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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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2
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Marshall EH, Brumbaugh B, Holt A, Chen ST, Hoang MP. Cutaneous Intravascular Hematolymphoid Entities: A Review. Diagnostics (Basel) 2024; 14:679. [PMID: 38611591 PMCID: PMC11011375 DOI: 10.3390/diagnostics14070679] [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: 02/11/2024] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 04/14/2024] Open
Abstract
Intravascular lymphomas are rare disease conditions that exhibit neoplastic lymphoid cells that are confined mainly to the lumens of small capillaries and medium-sized vessels. The majority of the intravascular lymphomas are of B-cell origin, but they can include NK/T-cell and CD30+ immunophenotypes. In the histologic differential diagnosis are benign proliferations such as intralymphatic histiocytosis and intravascular atypical CD30+ T-cell proliferation. In this review, we discuss the clinical, histopathologic, and molecular findings of intravascular B-cell lymphoma, intravascular NK/T-cell lymphoma, intralymphatic histiocytosis, and benign atypical intravascular CD30+ T-cell proliferation.
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Affiliation(s)
| | - Bethany Brumbaugh
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA; (B.B.); (A.H.); (S.T.C.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Allison Holt
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA; (B.B.); (A.H.); (S.T.C.)
- University of Massachusetts Chan Medical School, Worcester, MA 01655, USA
| | - Steven T. Chen
- Department of Dermatology, Massachusetts General Hospital, Boston, MA 02114, USA; (B.B.); (A.H.); (S.T.C.)
- Harvard Medical School, Boston, MA 02115, USA
| | - Mai P. Hoang
- Department of Pathology, Massachusetts General Hospital, Boston, MA 02114, USA;
- Harvard Medical School, Boston, MA 02115, USA
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3
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Koizumi S, Togawa Y, Saeki Y, Shimizu R, Nakano M. A case of cutaneous variant of intravascular large B-cell lymphoma in which dermoscopy revealed telangiectasias associated with erythematous induration. Dermatol Reports 2024; 16:9731. [PMID: 38623370 PMCID: PMC11017709 DOI: 10.4081/dr.2023.9731] [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] [Received: 04/16/2023] [Accepted: 04/26/2023] [Indexed: 04/17/2024] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare type of extranodal, diffuse, large B-cell lymphoma characterized by the selective growth of lymphoma cells within the lumen of small blood vessels, with no lymphadenopathy or masses. Herein, we report a cutaneous variant of IVLBCL that is rare in Asia. A healthy 73-year-old Japanese woman presented to our hospital with painful erythematous indurations and telangiectasia of the lower extremities, which was confirmed on dermoscopy. Physical examination revealed no systemic involvement, and laboratory parameters were within normal ranges. No abnormal fluorodeoxyglucose (FDG) uptake was detected on 18FDG positron emission tomography/computed tomography. Histopathological examination revealed proliferation and dilatation of blood vessels in the subcutis layer, occluded by CD20-positive atypical lymphoid cells. Thus, the patient was diagnosed with a cutaneous variant of IVLBCL without systemic symptoms. In conclusion, it is important to confirm telangiectasia using dermoscopy and perform skin biopsies in patients presenting with sudden-onset erythematous induration.
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Affiliation(s)
| | - Yaei Togawa
- Department of Dermatology, Chiba University Hospital, Chiba
| | - Yuka Saeki
- Department of Dermatology, Chiba University Hospital, Chiba
| | - Ryo Shimizu
- Division of Hematology, Asahi General Hospital, Asahi, Japan
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4
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Bentivenga GM, Baiardi S, Righini L, Ladogana A, Capellari S, Sabattini E, Parchi P. Rapidly progressive dementia due to intravascular lymphoma: A prion disease reference center experience. Eur J Neurol 2024; 31:e16068. [PMID: 37738529 DOI: 10.1111/ene.16068] [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: 06/13/2023] [Accepted: 09/05/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Intravascular large B-cell lymphoma (IVLBCL) is a rare extranodal lymphoma that is characterized by the selective growth of neoplastic cells in blood vessels, representing a potentially treatable cause of rapidly progressive dementia (RPD). Given its diverse clinical and instrumental presentation, it is often misdiagnosed with more common RPD causes, for example, Creutzfeldt-Jakob disease (CJD) or vascular dementia. METHODS This study presents the clinical and histopathological characteristics of four IVLBCL cases that we diagnosed post-mortem over 20 years among over 600 brain samples received as suspected CJD cases at our prion disease reference center. RESULTS Our patients exhibited various presenting symptoms, including behavioral disturbances, disorientation, and alertness fluctuations. The diagnostic tests performed at the time, including blood work, cerebrospinal fluid (CSF) analyses, electroencephalography, and neuroimaging, yielded nonspecific and occasionally misleading results. Consequently, the patients were repeatedly diagnosed as variably having CJD, epilepsy, vascular dementia, and encephalitis. The stored CSF samples of two patients tested negative at prion real-time quaking-induced conversion (RT-QuIC), which we performed afterwards for research purposes. Neuropathological analysis revealed a differential involvement of various brain areas, with frontotemporal neocortices being the most affected. CONCLUSIONS Our results confirm the significant clinical and instrumental heterogeneity of IVLBCL. Neuropathological evidence of the preferential involvement of frontotemporal neocortices, potentially conditioning the clinical phenotype, could be relevant to reach an early diagnosis. Finally, given the therapeutic implications of its misdiagnosis with CJD, we emphasize the utility of prion RT-QuIC as a test for ruling out CJD in these patients.
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Affiliation(s)
| | - Simone Baiardi
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Lorenzo Righini
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
| | - Anna Ladogana
- Department of Neuroscience, Istituto Superiore di Sanità, Rome, Italy
| | - Sabina Capellari
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Elena Sabattini
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Piero Parchi
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Bologna, Italy
- IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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5
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Pina-Oviedo S, Roggli VL, Sporn TA, Li H, Glass C, DiBernardo LR, Pavlisko EN. Diagnostic Approach to Pulmonary B-Cell Lymphomas in Small Biopsies, with Practical Recommendations to Avoid Misinterpretation. Diagnostics (Basel) 2023; 13:3321. [PMID: 37958219 PMCID: PMC10650405 DOI: 10.3390/diagnostics13213321] [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: 10/01/2023] [Revised: 10/15/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Pulmonary lymphomas are rare. With the current less invasive approaches used to obtain material for diagnosis, the diagnosis of pulmonary lymphoma is now frequently established in a small biopsy rather than in a resection. Therefore, the diagnosis has become more challenging and requires correlation with the clinico-radiologic presentation and with ancillary studies (immunohistochemistry, flow cytometry, cytogenetics, and/or molecular analysis). Due to the rarity of pulmonary lymphomas, clinical suspicion of a lymphomatous process is low at initial presentation, and material may be only submitted for histopathology. For this reason, herein, we provide recommendations to arrive at the correct diagnosis of the most common lung B-cell lymphomas (marginal zone lymphoma of mucosa-associated lymphoid tissue, diffuse large B-cell lymphoma, intravascular large B-cell lymphoma, lymphomatoid granulomatosis) in the setting of small biopsies, utilizing only immunohistochemistry. The differential diagnosis varies according to the lymphoma subtype and includes reactive conditions, solid tumors, and other hematolymphoid malignancies. Although morphology and immunohistochemistry may be sufficient to establish a diagnosis, in some cases, the best recommendation is to obtain additional tissue via a VATS biopsy/wedge resection with material submitted for flow cytometry, cytogenetics, and/or molecular studies to be able to properly classify a pulmonary lymphoid process.
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Affiliation(s)
- Sergio Pina-Oviedo
- Department of Pathology, Duke University Medical Center, Durham, NC 27710-4000, USA (E.N.P.)
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6
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Kitahara S, Kanazawa M, Natsumeda M, Sato A, Ishikawa M, Hara K, Tabe H, Makino K, Okamoto K, Fujita N, Kakita A, Fuji Y, Onodera O. Progressive conus medullaris lesions are suggestive of intravascular large B-cell lymphoma. Eur J Neurol 2023; 30:3236-3243. [PMID: 37350144 DOI: 10.1111/ene.15941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND AND PURPOSE Spinal cord lesions are observed in 40% of all central nervous system lesions in intravascular large B-cell lymphoma (IVLBCL). However, because IVLBCL is a very rare disease, its clinical features are not well defined, which may delay appropriate diagnosis and treatment, whilst the acute to subacute course of brain lesions in patients with IVLBCL is well established. Therefore, this study aimed to clarify the clinical features of spinal cord lesions in patients with IVLBCL. METHODS The medical records of patients with IVLBCL admitted to our hospital between 2010 and 2020 were searched. The inclusion criteria were preceding neurological symptoms without non-neurological symptoms and pathologically confirmed IVLBCL in various organs. Clinical features of spinal cord involvement in patients with IVLBCL were assessed and distinguished from those of brain involvement. RESULTS Sixteen consecutive patients with IVLBCL were divided into two groups: six patients with spinal involvement (spinal cord type) and 10 patients with brain involvement (brain type). In the spinal cord type, four patients had chronic progression and two had subacute progression. Acute progression (0% vs. 80.0%) and sudden onset (0% vs. 50.0%) occurred significantly less frequently in the spinal cord than in the brain. All spinal cord lesions involved the conus medullaris. CONCLUSIONS Spinal cord involvement in IVLBCL has a predominantly chronic progressive course that is exclusive to brain involvement. Conus medullaris lesions are suggestive of IVLBCL and are useful for early and accurate diagnosis and treatment.
