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A Western Case of Intravascular Large B-Cell Lymphoma as Unusual Cause of Persistent Fever. Case Rep Hematol 2019; 2019:1480710. [PMID: 31827947 PMCID: PMC6881760 DOI: 10.1155/2019/1480710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/09/2019] [Accepted: 07/31/2019] [Indexed: 12/23/2022] Open
Abstract
Fever of unknown origin (FUO) is a common and challenging clinical condition that can be referred, among others, to infections, drug's effects, various inflammatory disorders, and cancers. Among the latter, lymphomas can indeed cause fever, which is therefore accounted as a lymphoma-related sign in patients' staging. Intravascular large B-cell lymphoma (IVLBCL) is a very rare tumor, characterized by lymphoma cell accumulation within sinusoids and, despite a very aggressive course, the evidence of this disease is scarce. Two variants are currently recognized, respectively, occurring in either Western (mainly characterized by neurological symptoms and skin involvement) or Eastern countries (with hemophagocytic syndrome, bone marrow, spleen, and liver involvement). We describe an atypical and unprecedented IVLBCL patient, presenting with pronounced features of Eastern cases as well as skin involvement. Due to the scant amount of neoplastic cells, the diagnosis was very challenging, with FUO being the first and for a certain time unique clinical sign. Although lymphoma was suspected, the lack of evidence for neoplastic cells delayed the final diagnosis. Eventually, only autopsy revealed the extensive involvement of different organs and tissues.
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Shiroshita K, Kida JI, Matsumoto K, Uemura M, Yamaoka G, Miyai Y, Haba R, Imataki O. Intravascular proliferating anaplastic lymphoma kinase-positive anaplastic large-cell lymphoma. World J Hematol 2015; 4:10-15. [DOI: 10.5315/wjh.v4.i2.10] [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: 07/17/2014] [Revised: 09/20/2014] [Accepted: 03/18/2015] [Indexed: 02/05/2023] Open
Abstract
An 82-year-old Japanese man visited our emergency unit complaining of dyspnea. Laboratory data showed 15% atypical lymphocytes in peripheral blood which expressed the T-cell phenotype. Chest/abdominal computed tomography depicted hepatosplenomegaly and swelling of systemic lymph nodes. The patient died of advanced respiratory failure 5 d after the first occurrence of his dyspnea. At autopsy, the pathological features revealed a diffuse infiltration of large atypical lymphocytes to systemic organs including the spleen and lung. In immunohistochemical staining, these cells expressed CD30, TIA-1, anaplastic lymphoma kinase (ALK), CD5 and CD3. An advanced surface molecule analysis revealed a lack of CD54 (intercellular cell adhesion molecule-1) and CD56 (neural cell adhesion molecule). We observed the proliferation and infiltration of these lymphoma cells specifically at the intravascular lesions similar to intravascular lymphoma (IVL). T-cell IVL is not established as an independent clinical entity in the World Health Organization classification, and our patient’s ALK-positive T-IVL in lung appears to be the first reported case.
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Fernandez-Flores A. Comments on cutaneous lymphomas: since the WHO-2008 classification to present. Am J Dermatopathol 2011; 34:274-84. [PMID: 22126841 DOI: 10.1097/dad.0b013e31821b8bfe] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The last classification of lymphomas of the World Health Organization in 2008 made a few changes from the preceding classification. Although useful, at the same time, it has posed new questions, concerns, and dilemmas which have been raised in the literature. The current report highlights some of these controversies, of each of these primary cutaneous entities, going through cutaneous mature T-cell and NK-cell neoplasms, mature B-cell neoplasms, precursor neoplasms, and other entities, which for several reasons do not fit in the previous categories. It also reviews some advances on many of these lymphomas published in the last 2 years.
