematology should be consulted for further management. Consideration of a false negative biopsy or alternative diagnoses should be explored if RSB is negative for IVBCL. Following a standard approach for RSB in these patients will increase diagnostic yield of IVBCL while decreasing the risk of harm to the patient.
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Affiliation(s)
- Michael L. MacGillivary
- Division of Dermatology, Dalhousie University, Halifax, Canada,Michael L. MacGillivary, Division of Dermatology, Dalhousie University, Suite 4-193 Dickson Building, 5820 University Avenue, Halifax, NS B3H 2Y9, Canada;
| | - Kerri S. Purdy
- Division of Dermatology, Dalhousie University, Halifax, Canada
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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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