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Affiliation(s)
- Sho Kitahara
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Masato Kanazawa
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Manabu Natsumeda
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Aki Sato
- Department of Neurology, Niigata City General Hospital, Niigata, Japan
| | - Masanori Ishikawa
- Department of Neurology, Niigata Prefectural Central Hospital, Niigata, Japan
| | - Kenju Hara
- Department of Neurology, Akita Red Cross Hospital, Akita, Japan
| | - Hiroyuki Tabe
- Department of Neurology, Niigata Prefectural Central Hospital, Niigata, Japan
| | - Kunihiko Makino
- Department of Neurology, Niigata Prefectural Shibata Hospital, Niigata, Japan
| | - Kouichirou Okamoto
- Department of Translational Research, Brain Research Institute, Niigata University, Niigata, Japan
| | - Nobuya Fujita
- Department of Neurology, Nagaoka Red Cross Hospital, Nagaoka, Japan
| | - Akiyoshi Kakita
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Yukihiko Fuji
- Department of Neurosurgery, Brain Research Institute, Niigata University, Niigata, Japan
| | - Osamu Onodera
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
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7
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Burningham KM, Patel RR, Gonzalez CD, Mauskar M, Vandergriff T, Goff HW. Western variant intravascular large B-cell lymphoma in an Indian man. JAAD Case Rep 2023; 40:8-10. [PMID: 37675066 PMCID: PMC10477727 DOI: 10.1016/j.jdcr.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Ravi R. Patel
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Cristian D. Gonzalez
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Melissa Mauskar
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Travis Vandergriff
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Heather W. Goff
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
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8
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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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9
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Zhao CW, Fan TH, Denize T, Coraini A, Kraft A, Kumar AM, Gao LG, Lorenzo ME, Duncan LM, Camargo Faye EC, Lin DJ. Intravascular Lymphoma as a Cause of Recurrent Strokes - Case Report and Review of the Literature. Neurohospitalist 2023; 13:419-424. [PMID: 37701250 PMCID: PMC10494820 DOI: 10.1177/19418744231183483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Abstract
Background Intravascular lymphoma is an uncommon cause of ischemic strokes. Because of its rarity and atypical pattern, most diagnoses are made post-mortem. Case study We present a case of a 68-year-old male with multiple cardiovascular risk factors and recent SARS-CoV-2 infection who presented with recurrent strokes. Because of his stroke risk factors, he was initially managed with a sequentially escalating antithrombotic regimen. A malignant process was low on the differential at this point given his lack of systemic symptoms. When he continued to have new strokes despite these measures, including a spinal cord infarct, a broad workup was sent including for hypercoagulable states, vasculitis, and intravascular lymphoma. Eventually, a skin biopsy of a cherry angioma returned positive for lymphoma cells. He was treated with methotrexate followed by chemotherapy and rituximab. Unfortunately, he did not improve and was made comfort measures only by his family. Conclusion This case illustrates the importance of considering intravascular lymphoma as a potential etiology of recurrent strokes, as early diagnosis and treatment are important for preventing irreversible neurological damage.
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Affiliation(s)
- Charlie Weige Zhao
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Tracey H. Fan
- Neurosciences Critical Care Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Thomas Denize
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | - Alba Coraini
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew Kraft
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Anusha M. Kumar
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Lucy G. Gao
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Mayra E. Lorenzo
- Department of Dermatology, Massachusetts General Hospital, Boston, MA, USA
| | - Lyn M. Duncan
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | | | - David J. Lin
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Neurosciences Critical Care Unit, Massachusetts General Hospital, Boston, MA, USA
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10
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Erol VB, Mutlu YG, Balik B, Mert A, Mergen S, Mergen M, Serin I, Cakir A, Ozden F, Sevindik OG. Intravascular B-cell lymphoma with generalized telangiectasias. J Dtsch Dermatol Ges 2023; 21:1025-1027. [PMID: 37401140 DOI: 10.1111/ddg.15148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 05/10/2023] [Indexed: 07/05/2023]
Affiliation(s)
- Vedat Bugra Erol
- Department of Internal Medicine, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Yaşa Gul Mutlu
- Department of Hematology, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Berrin Balik
- Department of Hematology, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Ali Mert
- Department of Internal Medicine, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Sena Mergen
- Department of Internal Medicine, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Mahmut Mergen
- Department of Internal Medicine, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Istemi Serin
- Department of Hematology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Aslı Cakir
- Department of Pathology, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Ferhat Ozden
- Department of Pathology, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Omur Gokmen Sevindik
- Department of Hematology, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
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11
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Erol VB, Mutlu YG, Balik B, Mert A, Mergen S, Mergen M, Serin I, Cakir A, Ozden F, Sevindik OG. Intravaskuläres B-Zell-Lymphom mit generalisierten Teleangiektasien. J Dtsch Dermatol Ges 2023; 21:1025-1028. [PMID: 37700402 DOI: 10.1111/ddg.15148_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 05/10/2023] [Indexed: 09/14/2023]
Affiliation(s)
- Vedat Bugra Erol
- Department of Internal Medicine, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Yaşa Gul Mutlu
- Department of Hematology, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Berrin Balik
- Department of Hematology, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Ali Mert
- Department of Internal Medicine, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Sena Mergen
- Department of Internal Medicine, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Mahmut Mergen
- Department of Internal Medicine, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Istemi Serin
- Department of Hematology, University of Health Sciences, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Aslı Cakir
- Department of Pathology, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Ferhat Ozden
- Department of Pathology, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Omur Gokmen Sevindik
- Department of Hematology, Istanbul Medipol University Faculty of Medicine, Istanbul, Turkey
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Liu W, Liu M, Guan M, Huang J, Xie P. Intravascular Large B-Cell Lymphoma Identified by PET/CT. Clin Nucl Med 2023; 48:528-529. [PMID: 37019128 DOI: 10.1097/rlu.0000000000004632] [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: 04/07/2023]
Abstract
ABSTRACT Intravascular large B-cell lymphoma is a rare subtype of extranodal invasive non-Hodgkin lymphoma, and the diagnosis is challenging. Here we report findings of 18 F-FDG PET/CT study in a case of intravascular large B-cell lymphoma invading bilateral lungs and kidneys in a 63-year-old woman. The PET/CT images showed diffuse increased FDG uptake in bilateral lungs and kidneys. Unexpectedly, there was no abnormal density on the CT images. The 18 F-FDG PET/CT seems to be valuable and sensitive in the diagnosis of intravascular large B-cell lymphoma.
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Affiliation(s)
- Wei Liu
- From the Department of Nuclear Medicine, The Third Hospital, Hebei Medical University, Shijiazhuang, Hebei, China
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13
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Jackson NR. Intravascular Large B-cell Lymphoma Presenting as Sudden Death. Am J Forensic Med Pathol 2023:00000433-990000000-00072. [PMID: 37093884 DOI: 10.1097/paf.0000000000000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
ABSTRACT Intravascular large B-cell lymphoma is a rare subset of non-Hodgkin lymphoma composed of mature B lymphoma cells confined to the intravascular space. This disease remains elusive because it lacks a discrete tumor mass, can affect any part of the body, and has vague symptoms paired with heterogeneous clinical findings resulting in delayed or missed accurate diagnosis, even at postmortem examination. This is a case of a woman who died within hours of presenting to the emergency department with a diagnosis of intravascular large B-cell lymphoma made through autopsy examination, adding to the knowledge of this rare disease and bringing it to the attention of practicing autopsy and forensic pathologists.