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Gleason BC, Brinster NK, Granter SR, Pinkus GS, Lindeman NI, Miller DM. Intravascular cytotoxic T-cell lymphoma: A case report and review of the literature. J Am Acad Dermatol 2008; 58:290-4. [PMID: 18222325 DOI: 10.1016/j.jaad.2006.12.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2006] [Revised: 10/12/2006] [Accepted: 12/24/2006] [Indexed: 02/08/2023]
Abstract
Intravascular lymphoma (IVL) is a rare subtype of extranodal diffuse large B-cell lymphoma in the World Health Organization classification. Although the majority of cases are of B-cell lineage, cases of IVL with a T-cell phenotype and, rarely, histiocytic and natural killer (NK)-cell phenotypes have been reported. We report a case of T-cell IVL with a cytotoxic phenotype. A 62-year-old male presented with erythematous patches and plaques on the lower extremities, and a biopsy revealed IVL with an activated cytotoxic phenotype (CD56(+), perforin+, granzyme B+, TIA-1+, CD3epsilon(+), CD20(-), CD4(-), CD8(-), CD5(-), and T-cell receptor [TCR] betaF1(-)), consistent with either NK-cell or T-cell origin. TCR gene analysis showed a monoclonal T-cell population, supporting the diagnosis of a T-cell IVL. Although the patient's skin lesions were refractory to combination chemotherapy and salvage chemotherapy regimens, there has been no evidence of disease progression in 24 months of follow-up.
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Affiliation(s)
- Briana C Gleason
- Department Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
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6
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Röglin J, Böer A. Skin manifestations of intravascular lymphoma mimic inflammatory diseases of the skin. Br J Dermatol 2007; 157:16-25. [PMID: 17506787 DOI: 10.1111/j.1365-2133.2007.07954.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Intravascular lymphoma (IVL) is fatal when it is diagnosed late in the course. Sometimes skin lesions enable early diagnosis, but criteria for diagnosis are not well established. OBJECTIVES To demonstrate the clinical spectrum of skin lesions of IVL and to correlate it with clinical outcome; to identify features differentiating between B-cell and T-cell IVL with skin involvement. METHODS Review of 97 articles reporting on total of 224 patients with IVL. RESULTS Skin lesions were mentioned in 90 of 224 patients. They were nodules and/or plaques (49%) or macules (22.5%) of red (31%) or blue to livid (19%) colour on the leg (35%), the thigh (41%) and the trunk (31%). Telangiectases were present in only 20% of the patients. Oedema (27.5%) of the legs and pain (24%) were often accompanying. No criteria enabled distinction between lesions restricted to the skin and skin lesions concurrent with IVL in other organs, but when the disease was restricted to the skin, the prognosis was favourable (10% vs. 85% fatal outcome). Skin lesions of T-cell IVL are indistinguishable from those of B-cell IVL. CONCLUSIONS Forty per cent of all patients with IVL have skin lesions, these being red, sometimes painful plaques located typically on the lower extremities, accompanied by oedema. A clinician risks misinterpreting these changes as thrombophlebitis, erythema nodosum or erysipelas. Neither clinical course nor differentiation of the lymphoma can be predicted from the morphology of skin lesions, but involvement of other organs at the time of diagnosis indicates a poor prognosis.
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Affiliation(s)
- J Röglin
- DERMATOLOGIKUM Hamburg, Stephansplatz 5, 20354 Hamburg, Germany
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7
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Raidal S, Clark P, Raidal S. Angiotrophic T-Cell Lymphoma as a Cause of Regenerative Anemia in a Horse. J Vet Intern Med 2006. [DOI: 10.1111/j.1939-1676.2006.tb01820.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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8
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Smoller BR, Santucci M, Wood GS, Whittaker SJ. Histopathology and genetics of cutaneous T-cell lymphoma. Hematol Oncol Clin North Am 2003; 17:1277-311. [PMID: 14710885 DOI: 10.1016/s0889-8588(03)00115-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There is emerging evidence that genomic and chromosomal instability are features of CTCL, including variants such as MF, Sézary syndrome, and primary cutaneous CD30+ LCAL, and that specific chromosomal abnormalities are common. Additional resolution of specific regions of chromosomal loss and gain are required to define putative genes that may be of fundamental pathogenetic importance in CTCL. Inactivation of well-defined cell cycle and TSG are common as for other types of NHL. The prognostic significance of these abnormalities in CTCL has yet to be determined. The dysregulation of specific transcription factors is of interest, but requires further study. It is hoped that greater understanding of these molecular abnormalities will permit the development of CTCL-specific therapies that alleviate suffering and prolong survival.
