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Aggressive Cutaneous Lymphomas and Their Mimics. Surg Pathol Clin 2023; 16:361-383. [PMID: 37149363 DOI: 10.1016/j.path.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Cutaneous lymphomas encompass a heterogeneous group of neoplasms with a wide spectrum of clinical presentations, histopathologic features, and prognosis. Because there are overlapping pathologic features among indolent and aggressive forms and with systemic lymphomas that involve the skin, clinicopathologic correlation is essential. Herein, the clinical and histopathologic features of aggressive cutaneous B- and T-cell lymphomas are reviewed. Indolent cutaneous lymphomas/lymphoproliferative disorders, systemic lymphomas, and reactive processes that may mimic these entities are also discussed. This article highlights distinctive clinical and histopathologic features, increases awareness of rare entities, and presents new and evolving developments in the field.
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Sánchez-Vicente JL, De Las Morenas-Iglesias J, Franco-Ruedas C, Rueda-Rueda T, Moruno-Rodríguez A, Lechón-Caballero B, Romero-Martínez A, Del Estad-Caballero A, González-Jauregui B, Cabrera-Pérez R, López-Herrero F. Ocular Involvement in a Patient with Intravascular Large B-Cell Lymphoma: A Diagnostic Challenge. Clinical Case Report and Literature Review. Ocul Immunol Inflamm 2023:1-8. [PMID: 36745689 DOI: 10.1080/09273948.2022.2103712] [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: 04/07/2021] [Revised: 05/30/2022] [Accepted: 07/14/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE To describe the ophthalmic findings and diagnosis of a case of intravascular large B-cell lymphoma. METHODS Clinical case observational report. CLINICAL CASE A Spanish 51-year-old man referred to our hospital with a diagnosis of panuveitis. The patient presented with blurred vision, photophobia, fever, and weight loss. Ocular examination revealed anterior uveitis, vitritis, and multiple round and oval creamy spots on the posterior pole. Fluorescein angiography, optical coherence tomography (OCT), and angio-OCT were used for the ocular examination. The diagnosis of lymphoma was formulated on the basis of a random normal skin biopsy, which showed significant CD20 cellularity within the vessels and extensive CD3 expression. CONCLUSIONS Intravascular lymphoma is a rare form of extranodal diffuse large B-cell lymphoma, often with delayed diagnosis because of the nonspecific symptoms. Hence, random skin biopsy could be useful in the diagnosis.
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Affiliation(s)
| | | | | | - Trinidad Rueda-Rueda
- Department of Ophthalmology, Virgen Del Rocío University Hospital, Seville, Spain
| | | | | | | | | | | | - Rocío Cabrera-Pérez
- Department of Anathomical Pathology, Virgen Del Rocío University Hospital, Seville, Spain
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Barranco R, Caputo F, Bedocchi D, Frigiolini FME, Castelletti L, Fraternali Orcioni G, Ventura F. Unusual and Fatal Case of an Undiagnosed Intravascular Large B-cell Lymphoma: The Oncologist's Great Imitator †. J Forensic Sci 2019; 65:314-317. [PMID: 31361917 DOI: 10.1111/1556-4029.14141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/04/2019] [Accepted: 07/10/2019] [Indexed: 12/18/2022]
Abstract
Intravascular lymphoma (IVL) is a rare subtype of extranodal lymphomas that is characterized by the selective growth of neoplastic cells within the lumen of small vessels. Authors document the case of an unexpected death caused by an undiagnosed intravascular large B-cell lymphoma with multi-organ involvement, which had initially manifested as an infection and then as an unclarified central nervous system pathology. Histological examination showed a diffuse intravascular large B-cell brain lymphoma with prominent cerebral involvement. The relevance of the case report reveals the importance of an autopsy of an extremely rare and threatening pathology that in most cases is diagnosed only postmortem. As a result, the role of the forensic pathologist becomes particularly important. When specifically performing an in-depth autopsy evaluation with a specific histologic analysis, it is possible to identify the intravascular lymphoma and declare a more accurate cause of death.