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14
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Zhong N. Clinical Spectrum, Diagnosis, and Treatment Outcome in Individuals With Intravascular Large B-cell Lymphoma Affecting the Nervous System: A Case Series. Cureus 2023; 15:e37007. [PMID: 37139035 PMCID: PMC10150837 DOI: 10.7759/cureus.37007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2023] [Indexed: 04/03/2023] Open
Abstract
We treated five patients, three females, and two males, with intravascular lymphoma that affected the central or peripheral nervous systems. We reviewed their clinical, laboratory, neuro-imaging, and pathological data and treatment outcomes. The median age of onset was 60 years, with a range of 39 to 69 years. Three patients presented with central nervous system symptoms only, such as confusion, aphasia, seizure, stroke, and ataxia. Three patients presented with systemic lymphoma stage B symptoms, one with peripheral nervous system symptoms, and one with multi-organ failure. Brain imaging revealed white matter lesions, infarcts, hemorrhages, or combinations. Histology showed CD20-positive B-lymphocytes confined to small-size vessels in autopsy or biopsy specimens from the brain or muscle, confirming the diagnosis of intravascular large B-cell lymphoma (IVLBL). The patient with multi-organ failure had diffuse infiltration to the spleen, liver, and kidney. Three patients died within three to four months after the clinical presentation and were diagnosed at autopsy. The other two were diagnosed by biopsy and underwent chemotherapy CHOP-R (cyclophosphamide, hydroxydaunorubicin, Oncovin, and prednisone) or MTX (methotrexate)+Rituximab. The median survival of the chemotherapy patients was 17.5 months, compared to three to four months in those who did not receive chemotherapy. Although IVLBL has distinct pathological features, its clinical presentation can be variable. The patient's best chance for survival depends on the early pathological diagnosis and prompt, aggressive chemotherapy.
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15
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Inagaki R, Inoue A, Miyazaki Y, Kanehisa K, Kunihiro J, Kondo T, Katayama E, Taniwaki M, Shigekawa S, Watanabe H, Kitazawa R, Kunieda T. Clinical utility of positron emission tomography leading to rapid and accurate diagnosis of intravascular large B-cell lymphoma presenting with the central nervous system symptoms alone: A case report and review of the literature. Surg Neurol Int 2023; 14:89. [PMID: 37025518 PMCID: PMC10070256 DOI: 10.25259/sni_1175_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/24/2023] [Indexed: 03/19/2023] Open
Abstract
Background:
Intravascular large B-cell lymphoma (IVLBCL) is a rare entity among large B-cell non-Hodgkin lymphomas and is often difficult to diagnose. We report the case of a patient with IVLBCL who presented with central nervous system (CNS) symptoms alone, in which positron emission tomography (PET) enabled a rapid and accurate diagnosis.
Case Description:
An 81-year-old woman was admitted to our hospital with a 3-month history of gradually progressive dementia and declining spontaneity. Magnetic resonance imaging revealed multiple hyperintense lesions bilaterally on diffusion-weighted imaging without enhancement on gadolinium-enhanced T1-weighted imaging. Laboratory findings showed elevated serum lactate dehydrogenase (626 U/L) and soluble interleukin-2 receptor (sIL-2R) (4692 U/mL). Cerebrospinal fluid (CSF) analysis showed slightly elevated levels of protein (166 mg/dL) and lymphocytic cells (29/μL), and β2-microglobulin (β2-MG) (4.6 mg/L) was highly elevated. Whole-body computed tomography revealed faint ground-glass opacities in the upper and middle lung fields and diffuse enlargement of both kidneys without lymph node swelling. 18F-fluorodeoxyglucose (FDG)-PET showed diffuse and remarkably high FDG uptake in both upper lungs and kidneys without uptake by lymph nodes, suggesting a malignant hematological disease. IVLBCL was confirmed histologically by incisional random skin biopsy from the abdomen. Chemotherapy using R-CHOP regimen in combination with intrathecal methotrexate injection was started on day 5 after admission and follow-up neuroimaging showed no signs of recurrence.
Conclusion:
IVLBCL presenting with CNS symptoms alone is rare and often has a poor prognosis associated with delayed diagnosis, and various evaluations (including systemic analysis) are therefore necessary for early diagnosis. FDG-PET, in addition to identification of clinical symptoms and evaluation of serum sIL-2R and CSF β2-MG, enables rapid therapeutic intervention in IVLBCL presenting with CNS symptoms.
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Affiliation(s)
- Ryo Inagaki
- Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan
| | - Akihiro Inoue
- Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan
| | - Yukihiro Miyazaki
- Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University School of Medicine, Toon, Japan
| | - Kota Kanehisa
- Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan
| | - Joji Kunihiro
- Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan
| | - Takuya Kondo
- Division of Diagnostic Pathology, Ehime University Hospital, Toon, Japan
| | - Eiji Katayama
- Division of Diagnostic Pathology, Ehime University Hospital, Toon, Japan
| | - Mashio Taniwaki
- Division of Diagnostic Pathology, Ehime University Hospital, Toon, Japan
| | - Seiji Shigekawa
- Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan
| | - Hideaki Watanabe
- Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan
| | - Riko Kitazawa
- Division of Diagnostic Pathology, Ehime University Hospital, Toon, Japan
| | - Takeharu Kunieda
- Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan
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16
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Edwards D, Gelber AC, Sennett R, Jedrych J, Simpson CE, Wells JA. Clear and Bright: An Elusive Cause of Hypoxemia. Am J Med 2023; 136:273-276. [PMID: 36252706 DOI: 10.1016/j.amjmed.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 10/02/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Diep Edwards
- The Thayer Firm, Osler Medical Service, Johns Hopkins Hospital, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Allan C Gelber
- The Thayer Firm, Osler Medical Service, Johns Hopkins Hospital, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rachel Sennett
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jaroslaw Jedrych
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Catherine E Simpson
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John A Wells
- The Thayer Firm, Osler Medical Service, Johns Hopkins Hospital, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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17
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Mattei C, Oevermann A, Schweizer D, Guevar J, Maddox TW, Fleming KL, Ricci E, Rosati M, Biserni R, Iv JFG, Rupp A, Gutierrez-Quintana R, Masseau I, Newkirk KM, Hecht S, Specchi S. MRI ischemic and hemorrhagic lesions in arterial and venous territories characterize central nervous system intravascular lymphoma in dogs. Vet Radiol Ultrasound 2023; 64:294-305. [PMID: 36329600 DOI: 10.1111/vru.13165] [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: 04/29/2022] [Revised: 08/02/2022] [Accepted: 08/06/2022] [Indexed: 11/06/2022] Open
Abstract
Intravascular lymphoma (IVL) is characterized by the proliferation of large malignant lymphocytes within the lumen of blood vessels. This retrospective, multi-center, case series study aimed to describe the MRI features of confirmed central nervous system IVL in dogs and compare them with histopathological findings. Medical record databases from seven veterinary centers were searched for cases of histologically confirmed IVL. Dogs were included if an MRI was performed. The MRI studies and histopathology samples were reviewed to compare the MRI changes with the histopathological findings. Twelve dogs met the inclusion criteria (12 brains and three spinal cords). Imaging of the brains revealed multifocal T2-weighted/FLAIR hyperintense and T1-weighted iso-hypointense lesions, with variable contrast enhancement; areas of abnormal diffusion both in arterial and venous territories in diffusion-weighted imaging; and meningeal enhancement. On gradient echo images (GRE), the changes comprised tubular susceptibility artifacts, consistent with the "susceptibility vessel sign", and additional variably sized/shaped intraparenchymal susceptibility artifacts. Spinal cord lesions presented as fusiform T2-weighted hyperintensities with scattered susceptibility artifacts on GRE and variable parenchymal and meningeal contrast enhancement. On histopathology, subarachnoid hemorrhages and neuroparenchymal areas of edema and necrosis, with or without hemorrhage, indicating ischemic and hemorrhagic infarctions, were found. These lesions were concurrent with severely dilated meningeal and parenchymal arteries and veins plugged by neoplastic lymphocytes and fibrin. Due to the unique angiocentric distribution of IVL, ischemic and hemorrhagic infarcts of variable chronicity affecting both the arterial and venous territories associated with thrombi formation can be detected on MRI.