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MESH Headings
- Chromosome Aberrations
- Chromosomes, Human/genetics
- Chromosomes, Human/ultrastructure
- Genetic Techniques
- Humans
- Immunophenotyping
- Killer Cells, Natural/pathology
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/pathology
- Lymphoma, T-Cell, Cutaneous/classification
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/genetics
- Lymphoma, T-Cell, Cutaneous/pathology
- Mycosis Fungoides/diagnosis
- Mycosis Fungoides/pathology
- Neoplasm Staging
- Signal Transduction/genetics
- Skin Neoplasms/classification
- Skin Neoplasms/diagnosis
- Skin Neoplasms/genetics
- Skin Neoplasms/pathology
- T-Lymphocyte Subsets/pathology
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Affiliation(s)
- Bruce R Smoller
- Department of Pathology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA.
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Santucci M, Pimpinelli N, Massi D, Kadin ME, Meijer CJLM, Müller-Hermelink HK, Paulli M, Wechsler J, Willemze R, Audring H, Bernengo MG, Cerroni L, Chimenti S, Chott A, Díaz-Pérez JL, Dippel E, Duncan LM, Feller AC, Geerts ML, Hallermann C, Kempf W, Russell-Jones R, Sander C, Berti E. Cytotoxic/natural killer cell cutaneous lymphomas. Report of EORTC Cutaneous Lymphoma Task Force Workshop. Cancer 2003; 97:610-27. [PMID: 12548603 DOI: 10.1002/cncr.11107] [Citation(s) in RCA: 208] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cutaneous lymphomas expressing a cytotoxic or natural killer (NK) cell phenotype represent a group of lymphoproliferative disorders for which there is currently much confusion and little consensus regarding the best nomenclature and classification. METHODS This study analyzes 48 cases of primary cutaneous lymphoma expressing cytotoxic proteins and/or the NK cell marker, CD56. These cases were collected for a workshop of the European Organization for Research and Treatment of Cancer Cutaneous Lymphoma Task Force, to better clarify the clinical, morphologic, and phenotypic features of these uncommon tumors. RESULTS Several categories with different clinical and pathologic features were delineated: 1) aggressive, CD8+, epidermotropic, cytotoxic T-cell lymphoma; 2) mycosis fungoides, cytotoxic immunophenotype variant; 3) subcutaneous panniculitis-like T-cell lymphoma; 4) NK/T-cell lymphoma, nasal type; 5) CD4+, NK cell lymphoma; 6) blastoid NK cell lymphoma; (7) intravascular NK-like lymphoma; and 8) cytotoxic, peripheral T-cell lymphoma. CONCLUSIONS Our data show that primary cutaneous cytotoxic/NK cell lymphomas include distinct groups of diseases, clinically, histologically, and biologically. Because the finding of a cytotoxic phenotype often has prognostic significance, the routine use of cytotoxic markers in the diagnosis and classification of cutaneous lymphomas should be expanded.
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MESH Headings
- CD4-Positive T-Lymphocytes/immunology
- CD56 Antigen/immunology
- CD8-Positive T-Lymphocytes/immunology
- Humans
- Immunophenotyping
- Killer Cells, Natural/immunology
- Lymphoma/classification
- Lymphoma/immunology
- Lymphoma/pathology
- Lymphoma, T-Cell, Cutaneous/classification
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/pathology
- Lymphoma, T-Cell, Peripheral/classification
- Lymphoma, T-Cell, Peripheral/immunology
- Lymphoma, T-Cell, Peripheral/pathology
- Membrane Proteins/immunology
- Mycosis Fungoides/immunology
- Mycosis Fungoides/pathology
- Panniculitis/immunology
- Panniculitis/pathology
- Phenotype
- Poly(A)-Binding Proteins
- Proteins
- RNA-Binding Proteins/immunology
- Skin Neoplasms/classification
- Skin Neoplasms/immunology
- Skin Neoplasms/pathology
- T-Cell Intracellular Antigen-1
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Affiliation(s)
- Marco Santucci
- Department of Human Pathology and Oncology, University of Florence Medical School, Florence, Italy.