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Affiliation(s)
- Rosario Barranco
- Department of Legal and Forensic Medicine, University of Genova, Via De Toni 12, 16132, Genova, Italy
| | - Fiorella Caputo
- Department of Legal and Forensic Medicine, University of Genova, Via De Toni 12, 16132, Genova, Italy
| | - Davide Bedocchi
- Department of Legal and Forensic Medicine, University of Genova, Via De Toni 12, 16132, Genova, Italy
| | | | - Lara Castelletti
- Department of Neuroradiology, San Martino Hospital, Largo R. Benzi 10, 16132, Genova, Italy
| | - Giulio Fraternali Orcioni
- Department of Clinical Pathology, S. Croce e Carle Hospital, Via Michele Coppino 26, 12100, Cuneo, Italy
| | - Francesco Ventura
- Department of Legal and Forensic Medicine, University of Genova, Via De Toni 12, 16132, Genova, Italy
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Brunet V, Marouan S, Routy JP, Hashem MA, Bernier V, Simard R, Petrella T, Lamarre L, Théorêt G, Carrier C, Knecht H, Fleury I, Pavic M. Retrospective study of intravascular large B-cell lymphoma cases diagnosed in Quebec: A retrospective study of 29 case reports. Medicine (Baltimore) 2017; 96:e5985. [PMID: 28151891 PMCID: PMC5293454 DOI: 10.1097/md.0000000000005985] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Intravascular large B-cell lymphoma (IVL) is an extremely rare malignancy, mainly studied through European and Asian series. Due to the low incidence of this condition, our understanding of the clinical presentation as well as the management of IVL relies on a limited number of patients.We report the largest North American study to date on IVL with 29 cases from Quebec hospital diagnosed between 1990 and 2016. The aim of our study is to describe the clinical presentations, diagnostic and staging procedures, therapeutic management and clinical outcomes of IVL patients in our population and compare the disease phenotype to European and Asian series reported.In our cohort, all patients had stage IV IVL at diagnosis, with a median age of 66.7 years (range 47.2-90.8). Clinical presentation was characterized by constitutional symptoms (100%), poor ECOG-PS (100% ≥ 2), cytopenias (93% anemia), and elevated lactate dehydrogenase (97%) and C-reactive protein (96%). Our cohort presented with mainly cutaneous and neurological symptoms. However, neurological involvement (75.9%) was predominant and no "cutaneous variant" was observed; this differs from European literature, where "classical" IVL is reported with mainly cutaneous involvement. Two of our Caucasian patients presented "Asian variant" IVL; this observation is not unusual, as cases of "classical" IVL have been reported in Asians and "Asian variant" IVL has been reported in Europeans. All patients were classified according to their immunophenotypic features in 3 different subgroups (CD5 or CD5CD10, CD5CD10, CD5CD10) with no difference in outcome. Finally, 62% of our cohort received anthracycline-based chemotherapy and 53% of them achieved a complete response. After a median follow-up of 328 days, OS at 3 years was 42.7% for the entire cohort and 47.4% for the cases with in vivo diagnosis. CONCLUSION Unlike European studies on "classical" IVL, our study showed that the French Canadian presentation of this subtype of IVL is more frequently observed with neurological rather than cutaneous involvement. Finally, an early diagnosis is of primary importance since almost a quarter of patients receive a post-mortem diagnosis. A prompt diagnosis allows the introduction of an early treatment, associated with a CR in 53% of patients.