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Affiliation(s)
- Chiara Mattei
- Diagnostic Imaging Department (Mattei, Specchi) and Neurology Department (Biserni), Ospedale Veterinario "I Portoni Rossi", Anicura Italy, Zola Predosa, Italy
| | - Anna Oevermann
- Division of Neurological Sciences, Department of Clinical Research and Veterinary Public Health (Oevermann), Division of Clinical Radiology, Department of Clinical Veterinary Medicine (Schweizer), Division of Small Animal Surgery, Department of Clinical Veterinary Sciences (Guevar), Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Daniela Schweizer
- Division of Neurological Sciences, Department of Clinical Research and Veterinary Public Health (Oevermann), Division of Clinical Radiology, Department of Clinical Veterinary Medicine (Schweizer), Division of Small Animal Surgery, Department of Clinical Veterinary Sciences (Guevar), Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Julien Guevar
- Division of Neurological Sciences, Department of Clinical Research and Veterinary Public Health (Oevermann), Division of Clinical Radiology, Department of Clinical Veterinary Medicine (Schweizer), Division of Small Animal Surgery, Department of Clinical Veterinary Sciences (Guevar), Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Thomas W Maddox
- Department of Musculoskeletal and Ageing Sciences- Institute of Life Course and Medical Science- Faculty of Health & Life Sciences (Maddox), Department of Veterinary Science- School of Veterinary Science (Fleming), Department of Veterinary Anatomy- Physiology and Pathology- Institute of Infection- Veterinary and Ecological Sciences (Ricci), University of Liverpool, Neston, UK
| | - Kathryn L Fleming
- Department of Musculoskeletal and Ageing Sciences- Institute of Life Course and Medical Science- Faculty of Health & Life Sciences (Maddox), Department of Veterinary Science- School of Veterinary Science (Fleming), Department of Veterinary Anatomy- Physiology and Pathology- Institute of Infection- Veterinary and Ecological Sciences (Ricci), University of Liverpool, Neston, UK
| | - Emanuele Ricci
- Department of Musculoskeletal and Ageing Sciences- Institute of Life Course and Medical Science- Faculty of Health & Life Sciences (Maddox), Department of Veterinary Science- School of Veterinary Science (Fleming), Department of Veterinary Anatomy- Physiology and Pathology- Institute of Infection- Veterinary and Ecological Sciences (Ricci), University of Liverpool, Neston, UK
| | - Marco Rosati
- Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Roberta Biserni
- Diagnostic Imaging Department (Mattei, Specchi) and Neurology Department (Biserni), Ospedale Veterinario "I Portoni Rossi", Anicura Italy, Zola Predosa, Italy
| | - John F Griffin Iv
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Angie Rupp
- Small Animal Hospital (Gutierrez-Quintana), Division of Pathology, Public Health and Disease Investigation (Rupp), School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Rodrigo Gutierrez-Quintana
- Small Animal Hospital (Gutierrez-Quintana), Division of Pathology, Public Health and Disease Investigation (Rupp), School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Isabelle Masseau
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Quebec, Canada
| | - Kimberly M Newkirk
- Department of Biomedical and Diagnostic Sciences (Newkirk), Department of Small Animal Clinical Sciences (Hecht), University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, USA
| | - Silke Hecht
- Department of Biomedical and Diagnostic Sciences (Newkirk), Department of Small Animal Clinical Sciences (Hecht), University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, USA
| | - Swan Specchi
- Diagnostic Imaging Department (Mattei, Specchi) and Neurology Department (Biserni), Ospedale Veterinario "I Portoni Rossi", Anicura Italy, Zola Predosa, Italy
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18
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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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19
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Rivers D, Gunnell S, Clark J, Lenehan R, Phenis R, Shan Y, Castro E. Clinical Reasoning: A 66-Year-Old Woman With Progressive Encephalopathy and Bilateral Hearing Loss. Neurology 2023; 100:254-258. [PMID: 36332986 DOI: 10.1212/wnl.0000000000201536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Dustin Rivers
- From the Department of Neurology (D.R., S.G., J.C., R.L., P.D.), Baylor Scott & White, Temple, TX; and Department of Pathology (Y.S., E.C.), Baylor Scott & White, Temple, TX.
| | - Spencer Gunnell
- From the Department of Neurology (D.R., S.G., J.C., R.L., P.D.), Baylor Scott & White, Temple, TX; and Department of Pathology (Y.S., E.C.), Baylor Scott & White, Temple, TX
| | - Jeffrey Clark
- From the Department of Neurology (D.R., S.G., J.C., R.L., P.D.), Baylor Scott & White, Temple, TX; and Department of Pathology (Y.S., E.C.), Baylor Scott & White, Temple, TX
| | - Richard Lenehan
- From the Department of Neurology (D.R., S.G., J.C., R.L., P.D.), Baylor Scott & White, Temple, TX; and Department of Pathology (Y.S., E.C.), Baylor Scott & White, Temple, TX
| | - Richard Phenis
- From the Department of Neurology (D.R., S.G., J.C., R.L., P.D.), Baylor Scott & White, Temple, TX; and Department of Pathology (Y.S., E.C.), Baylor Scott & White, Temple, TX
| | - Yuan Shan
- From the Department of Neurology (D.R., S.G., J.C., R.L., P.D.), Baylor Scott & White, Temple, TX; and Department of Pathology (Y.S., E.C.), Baylor Scott & White, Temple, TX
| | - Eduardo Castro
- From the Department of Neurology (D.R., S.G., J.C., R.L., P.D.), Baylor Scott & White, Temple, TX; and Department of Pathology (Y.S., E.C.), Baylor Scott & White, Temple, TX
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20
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Irigoín MV, Oliver C, Gualco G, de Galvez G. Intravascular large B-cell lymphoma presented as hemophagocytic lymphohistiocytosis. Hematol Transfus Cell Ther 2023; 45:116-118. [PMID: 34266808 PMCID: PMC9938482 DOI: 10.1016/j.htct.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/05/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Affiliation(s)
- Maria Victoria Irigoín
- Centro de Asistencia del Sindicato Médico del Uruguay, CASMU IAMPP, Montevideo, Uruguay.
| | - Carolina Oliver
- Centro de Asistencia del Sindicato Médico del Uruguay, CASMU IAMPP, Montevideo, Uruguay
| | | | - Gabriela de Galvez
- Centro de Asistencia del Sindicato Médico del Uruguay, CASMU IAMPP, Montevideo, Uruguay
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21
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Conus medullaris syndrome caused by intravascular large B cell lymphoma. Hematol Transfus Cell Ther 2023; 45:141-143. [PMID: 34924353 PMCID: PMC9938485 DOI: 10.1016/j.htct.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/09/2021] [Accepted: 11/02/2021] [Indexed: 02/06/2023] Open
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22
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Nehme A, Boulanger M, Aouba A, Pagnoux C, Zuber M, Touzé E, de Boysson H. Diagnostic and therapeutic approach to adult central nervous system vasculitis. Rev Neurol (Paris) 2022; 178:1041-1054. [PMID: 36156251 DOI: 10.1016/j.neurol.2022.05.003] [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: 04/20/2022] [Accepted: 05/16/2022] [Indexed: 12/14/2022]
Abstract
The clinical manifestations of central nervous system (CNS) vasculitis are highly variable. In the absence of a positive CNS biopsy, CNS vasculitis is particularly suspected when markers of both vascular disease and inflammation are present. To facilitate the clinical and therapeutic approach to this rare condition, CNS vasculitis can be classified according to the size of the involved vessels. Vascular imaging is used to identify medium vessel disease. Small vessel disease can only be diagnosed with a CNS biopsy. Medium vessel vasculitis usually presents with focal neurological signs, while small vessel vasculitis more often leads to cognitive deficits, altered level of consciousness and seizures. Markers of CNS inflammation include cerebrospinal fluid pleocytosis or elevated protein levels, and vessel wall, parenchymal or leptomeningeal enhancement. The broad range of differential diagnoses of CNS vasculitis can be narrowed based on the disease subtype. Common mimickers of medium vessel vasculitis include intracranial atherosclerosis and reversible cerebral vasoconstriction syndrome. The diagnostic workup aims to answer two questions: is the neurological presentation secondary to a vasculitic process, and if so, is the vasculitis primary (i.e., primary angiitis of the CNS) or secondary (e.g., to a systemic vasculitis, connective tissue disorder, infection, malignancy or drug use)? In primary angiitis of the CNS, glucocorticoids and cyclophosphamide are most often used for induction therapy, but rituximab may be an alternative. Based on the available evidence, all patients should receive maintenance immunosuppression. A multidisciplinary approach is necessary to ensure an accurate and timely diagnosis and to improve outcomes for patients with this potentially devastating condition.
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Affiliation(s)
- A Nehme
- Normandie University, Caen, France; Department of Neurology, Caen University Hospital, Caen, France; Inserm UMR-S U1237 PhIND/BB@C, Caen, France.
| | - M Boulanger
- Normandie University, Caen, France; Department of Neurology, Caen University Hospital, Caen, France; Inserm UMR-S U1237 PhIND/BB@C, Caen, France
| | - A Aouba
- Normandie University, Caen, France; Department of Internal Medicine, Caen University Hospital, Caen, France
| | - C Pagnoux
- Vasculitis clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - M Zuber
- Department of Neurology, Saint-Joseph Hospital, Paris, France; Université Paris Cité, Paris, France
| | - E Touzé
- Normandie University, Caen, France; Department of Neurology, Caen University Hospital, Caen, France; Inserm UMR-S U1237 PhIND/BB@C, Caen, France
| | - H de Boysson
- Normandie University, Caen, France; Department of Internal Medicine, Caen University Hospital, Caen, France
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23
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Ying Y, Li X, Mei N, Liu X, Xie Y, Ruan Z, Yin B, Lu Y. Dominant susceptibility-weighted imaging features of intravascular large B-cell lymphoma with central nervous system involvement. Ann Hematol 2022; 101:2807-2808. [DOI: 10.1007/s00277-022-05008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022]
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24
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Goyal N, O’Leary D, Carter JB, Comfere N, Sokumbi O, Goyal A. A Practical Review of the Presentation, Diagnosis, and Management of Cutaneous B-Cell Lymphomas. Dermatol Clin 2022; 41:187-208. [DOI: 10.1016/j.det.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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25
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Acute Myeloid Leukemia in a Cholecystectomy Specimen. Case Rep Pathol 2022; 2022:2956052. [PMID: 36199751 PMCID: PMC9529482 DOI: 10.1155/2022/2956052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
A 76-year-old man was admitted into the ER for upper abdominal pain. Physical exam and CT scan confirmed acute cholecystitis with multiple cholelithis, and a cholecystectomy was performed. The cholecystectomy specimen showed chronic cholecystitis with exuberant inflammatory infiltrate. On careful examination of the specimen, large atypical cells with vesicular chromatin, folded nuclei, and inconspicuous red nucleoli were noted percolating into the gallbladder wall and lining vascular spaces. These cells were positive for CD117, CD43, and myeloperoxidase and negative for CD20 and CD3 stains. Further workup including peripheral blood flow cytometry confirmed a population of circulating immature myeloid precursors comprising about 38% of events. This is a rare case of acute myeloid leukemia that came to clinical attention by incidentally involving the gallbladder.