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Asagoe K, Fujimoto W, Yoshino T, Mannami T, Liu Y, Kanzaki H, Arata J. Intravascular lymphomatosis of the skin as a manifestation of recurrent B-cell lymphoma. J Am Acad Dermatol 2003; 48:S1-4. [PMID: 12582370 DOI: 10.1067/mjd.2003.112] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Intravascular lymphomatosis (IVL) is a rare type of lymphoma with a poor prognosis. Its distinctive clinical and histopathologic features are generated by the proliferation of neoplastic mononuclear cells within blood vessels. We describe a patient with IVL of the skin as a manifestation of a recurrent diffuse large B-cell lymphoma of ureteral origin. Lymphoma cells were located both within the vessels and the parenchyma in an early cutaneous lesion. After recurrence in the skin, lymphoma cells gradually located only in the vascular lumina. This transition suggests that cells localized within the vessels were selected as a consequence of chemotherapy. Immunohistochemical examination revealed that the expression of surface adhesion molecules of lymphoma cells did not significantly change. The results of polymerase chain reaction revealed that the ureteral and cutaneous tumors were identical in clonality. Our findings suggest that conventional diffuse large B-cell lymphoma can change into IVL.
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Affiliation(s)
- Kenji Asagoe
- Department of Dermatology, Okayama University Medical School, Okayama, Japan.
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Erös N, Károlyi Z, Kovács A, Takács I, Radványi G, Kelényi G. Intravascular B-cell lymphoma. J Am Acad Dermatol 2002; 47:S260-2. [PMID: 12399744 DOI: 10.1067/mjd.2002.108493] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Intravascular (angiotropic) lymphoma is a unique and rare cutaneous lymphoma in which the malignant T or B lymphoid cells proliferate within the lumens of small blood vessels, primarily in the skin and central nervous system. Erythematous, tender nodules, tumors, and telangiectases are the most common skin symptoms in addition to various neurologic signs. Progression of the disease produces secondary organ involvement with variable symptoms and can be fatal. We describe a case of a 74-year-old woman with edematous, infiltrated, orange-like skin with multiple telangiectases, generalized edema, severe weakness, and extremely high values of lactate dehydrogenase. Skin biopsy specimens revealed atypical large cells filling up the lumens of dermal capillaries. Immunohistochemical investigation results identified them as B cells with CD20, CD45, CD79a, Ki-67, and HLA-DR positivity. After administration of diuretics, colchicine, and systemic PUVA therapy, the patient lost her edema, her skin became tender and free of telangiectases, and laboratory alterations normalized. Because of heavy neuralgia in her legs, oral monochemotherapy was introduced with chlorambucil, and now the patient is in remission.
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Affiliation(s)
- Nóra Erös
- Department of Dermatology, Semmelweis Hospital, Miskolc, Hungary
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12
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Fiegl M, Greil R, Pechlaner C, Krugmann J, Dirnhofer S. Intravascular large B-cell lymphoma with a fulminant clinical course: a case report with definite diagnosis post mortem. Ann Oncol 2002; 13:1503-6. [PMID: 12196378 DOI: 10.1093/annonc/mdf214] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
A patient is described who presented with pancytopenia, splenomegaly and excessively elevated lactate dehydrogenase levels in concurrence with signs of extramedullary hematopoiesis. Although initially considered in the differential diagnostic spectrum, a highly aggressive lymphoma could not be identified before the patient died, 6 weeks after admission. Even an intensive diagnostic work-up including splenectomy and repeated bone marrow biopsies was inconclusive. Finally, the diagnosis of an intravascular large B-cell lymphoma, a highly aggressive clinical subtype of a diffuse large B-cell lymphoma, spreading within vascular structures of multiple organs was established by autopsy. Intravascular large B-cell lymphoma is often not diagnosed before death due to the exclusive intravascular growth pattern of the tumor cells and a fulminant clinical course. The heterogeneous clinical features of this lymphoma subtype are discussed.