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Affiliation(s)
- Vanessa Brunet
- Department of Hematology-Oncology at Sherbrooke University Hospital Center, CIUSSS Estrie, University of Sherbrooke, Sherbrooke
| | - Sofia Marouan
- Department of Pathology at Sherbrooke University Hospital Center, CIUSSS Estrie, University of Sherbrooke, Sherbrooke
| | - Jean-Pierre Routy
- Department of Hematology-Oncology at McGill University Health Centre, CIUSSS Centre-Ouest-de-l’Île-de-Montréal, McGill University, Montreal
| | - Mohamed Amin Hashem
- Department of Pathology at Laval University Hospital Center, CIUSSS Capitale Nationale, University Laval, Quebec
| | - Vincent Bernier
- Department of Pathology at Laval University Hospital Center, CIUSSS Capitale Nationale, University Laval, Quebec
| | - Raynald Simard
- Department of Hematology-Oncology at Chicoutimi Hospital, CIUSSS Saguenay-Lac-Saint-Jean, University of Sherbrooke, Chicoutimi
| | - Tony Petrella
- Department of Pathology at Montreal University Hospital Center, CIUSSS Est-de-l’Île-de-Montréal, University of Montreal, Montreal
| | - Louis Lamarre
- Department of Pathology at Charles-Lemoyne Hospital, CIUSSS Montérégie-Centre, University of Sherbrooke, Longueuil
| | - Gilles Théorêt
- Department of Pathology at Cité-de-la-Santé Hospital, CIUSSS Laval, Laval
| | - Christian Carrier
- Department of Hematology-Oncology at Montreal University Hospital Center in Trois-Rivières, CIUSSS Mauricie-et-du-Centre-du-Québec, Trois-Rivieres
| | - Hans Knecht
- Department of Hematology-Oncology at McGill University Health Centre, CIUSSS Centre-Ouest-de-l’Île-de-Montréal, McGill University, Montreal
| | - Isabelle Fleury
- Department of Hematology-Oncology at Maisonneuve-Rosemont Hospital, CIUSSS Est-de-l’Île-de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Michel Pavic
- Department of Hematology-Oncology at Sherbrooke University Hospital Center, CIUSSS Estrie, University of Sherbrooke, Sherbrooke
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Scott JF, Honda K, Lu K. Seemed Like Cellulitis: Intravascular Large B-Cell Lymphoma. Am J Med 2016; 129:685-7. [PMID: 27038674 DOI: 10.1016/j.amjmed.2016.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 03/21/2016] [Accepted: 03/21/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Jeffrey F Scott
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio; Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Kord Honda
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio; Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Kurt Lu
- Department of Dermatology, University Hospitals Case Medical Center, Cleveland, Ohio; Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Pongpairoj K, Rerknimitr P, Wititsuwannakul J, Asawanonda P. Eruptive telangiectasia in a patient with fever and haemophagocytic syndrome. Clin Exp Dermatol 2016; 41:696-8. [PMID: 27338024 DOI: 10.1111/ced.12859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2015] [Indexed: 11/29/2022]
Affiliation(s)
- K Pongpairoj
- Division of Dermatology, Allergy and Clinical Immunology Research Group, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Dermatology Unit, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - P Rerknimitr
- Division of Dermatology, Allergy and Clinical Immunology Research Group, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Dermatology Unit, Department of Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - J Wititsuwannakul
- Division of Dermatology, Allergy and Clinical Immunology Research Group, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - P Asawanonda
- Division of Dermatology, Allergy and Clinical Immunology Research Group, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Usuda D, Arahata M, Temaru R, Iinuma Y, Kanda T, Hayashi S. Autopsy-Proven Intravascular Lymphoma Presenting as Rapidly Recurrent Strokes. Case Rep Oncol 2016; 9:148-53. [PMID: 27065845 PMCID: PMC4821140 DOI: 10.1159/000444632] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We present a 79-year-old Japanese woman diagnosed with cerebral infarction. In spite of enough antiplatelet and anticoagulant therapy, she presented rapidly recurrent strokes three times for 3 months. Magnetic resonance imaging showed progression of bilateral cerebral infarcts, and chest-abdominal computed tomography showed multiple bilateral nodular lesions in the lung and multiple tumor lesions in the liver. Autopsy revealed diagnosis of intravascular lymphoma (IVL). This case indicates that IVL is rare and usually goes undiagnosed until time of autopsy because of its protean neurological manifestations; hence, it should be considered as a possible etiology if multiple strokes occur in a short period of time.