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26
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Renal Involvement of CD20-Negative Intravascular Large B Cell Lymphoma with Neurological Manifestations. Case Rep Nephrol 2022; 2022:8613965. [PMID: 36124007 PMCID: PMC9482497 DOI: 10.1155/2022/8613965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022] Open
Abstract
The involvement of hematological tumors such as lymphoma in the kidneys is a well-recognized phenomenon. Some of the distinct reported pathological processes resulting in kidney dysfunction include minimal change disease, lymphocytic invasion of the parenchyma, immune complex disposition, immunotactoid glomerulopathy, membranous glomerulopathy, and acute tubular injury. We report a rare case of CD20-negative intravascular lymphoma found on a kidney biopsy in a male with primary angiitis of the central nervous system (CNS) who presented with acute kidney injury and proteinuria. After the initiation of rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone (R-CHOP), kidney function improved and proteinuria resolved.
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27
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Lauer EM, Mutter J, Scherer F. Circulating tumor DNA in B-cell lymphoma: technical advances, clinical applications, and perspectives for translational research. Leukemia 2022; 36:2151-2164. [PMID: 35701522 PMCID: PMC9417989 DOI: 10.1038/s41375-022-01618-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 12/22/2022]
Abstract
Noninvasive disease monitoring and risk stratification by circulating tumor DNA (ctDNA) profiling has become a potential novel strategy for patient management in B-cell lymphoma. Emerging innovative therapeutic options and an unprecedented growth in our understanding of biological and molecular factors underlying lymphoma heterogeneity have fundamentally increased the need for precision-based tools facilitating personalized and accurate disease profiling and quantification. By capturing the entire mutational landscape of tumors, ctDNA assessment has some decisive advantages over conventional tissue biopsies, which usually target only one single tumor site. Due to its non- or minimal-invasive nature, serial and repeated ctDNA profiling provides a real-time picture of the genetic composition and facilitates quantification of tumor burden any time during the course of the disease. In this review, we present a comprehensive overview of technologies used for ctDNA detection and genotyping in B-cell lymphoma, focusing on pre-analytical and technical requirements, the advantages and limitations of various approaches, and highlight recent advances around improving sensitivity and suppressing technical errors. We broadly review potential applications of ctDNA in clinical practice and for translational research by describing how ctDNA might enhance lymphoma subtype classification, treatment response assessment, outcome prediction, and monitoring of measurable residual disease. We finally discuss how ctDNA could be implemented in prospective clinical trials as a novel surrogate endpoint and be utilized as a decision-making tool to guide lymphoma treatment in the future.
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Affiliation(s)
- Eliza M Lauer
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jurik Mutter
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Florian Scherer
- Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- German Cancer Consortium (DKTK) partner site Freiburg, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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28
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Kuhlman JJ, Moustafa MA, Jiang L, Iqbal M, Seegobin K, Wolcott Z, Ayala E, Ansell S, Rosenthal A, Paludo J, Micallef I, Johnston P, Inwards D, Habermann T, Kharfan-Dabaja M, Witzig TE, Nowakowski GS, Tun HW. Leukemic High Grade B Cell Lymphoma is Associated With MYC Translocation, Double Hit/Triple Hit Status, Transformation, and CNS Disease Risk: The Mayo Clinic Experience. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e815-e825. [PMID: 35534379 DOI: 10.1016/j.clml.2022.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/06/2022] [Accepted: 04/08/2022] [Indexed: 05/14/2023]
Abstract
INTRODUCTION Leukemic involvement in high grade B cell lymphoma (L-HGBL) is rare and has been sparsely described in the literature. We report our experience in a large single institution multicenter academic setting. MATERIALS AND METHODS Medical records of patients with HGBL who received care at Mayo Clinic between 2003 and 2020 were reviewed. L-HGBL was confirmed by peripheral blood smear and flow cytometry with corroboration from tissue and bone marrow biopsy findings. RESULTS Twenty patients met inclusion criteria. All patients had significant bone marrow involvement by HGBL. Leukemic involvement presented in 11 of 20 (55%) in the de novo and 9 of 20 (45%) in the relapsed setting. Seven of 20 patients had DLBCL, NOS, 6 of 20 had transformation (t-DLBCL), 3 of 20 had transformed double/triple hit lymphoma (t-DHL/THL), 2 of 20 had double hit lymphoma (DHL), and 2 of 20 had HGBL with intermediate features between DLBCL and Burkitt lymphoma. Nine of 15 patients had MYC translocation. Based on Hans criteria, 11 of 20 had germinal center B-cell (GCB) cell of origin (COO) and 9/20 had non-GCB COO. Five of 11 de novo patients experienced CNS relapse/progression. All de novo patients received anthracycline-based chemoimmunotherapy. Eighteen of 20 patients died of progressive disease. Median overall survival was significantly better in the de novo compared to relapsed group (8.9 months vs. 2.8 months, P = .01). COO, MYC status, DHL/THL status, HGBL subtype, or treatment group did not demonstrate a significant effect on overall survival. CONCLUSION L-HGBL carries a poor prognosis and is associated with MYC translocation, DHL/THL status, transformation, and high CNS risk. Novel therapeutic approaches are needed for L-HGBL.
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Affiliation(s)
| | | | - Liuyan Jiang
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Jacksonville, FL
| | - Madiha Iqbal
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | - Karan Seegobin
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | - Zoe Wolcott
- Department of Neurology, Mayo Clinic, Jacksonville, FL
| | - Ernesto Ayala
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL
| | - Steve Ansell
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - Allison Rosenthal
- Division of Hematology and Medical Oncology, Mayo Clinic, Scottsdale, AZ
| | - Jonas Paludo
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - Ivana Micallef
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - Patrick Johnston
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - David Inwards
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | - Thomas Habermann
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | | | - Thomas E Witzig
- Division of Hematology and Medical Oncology, Mayo Clinic, Rochester, MN
| | | | - Han W Tun
- Division of Hematology and Medical Oncology, Mayo Clinic, Jacksonville, FL.
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Seegobin K, Li Z, Alhaj Moustafa M, Majeed U, Wang J, Jiang L, Kuhlman J, Menke D, Li K, Kharfan-Dabaja MA, Ayala E, Iqbal M, Nowakowski GS, Habermann TM, Witzig TE, Johnston P, Thompson C, Ansell S, Tun HW. Clinical Characteristics, Prognostic Indicators, and Survival Outcomes in Intravascular Lymphoma: Mayo Clinic Experience (2003-2018). Am J Hematol 2022; 97:1150-1158. [PMID: 35713565 PMCID: PMC9541514 DOI: 10.1002/ajh.26635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022]
Abstract
Intravascular lymphoma (IVL) is a rare extranodal non‐Hodgkin lymphoma. We performed a retrospective analysis of 55 IVL patients who were treated at our institution 2003–2018. Median age at diagnosis was 68 years, and 64% were males. The most frequent presenting symptoms were skin rash 43% and weight loss 30%. MRI brain on IVL patients with CNS involvement (CNS‐IVL) showed multifocal involvement in 76% (13/17). 89% (17/19) of non‐CNS‐IVL patients with abnormal FDG‐PET had biopsy of an avid lesion resulting in definitive diagnosis. The top diagnostic biopsy site was the bone marrow (45%). 56% had multiorgan involvement. Based on CNS involvement, 36.5% (20/55) had CNS‐IVL and 63.5% (35/55) had non‐CNS‐IVL. CNS‐IVL group consists of clinically isolated CNS involvement (CNS‐only IVL) (22%;12/55) and mixed clinical CNS and peripheral site involvement (M‐IVL) (14.5%; 8/55). Non‐CNS‐IVL group consists of clinically isolated skin involvement (skin‐only IVL) (9%; 5/55) and peripheral IVL with or without skin involvement (P‐IVL); (54.5%; 30/55). Skin involvement was predominantly in the lower extremities. Pathologically, 89% (48/54) were B‐cell IVL. Rituximab + high‐dose methotrexate‐based regimen were used in 75% (12/16) of CNS‐IVL patients and RCHOP in 60% (17/28) of non‐CNS‐IVL patients. Estimated 5‐year progression free survival (PFS) and overall survival (OS) for the entire cohort were 38.6% and 52%, respectively. Skin‐only IVL was associated with excellent survival. Platelet count <150x109/L, age > 60Y, and treatment without Rituximab were poor prognostic factors. Further research is necessary to identify novel therapies.