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MESH Headings
- Autopsy
- Biopsy, Needle
- Combined Modality Therapy
- Disease Progression
- Fatal Outcome
- Humans
- Immunohistochemistry
- Lymphoma, B-Cell/complications
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Middle Aged
- Severity of Illness Index
- Splenectomy
- Vascular Neoplasms/complications
- Vascular Neoplasms/pathology
- Vascular Neoplasms/therapy
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Affiliation(s)
- M Fiegl
- Department of Internal Medicine, Division of Hematology and Oncology University of Innsbruk, Innsbruck, Austria.
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Yegappan S, Coupland R, Arber DA, Wang N, Miocinovic R, Tubbs RR, Hsi ED. Angiotropic lymphoma: an immunophenotypically and clinically heterogeneous lymphoma. Mod Pathol 2001; 14:1147-56. [PMID: 11706077 DOI: 10.1038/modpathol.3880450] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Angiotropic lymphoma (AL) is an uncommon lymphoma often presenting with nonspecific clinical features and having a high mortality rate. Although not specifically recognized by the Revised European-American Classification of Lymphoid Neoplasms, it likely will appear as a subtype of diffuse large B-cell lymphoma in the upcoming WHO classification. Some authors may also consider it to be a subtype of cutaneous lymphomas. Recent studies have reported an immunophenotypic heterogeneity of AL, and in rare instances, an association with other NHL. To further characterize AL, we studied the immunophenotype by immunohistochemistry for CD5, CD10, CD20, bcl-2, and bcl-6 in 18 cases of B-cell AL identified at three medical centers in North America. Bcl-2 gene rearrangement status by polymerase chain reaction and Epstein Barr virus status by in situ hybridization also were evaluated. Eight men and 10 women were identified with AL (median age 71 years). Eleven patients were diagnosed in life and seven were diagnosed at autopsy. Neurologic symptoms were the most common presentation, seen in six patients. Skin was the most commonly biopsied site. All showed classic intravascular localization; in two cases, there was also a minor diffuse large cell lymphoma component observed in some organs. Most (89%) of the cases expressed bcl-2 protein; CD10, bcl-6 and CD5 were each expressed in 22% of cases. Based on CD5 and CD10 expression, three major groups were evident: CD5-, CD10- (11 cases); CD5+, CD10- (3 cases), and CD5-, CD10+ (3 cases). Even though a follicle center lymphoma preceded the AL in one patient, we did not detect bcl-2 gene rearrangement in any of these cases. All cases were negative for Epstein Barr virus. Of the five treated with chemotherapy, two achieved a complete remission. Based on these findings, we conclude that ALs are clinically and immunophenotypically heterogeneous and may represent more than one pathogenetic entity. In some instances AL may be preceded by another lymphoproliferative disorder, raising the possibility that some cases of AL may represent a transformation from another type of lymphoma. Cutaneous manifestations of AL are common; however, it appears to be a systemic lymphoma. Although often fatal, patients with AL who are diagnosed early and treated with chemotherapy may achieve remission.
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MESH Headings
- Aged
- Aged, 80 and over
- Antigens, CD/analysis
- Antigens, CD20/analysis
- CD5 Antigens/analysis
- CD79 Antigens
- Chromosomes, Human, Pair 14/genetics
- Chromosomes, Human, Pair 18/genetics
- DNA, Neoplasm/genetics
- DNA-Binding Proteins/analysis
- Female
- Gene Rearrangement, B-Lymphocyte, Heavy Chain/genetics
- Humans
- Immunohistochemistry
- Leukocyte Common Antigens/analysis
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/pathology
- Male
- Middle Aged
- Neprilysin/analysis
- Proto-Oncogene Proteins/analysis
- Proto-Oncogene Proteins c-bcl-2/analysis
- Proto-Oncogene Proteins c-bcl-2/genetics
- Proto-Oncogene Proteins c-bcl-6
- Receptors, Antigen, B-Cell/analysis
- Transcription Factors/analysis
- Translocation, Genetic
- Vascular Neoplasms/genetics
- Vascular Neoplasms/metabolism
- Vascular Neoplasms/pathology
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Affiliation(s)
- S Yegappan
- Department of Clinical Pathology, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44195, USA
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15
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Abstract
We describe the case of a 56-year-old man who presented with numbness and tingling of the extremities, weakness, and fatigue. Laboratory findings included anemia and thrombocytopenia. A diagnosis of intravascular lymphomatosis was established when liver, omentum, and bone marrow samples were examined. A review of the literature reveals that most cases of intravascular lymphomatosis have cytopenias, mainly anemia and thrombocytopenia, but bone marrow involvement is rare. In our case, a subtle neoplastic infiltrate in the marrow sinusoids was highlighted with a B-cell marker. While immunohistochemical analysis was not performed in most reported cases in the literature, our studies suggest that a systematic search in bone marrow of cases of intravascular lymphomatosis may reveal unsuspected neoplastic cells. We conclude that bone marrow involvement in intravascular lymphomatosis appears to be rare, has subtle features, and is difficult to diagnose if unsuspected and not searched for.