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Affiliation(s)
- Daisuke Usuda
- Department of Infectious Diseases, Kanazawa Medical University, Uchinada, Japan
- Department of Community Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan
- *Daisuke Usuda Department of Infectious Diseases, Kanazawa Medical University 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa-ken 920-0293 (Japan) E-Mail
| | - Masahisa Arahata
- Department of Internal Medicine, Nanto Municipal Hospital, Nanto, Japan
| | - Rie Temaru
- Department of Internal Medicine, Nanto Municipal Hospital, Nanto, Japan
| | - Yoshitsugu Iinuma
- Department of Infectious Diseases, Kanazawa Medical University, Uchinada, Japan
| | - Tsugiyasu Kanda
- Department of Community Medicine, Kanazawa Medical University Himi Municipal Hospital, Himi, Japan
| | - Shinichi Hayashi
- Department of Diagnostic Pathology, Toyama University Hospital, Toyama, Japan
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Cutaneous Involvement in a Case of Intravascular T-Cell Lymphoma With a γδ Phenotype. Am J Dermatopathol 2015; 38:e27-9. [PMID: 26460624 DOI: 10.1097/dad.0000000000000383] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Intravascular lymphomas (IVL) are uncommon variants of extranodal non-Hodgkin which are usually difficult to diagnose because of their lack of clinical uniformity. Most cases are of B-cell differentiation followed by natural killer/T-cell differentiation and underlying CD30 lymphoproliferative conditions. Epstein-Barr virus is pathogenically related in most of the natural killer/T-cell variants, and the skin is a common site of presentation noted in approximately 40% of cases. Recently, cases with uncommon phenotypes have been described, expanding our understanding of the pathogenesis of this condition. In this report, we describe a 67-year-old man with a 3-month history of constitutional symptoms associated with linear purpuric macules on the trunk, pancytopenia, and high levels of serum lactate dehydrogenase. He had been followed for longstanding adenopathy and hepatosplenomegaly. Skin biopsy demonstrated a intravascular lymphocytic proliferation with positivity for CD3, CD2, CD5, and γδ T-cell receptor marker; in situ hybridization Epstein-Barr virus RNA was negative. The patient was subsequently treated with chemotherapy and allogenic stem cell transplant. He remains in complete remission 6 months posttransplant. Although the presence of hepatosplenomegaly led to consideration of a hepatosplenic T-cell lymphoma, it was pre-existing for several years making the diagnosis doubtful. To our knowledge, this is the first case report of an IVL γδ T-cell lymphoma.
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Bilgili SG, Yılmaz D, Soyoral YU, Karadag AS, Bayram I. Intravascular large B-cell lymphoma presenting with anasarca-type edema and acute renal failure. Ren Fail 2013; 35:1163-6. [PMID: 23885711 DOI: 10.3109/0886022x.2013.817277] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Intravascular lymphoma (IVL) is a rare extra nodal subtype (usually of B-cell origin) presenting with infiltration of large neoplastic lymphocytes into lumina of blood vessels, leading to vascular occlusion. The early diagnosis is very crucial, however it is usually diagnosed postmortem investigation in most of the cases. A 56-year-old female presented with elevated creatinine level, and anasarca-type edema that superimposed with hard, indurated, erythematous plaques extending to inguinal region, abdomen, anterior aspect of chest, and face. B-cell IVL was confirmed with skin biopsy. The patient had some degree of clinical improvement following chemotherapy. B-cell IVL presenting with anasarca edema was not previously reported in the literature. Even if its rarity, IVL should be considered in the differential diagnosis of renal failure with anasarca edema.
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Affiliation(s)
- Serap Gunes Bilgili
- Department of Dermatology, Yuzuncu Yil University, Faculty of Medicine, Van, Turkey.
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Hallermann C, Niermann C, Fluck M, Fischedick AR, Schulze HJ. [Malignant lymphoma of the skin: update on diagnostics and therapy of primary cutaneous B-cell lymphoma]. Hautarzt 2011; 62:947-58. [PMID: 22160228 DOI: 10.1007/s00105-011-2275-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The diagnosis of primary cutaneous B-cell lymphoma is made based principally on the results of histological investigations and staging. For an exact staging abdominal sonography and chest X-ray examinations and for appropriate clinical symptoms special investigations as well as radiological imaging procedures including PET are indicated in addition to conventional laboratory investigations. For therapy rituximab is normally administered as monotherapy in order to avoid over therapy of indolent lymphoma. Further options are radiotherapy and new approaches with electrochemotherapy as well as pegylated doxorubicin.
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Affiliation(s)
- C Hallermann
- Abt. für Dermatologie, Fachklinik Hornheide, Münster, Deutschland
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