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Affiliation(s)
- Karan Seegobin
- Department of Haematology and Medical Oncology, Mayo Clinic Jacksonville, Florida
| | - Zhuo Li
- Department of Biomedical Statistics and Informatics, Mayo Clinic Jacksonville, Florida
| | | | - Umair Majeed
- Department of Haematology and Medical Oncology, Mayo Clinic Jacksonville, Florida
| | - Jing Wang
- Department of Internal Medicine, Mayo Clinic Jacksonville, Florida
| | - Liuyan Jiang
- Department of Pathology, Mayo Clinic Jacksonville, Florida
| | - Justin Kuhlman
- Department of Internal Medicine, Mayo Clinic Jacksonville, Florida
| | - David Menke
- Department of Pathology, Mayo Clinic Jacksonville, Florida
| | - Ke Li
- Department of Pathology, Mayo Clinic Jacksonville, Florida
| | | | - Ernesto Ayala
- Department of Haematology and Medical Oncology, Mayo Clinic Jacksonville, Florida
| | - Madiha Iqbal
- Department of Haematology and Medical Oncology, Mayo Clinic Jacksonville, Florida
| | - Grzegorz S Nowakowski
- Department of Haematology and Medical Oncology, Mayo Clinic Rochester, Minnesota, United States
| | - Thomas M Habermann
- Department of Haematology and Medical Oncology, Mayo Clinic Rochester, Minnesota, United States
| | - Thomas E Witzig
- Department of Haematology and Medical Oncology, Mayo Clinic Rochester, Minnesota, United States
| | - Patrick Johnston
- Department of Haematology and Medical Oncology, Mayo Clinic Rochester, Minnesota, United States
| | - Carrie Thompson
- Department of Haematology and Medical Oncology, Mayo Clinic Rochester, Minnesota, United States
| | - Stephen Ansell
- Department of Haematology and Medical Oncology, Mayo Clinic Rochester, Minnesota, United States
| | - Han W Tun
- Department of Haematology and Medical Oncology, Mayo Clinic Jacksonville, Florida
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Allen J, Shaikh A, Laurent-Ariot K, Merola M. A Rare Case of Intravascular Large B-cell Lymphoma Presenting With Bilateral Ophthalmoplegia, Along With a Literature Review. Cureus 2022; 14:e25920. [PMID: 35844347 PMCID: PMC9280704 DOI: 10.7759/cureus.25920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 11/23/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a subtype of extranodal lymphoma that characteristically contains malignant lymphocytes within blood vessels. The clinical presentation of IVLBCL has high variability. In our case, the patient’s initial presentation involved bilateral ptosis, restricted extraocular movements, periorbital pain, and bitemporal headache. The patient denied the classic “B symptoms” such as fever, night sweats, or weight loss. The patient also denied a family history of malignancy. Initial imaging studies were unremarkable, making diagnosis particularly challenging. Ultimately, functional endoscopic sinus surgery was performed. Pathological examination of the intraoperative specimen revealed a CD5+ large B-cell lymphoma within the vessels involving the left ethmoid sinus, respiratory mucosa, and nasal septum. The patient underwent steroid therapy prior to diagnosis, which led to rapid improvement in headache and mild improvement in extraocular function and ptosis. Following diagnosis, the patient underwent chemotherapy with supportive medications. Our case report may be considered a reference for cases presenting with extensive bilateral extraocular muscle deficits and levator palpebrae dysfunction in the absence of notable initial imaging findings, “B symptoms,” or positive family history. The teaching point from this case is to demonstrate the difficulty of diagnosis and our train of thought in investigating an abnormal presentation with no clearly identifiable etiology following initial diagnostic workup and treatment.
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Bonnet A, Bossard C, Gabellier L, Rohmer J, Laghmari O, Parrens M, Sarkozy C, Dulery R, Roland V, Llamas-Gutierrez F, Oberic L, Fornecker LM, Bounaix L, Villemagne B, Szablewski V, Choquet S, Bouabdallah K, Traverse-Glehen A, Mohty M, Sanhes L, Houot R, Gastinne T, Leux C, Le Gouill S. Clinical presentation, outcome, and prognostic markers in patients with intravascular large B-cell lymphoma, a lymphoma study association (LYSA) retrospective study. Cancer Med 2022; 11:3602-3611. [PMID: 35538643 PMCID: PMC9554445 DOI: 10.1002/cam4.4742] [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] [Received: 09/06/2021] [Revised: 12/03/2021] [Accepted: 12/23/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Intravascular large B-cell lymphoma (lVLBCL) is a very rare type of large B-cell lymphoma. METHODS We conducted a retrospective study on IVLBCL patients treated from 2000 to 2016 in LYSA cooperative group centers. RESULTS Sixty-five patients were identified in 23 centers. Median age at diagnosis was 69 years (range 23-92). Thirty-four patients (64%) had an IPI score >3 and 40 patients (67%) had a performance status ≥2. The most frequent extra-nodal locations were bone marrow (n = 34; 52%), central nervous system (n = 25; 39%), and skin (n = 21; 33%). Nodal involvement and endocrine system were observed in 34% (n = 22) and 18% (n = 12) of all cases, respectively. Twenty-six patients (41%) had macrophage activation syndrome. Tumor cells were frequently CD5 positive (52%) with a non-germinal center origin (86%). BCL2 was expressed in 87% of all samples analyzed (n = 20) and 43% of patients had a MYC/BCL2 double expression. Fifty-six patients were treated with a regimen of chemotherapy containing rituximab, among whom 73% reached complete remission. The median progression-free survival (PFS) and median overall survival (OS) were 29.4 months and 63.8 months, respectively. History of autoimmune disorder (Hazard ratio [HR] 3.3 [1.4-7.8]; p < 0.01), nodal involvement (HR 2.6 [1.4-5.1]; p < 0.01), lack of anthracycline (HR 0.1 [0-0.4] for use; p < 0.001), or no intensification at first-line regimen (p = 0.02) were associated with worse PFS. High-dose methotrexate use was not associated with better PFS or OS. CONCLUSIONS Our study highlights the aggressive clinical picture of IVLBCL, in particular the frequency of macrophage activation syndrome, and the need for new therapies despite a response to R-CHOP-like regimen similar to non-intravascular diffuse large B-cell lymphomas.