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Affiliation(s)
- T J Tucker
- Department of Pathology, Truman Medical Center, University of Missouri-Kansas City, School of Medicine, Kansas City
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Calamia KT, Miller A, Shuster EA, Perniciaro C, Menke DM. Intravascular Lymphomatosis. RHEUMADERM 1999. [DOI: 10.1007/978-1-4615-4857-7_37] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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17
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Chang A, Zic JA, Boyd AS. Intravascular large cell lymphoma: a patient with asymptomatic purpuric patches and a chronic clinical course. J Am Acad Dermatol 1998; 39:318-21. [PMID: 9703143 DOI: 10.1016/s0190-9622(98)70380-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intravascular large cell lymphoma (malignant angioendotheliomatosis) is a rare, multifocal, intravascular neoplasm of lymphoid cells that preferentially involves the vasculature of the skin and central nervous system. We describe a 54-year-old man with asymptomatic purpuric patches on the lower extremities for 10 years duration and a more recent lesion on the right arm. A biopsy specimen showed intravascular collections of tumor cells with irregular nuclear contours and prominent nucleoli. These cells were leukocyte common antigen (CD45), CD20, and CDW75 positive, but CD3, CD43, CD45RO, and cytokeratin negative. Polymerase chain reaction analysis of the skin for immunoglobulin heavy chain gene rearrangement detected a clonal population of B cells, supporting the diagnosis of a B-cell lymphoma. Peripheral blood showed no abnormal circulating cells. This case of malignant angioendotheliomatosis is unusual for its prolonged clinical course and presence of purpuric patches.
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MESH Headings
- Antigens, CD/analysis
- Antigens, CD20/analysis
- Humans
- Leukocyte Common Antigens/analysis
- Lymphoma, B-Cell/chemistry
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Purpura/complications
- Purpura/pathology
- Sialyltransferases
- Skin Diseases, Vascular/complications
- Skin Diseases, Vascular/pathology
- Vascular Neoplasms/complications
- Vascular Neoplasms/immunology
- Vascular Neoplasms/pathology
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Affiliation(s)
- A Chang
- Department of Dermatology, Vanderbilt University, Nashville, Tennessee, USA
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von Kempis J, Köhler G, Herbst EW, Peter HH. Intravascular lymphoma presenting as symmetric polyarthritis. ARTHRITIS AND RHEUMATISM 1998; 41:1126-30. [PMID: 9627024 DOI: 10.1002/1529-0131(199806)41:6<1126::aid-art21>3.0.co;2-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Intravascular lymphoma (IVL) is an uncommon neoplastic disorder characterized by monoclonal intravascular expansion of lymphoid cells. Occlusion of small vessels in various organ systems probably accounts for the broad clinical spectrum of this type of lymphoma, which can closely mimic a variety of diseases, especially vasculitic disorders, and thus lead to delayed clinical diagnosis. This is the first report of a patient who presented with a predominant symptom of symmetric polyarthritis accompanied by fever. While her initial systemic symptoms, such as fever, improved rapidly after initiation of corticosteroid therapy, the response of the polyarthritic joint manifestations was only transient. The patient died of progressive lung involvement and was diagnosed as having IVL by histologic analysis of tissue samples obtained postmortem.
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