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Affiliation(s)
| | - Céline Bossard
- Service d'anatomie et cytologie pathologique, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Ludovic Gabellier
- Service d'hématologie, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Julien Rohmer
- Service d'hématologie, Hôpital Pitié - Salpêtrière - APHP, Sorbonne Université, Paris, France
| | - Othman Laghmari
- Service d'anatomie et cytologie pathologique, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Marie Parrens
- Département de pathologie, Hôpital Haut-Lévêque, CHU et université de Bordeaux, Bordeaux, France
| | | | - Rémy Dulery
- Service d'hématologie clinique et thérapie cellulaire, Hôpital Saint-Antoine, AP-HP, Université Sorbonne, INSERM, Centre de recherche Saint-Antoine, Paris, France
| | - Virginie Roland
- Centre Hospitalier de Perpignan, Service d'hématologie, Perpignan, France
| | | | - Lucie Oberic
- Service d'hématologie, Centre Hospitalier Universitaire Toulouse, Institut Universitaire du Cancer de Toulouse Oncopole, Toulouse, France
| | - Luc-Matthieu Fornecker
- Service d'hématologie, Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France
| | - Laura Bounaix
- Service de thérapie cellulaire et d'hématologie clinique adulte, Centre Hospitalier Universitaire Clermont-Ferrand, site Estaing, Clermont-Ferrand, France
| | - Bruno Villemagne
- Service d'onco-hématologie médecine interne, Centre Hospitalier Départemental Vendée, La Roche sur Yon, France
| | - Vanessa Szablewski
- Service d'anatomopathologie, Centre Hospitalier Universitaire Montpellier, Montpellier, France
| | - Sylvain Choquet
- Service d'hématologie, Hôpital Pitié - Salpêtrière - APHP, Sorbonne Université, Paris, France
| | - Krimo Bouabdallah
- Service d'hématologie clinique et thérapie cellulaire, Hôpital Haut-Lévèque, CHU Bordeaux, Bordeaux, France
| | | | - Mohamad Mohty
- Service d'hématologie clinique et thérapie cellulaire, Hôpital Saint-Antoine, AP-HP, Université Sorbonne, INSERM, Centre de recherche Saint-Antoine, Paris, France
| | - Laurence Sanhes
- Centre Hospitalier de Perpignan, Service d'hématologie, Perpignan, France
| | - Roch Houot
- Service d'hématologie, CHU Rennes, University of Rennes, INSERM U1236, Rennes, France
| | | | - Christophe Leux
- Service d'information médicale, Centre Hospitalier Universitaire Nantes, Nantes, France
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Wang J, Alhaj Moustafa M, Kuhlman JJ, Seegobin K, Jiang L, Gupta V, Tun HW. Intravascular Large B Cell Lymphoma with CNS Involvement Successfully Treated with High-Dose Methotrexate and High-Dose Ara-C Based CNS-Directed Chemoimmunotherapy Alternating with Anthracycline Based Chemoimmunotherapy. Blood Lymphat Cancer 2022; 12:47-54. [PMID: 35642208 PMCID: PMC9148600 DOI: 10.2147/blctt.s362736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/18/2022] [Indexed: 01/14/2023] Open
Abstract
Intravascular large B cell lymphoma (IVL) is a rare subtype of diffuse large B cell lymphoma confined to small blood vessels with a predilection for CNS involvement. The prognosis of IVL with CNS involvement (CNS-IVL) is extremely poor. The optimal treatment for CNS-IVL is not well defined. Thus, we report three patients with CNS-IVL successfully treated with a CNS-centric approach consisting of high-dose methotrexate (HDMTX) and high-dose Ara-C (HiDAC) based CNS-directed chemoimmunotherapy (CIT) alternating with anthracycline-based CIT. Our rationale for intensifying the CNS-directed therapy is the presence of intracerebral bleeding in two of our patients which would result in extravasation of lymphoma cells into the cerebral parenchyma with the development of CNS lymphoma. All three patients have achieved excellent therapeutic outcomes. Two patients with intracerebral bleeding have been in complete remission (CR) for about 11 years and 4 years. One patient was successfully induced into CR about 10 months ago and currently is in CR. This unique therapeutic approach should be further explored for CNS-IVL.
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Affiliation(s)
- Jing Wang
- Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, 32224, USA
| | - Muhamad Alhaj Moustafa
- Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville, FL, 32224, USA
| | - Justin J Kuhlman
- Department of Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, 32224, USA
| | - Karan Seegobin
- Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville, FL, 32224, USA
| | - Liuyan Jiang
- Department of Pathology and Laboratory Medicine, Mayo Clinic Florida, Jacksonville, FL, 32224, USA
| | - Vivek Gupta
- Department of Radiology, Mayo Clinic Florida, Jacksonville, FL, 32224, USA
| | - Han W Tun
- Division of Hematology and Medical Oncology, Mayo Clinic Florida, Jacksonville, FL, 32224, USA
- Correspondence: Han W Tun, Mayo Clinic Florida Division of Hematology/Oncology, 4500 San Pablo Road S, Jacksonville, FL, 32224, USA, Tel +1 904-953-2000, Email
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Intravascular Large B-Cell Lymphoma: A Review with a Focus on the Prognostic Value of Skin Involvement. Curr Oncol 2022; 29:2909-2919. [PMID: 35621627 PMCID: PMC9139413 DOI: 10.3390/curroncol29050237] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/06/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is an aggressive Non-Hodgkin lymphoma (NHL) characterised by the presence of neoplastic lymphoid cells within small- and medium-sized blood vessels. According to the clinical presentation, the current WHO classification distinguishes the ‘classic’ (formerly ‘Western’) from a hemophagocytic syndrome-associated (formerly ‘Asian’) variant. A third ‘cutaneous’ variant has been proposed, characterised by a good prognosis and unique clinical features. While laboratory findings can hint at diagnosis, symptoms are rather nonspecific, and deep skin biopsy supported by further measures such as bone marrow aspiration and positron emission tomography-computed tomography scanning is needed to make a definite diagnosis. Treatment is comprised of anthracycline-based chemotherapy supplemented with rituximab and central nervous system prophylaxis. While there are various prognostic models for NHL, only one is specific to IVLBCL, which does not sufficiently represent some patient groups, especially regarding the lack of differentiation within the patient collective with skin involvement. This underlines the necessity for the establishment of further prognostic models in particular for IVLBCL patients with cutaneous manifestations.
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34
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Kato H, Miyazaki S, Yabu K, Sawada Y, Kondo Y, Aoyama T, Nara Y, Yano M. Intravascular lymphoma masquerading as septic shock. Clin Case Rep 2022; 10:e05656. [PMID: 35414928 PMCID: PMC8981898 DOI: 10.1002/ccr3.5656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/19/2022] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
Intravascular lymphoma (IVL) is a rare type of extranodal lymphoma that selectively affects small blood vessels. We report a patient who presented with dyspnea and weight loss as well as refractory shock and multiple‐organ dysfunction. The postmortem revealed disseminated involvement of an IVL but no evidence of infection.
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Affiliation(s)
- Hiroki Kato
- Department of Gastroenterology Yokkaichi Municipal Hospital Yokkaichi Japan
| | - Shinichi Miyazaki
- Department of Respiratory Medicine Yokkaichi Municipal Hospital Yokkaichi Japan
| | - Kodai Yabu
- Department of Hematology Yokkaichi Municipal Hospital Yokkaichi Japan
| | - Yumi Sawada
- Department of Dermatology Yokkaichi Municipal Hospital Yokkaichi Japan
| | - Yuki Kondo
- Department of Respiratory Medicine Yokkaichi Municipal Hospital Yokkaichi Japan
| | - Tadashi Aoyama
- Department of Anesthesiology and Critical Care Medicine Yokkaichi Municipal Hospital Yokkaichi Japan
| | - Yoshiharu Nara
- Department of Pathology Yokkaichi Municipal Hospital Yokkaichi Japan
| | - Motoyoshi Yano
- Department of Gastroenterology Yokkaichi Municipal Hospital Yokkaichi Japan
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35
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Qiu L, Wang SA, Vega F, Khoury JD, Tang Z, Garces S, Medeiros LJ, Thakral B. From the archives of MD Anderson Cancer Center: Intravascular large B-cell lymphoma with numerous circulating lymphoma cells. Ann Diagn Pathol 2022; 58:151934. [DOI: 10.1016/j.anndiagpath.2022.151934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 02/23/2022] [Accepted: 03/04/2022] [Indexed: 11/01/2022]
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36
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Wang D, Marous CL, Ozay F, Timashpolsky A, Gulati RD, Gottesman SRS, Boruk M, Shinder R, Hodgson NM. Intravascular Large B-cell Lymphoma Diagnosed by Nasal Biopsy in a Patient Presenting with Bilateral Ptosis and Ophthalmoplegia. Orbit 2022:1-5. [PMID: 35226576 DOI: 10.1080/01676830.2022.2034170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare type of lymphoma, involving the lumen of predominantly small blood vessels, especially capillaries. The orbit is an uncommon site of involvement for IVLBCL, and diagnosis before autopsy is even more rare as most cases are established post-mortem. Herein, the authors describe a 73-year-old male who presented with 3 weeks of progressive bilateral ptosis and ophthalmoplegia. Computed tomography (CT) and subsequent magnetic resonance imaging (MRI) revealed diffuse abnormal thickening and enhancement of bilateral orbital apices, superior orbital fissures, and cavernous sinus, along with persistent focal opacification of the left frontal and ethmoid sinuses. Infectious and inflammatory workup of serum and cerebrospinal fluid was negative. Ethmoidal sinus and middle turbinate biopsy confirmed intravascular large B-cell lymphoma and the patient was started on R-CHOP chemotherapy regimen.
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Affiliation(s)
- Diane Wang
- Department of Ophthalmology, Suny Downstate Medical Center. Brooklyn, New York, USA
| | - Charlotte L Marous
- Department of Ophthalmology, Suny Downstate Medical Center. Brooklyn, New York, USA
| | - Fatih Ozay
- Department of Pathology, Suny Downstate Medical Center, Brooklyn, New York, USA
| | - Alisa Timashpolsky
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Rahul D Gulati
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Susan R S Gottesman
- Department of Pathology, Suny Downstate Medical Center, Brooklyn, New York, USA.,Department of Cell Biology, Suny Downstate Medical Center, Brooklyn, New York, USA
| | - Marina Boruk
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Roman Shinder
- Department of Ophthalmology, Suny Downstate Medical Center. Brooklyn, New York, USA.,Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Nickisa M Hodgson
- Department of Ophthalmology, Suny Downstate Medical Center. Brooklyn, New York, USA
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Tsukamoto E, Tanei T, Kato T, Hasegawa T. Intravascular Large B-Cell Lymphoma Diagnosed by Open Brain Biopsy and Achievement of Remission After Early Initiation of Chemotherapy: Case Report. Cureus 2022; 14:e21971. [PMID: 35282552 PMCID: PMC8905658 DOI: 10.7759/cureus.21971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2022] [Indexed: 12/26/2022] Open
Abstract
A 60-year-old man presented with progressive disturbance of consciousness. His father had died of malignant lymphoma, while his mother and sister died of acute leukemia. Magnetic resonance imaging (MRI) revealed multiple high-intensity lesions in the bilateral cerebral hemispheres on diffusion-weighted images. Serum soluble interleukin 2 receptor was 5,640 U/mL. Screenings of blood antibodies known to rise in autoimmune diseases were all normal. Cerebrospinal fluid examinations demonstrated slight elevation of protein and glucose, while the oligoclonal band and myelin basic protein were not elevated. Biopsies of bone marrow and random skin did not show any malignant features. His consciousness gradually deteriorated over a week, with lesions in his right frontal, left temporal, and bilateral parietal lobes shown to be growing. Therefore, open brain biopsy was performed, and one block of the right frontal lesion was harvested. Histological examination revealed atypical large cells only in the capillaries. Although immunohistochemical examinations showed positive staining for CD20, they were negative for CD3. Histopathological diagnosis was intravascular large B-cell lymphoma. After undergoing six cycles of intravenous chemotherapy with rituximab, cyclophosphamide, doxorubicin, and prednisone, his consciousness and neurological symptoms improved, and he appeared to achieve remission. Two years later, there have been no apparent recurrences, and the brain lesions have disappeared.
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CUTANEOUS B-CELL LYMPHOMAS: UPDATE ON DIAGNOSIS, RISK-STRATIFICATION, AND MANAGEMENT. Presse Med 2022; 51:104109. [PMID: 35026390 DOI: 10.1016/j.lpm.2022.104109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/27/2021] [Indexed: 12/18/2022] Open
Abstract
PCBCLs are a group of Non-Hodgkin's B-cell lymphomas originating in and usually confined to the skin, representing approximately one fourth of primary cutaneous lymphomas (PCL). Their current classification system has been the result of the joint World Health Organization (WHO) - European Organization for Research and Treatment of Cancer (EORTC) consensus in 2018. To date, several types of PCBCLs have been described in the scientific literature, with different clinical presentation and prognosis. Primary cutaneous follicle-center lymphoma (PCFCL) and primary cutaneous marginal zone lymphoma (PCMZL) are the most common forms, with a typical indolent course. On the contrary, primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL, LT) is less common, yet more aggressive, with a reported 5-year overall survival of approximatively 50%. In this review, we outline the PCBCLs defining diagnostic criteria, report the features of the less common subtypes and summarize the noteworthy therapeutical options currently available in this field.
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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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40
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Fujimoto N, Fuse M, Kobayashi Y, Kabuto M, Iwasa M, Minamiguchi H. Intravascular large B-cell lymphoma diagnosed by skin biopsy of a cellulitis-like skin lesion: Case report and review of literature. DERMATOL SIN 2022. [DOI: 10.4103/ds.ds_9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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41
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Ho M, Zanwar S, Duggan P, Carr R, Habermann T, Navin PJ, Salama ME, Parikh SA. Hiding in (not so) plain sight: Spontaneous tumor Lysis syndrome due to intravascular large B cell lymphoma. Am J Hematol 2022; 97:151-159. [PMID: 34677833 DOI: 10.1002/ajh.26383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/08/2021] [Accepted: 10/17/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Matthew Ho
- Division of General Internal Medicine, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Saurabh Zanwar
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Patrick Duggan
- Division of General Internal Medicine, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Ryan Carr
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | - Thomas Habermann
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
| | | | - Mohamed E. Salama
- Division of Hematopathology, Department of Laboratory Medicine and Pathology Mayo Clinic Rochester Minnesota USA
| | - Sameer A. Parikh
- Division of Hematology, Department of Internal Medicine Mayo Clinic Rochester Minnesota USA
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TRIANGULAR SIGN OF AMALRIC IN INTRAVASCULAR LYMPHOMA. Retin Cases Brief Rep 2022; 16:20-24. [PMID: 32826773 DOI: 10.1097/icb.0000000000001042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE AND METHODS To report a case of bilateral ocular ischemia caused by intravascular lymphoma with the presence of bilateral triangular sign of Amalric. RESULTS A 67-year-old woman was admitted to our hospital for progressive paraplegia and a 6-month history of acute painless vision loss in the right eye. Initial examination showed vision of counting fingers in the right eye and 20/20 in the left eye with normal anterior examination. Fundus examination revealed a likely previous central retinal artery occlusion in the right eye with pale nerve and attenuated vessels. Both fundi had triangular regions of pigmentary change known as the triangular sign of Amalric, indicative of choroidal ischemia. However, the left eye was asymptomatic. Neuroimaging revealed multifocal enhancing lesions throughout the central nervous system of unclear etiology. An extensive neurologic and systemic workup was unrevealing, including a brain biopsy, and empiric treatment for an unspecified inflammatory condition with intravenous corticosteroids was initiated. During her hospitalization, she developed acute painless vision loss in the left eye, and examination showed no light perception vision in both eyes with signs of acute retinal and choroidal ischemia in the left eye. A subsequent brain biopsy revealed intravascular lymphoma. CONCLUSION Triangular pigmentary changes indicate choroidal ischemia and can be seen in many conditions. This patient presented with the triangular sign of Amalric in both eyes, including her asymptomatic left eye. Intravascular lymphoma should be considered in cases of concomitant inflammatory brain lesions and chorioretinal ischemia.
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Asakage M, Umazume K, Takoi H, Akahane D, Ishibashi Y, Yamaguchi H, Gondo M, Goto H. A case of intravascular lymphoma diagnosed with a primary vitreoretinal lymphoma-like fundus lesion. J Ophthalmic Inflamm Infect 2021; 11:47. [PMID: 34951670 PMCID: PMC8709800 DOI: 10.1186/s12348-021-00280-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose We report a case of intravascular lymphoma with primary vitreoretinal lymphoma-like fundus findings. Case A 61-year-old man with a one-week history of temporal visual field defect in the left eye was referred by a local ophthalmologist to our department. A yellowish-white raised patchy lesion was found in the nasal fundus of the left eye. Vitreoretinal lymphoma was suspected, and vitrectomy was performed in the left eye for diagnostic purpose. However, vitreous interleukin-10 concentration was low and no significant result was obtained. He had fever of around 38 °C, and respiratory failure that started 2 weeks before ophthalmological examination, worsened. Intravascular lymphoma was diagnosed from the results of histopathological examinations of transbronchial lung biopsy, bone marrow biopsy and random skin biopsy. With the start of systemic chemotherapy, the subretinal lesions shrank gradually and systemic condition was stable. However, 5 months after the start of chemotherapy, spread to the central nervous system was observed, and chimeric antigen receptor T cell (CAR-T) therapy was started in another hospital. After the start of CAR-T therapy, the subretinal lesions shrank further. Conclusions Intravascular lymphoma may be accompanied by primary vitreoretinal lymphoma-like intraocular lesions. If intraocular lesions are accompanied by systemic symptoms such as fever of unknown origin, the possibility of intravascular lymphoma should be suspected and systemic work-up should be performed.
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Wu M, Lin Y, Huang X, Zhang B. Intravascular large B-cell lymphoma presenting as rapidly progressive dementia and stroke: A case report. Medicine (Baltimore) 2021; 100:e27996. [PMID: 35049207 PMCID: PMC9191555 DOI: 10.1097/md.0000000000027996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Intravascular large B-cell lymphoma (IVLBCL) is a rare form of large B-cell non-Hodgkin lymphoma. The diagnosis is challenging and frequently made at biopsy. Here we reported a case of IVLBCL limited to the central nervous system (CNS) presenting with progressive dementia and acute stroke, who was diagnosed by brain biopsy. PATIENT CONCERNS A 47-year-old woman was transferred to our hospital with a 6-month history of rapidly progressive dementia, and left limb weakness and numbness for 3 days. She was successively misdiagnosed with inflammatory demyelinating disease and stroke. Her condition deteriorated with elevated lactate dehydrogenase and multiple hyperintense lesions on the brain. DIAGNOSIS She was diagnosed with IVLBCL limited to the CNS by brain biopsy. INTERVENTIONS Bone marrow puncture and incisional random skin biopsy were not found neoplastic cells. Computed tomography scans were normal with no evidence of disease outside the CNS. OUTCOMES The patient died due to rapid clinical aggravation. LESSONS IVLBCL limited to the CNS is an aggressive disease with high mortality. Making a timely and correct diagnosis is crucial for early appropriate treatment in IVLBCL patients.
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Affiliation(s)
- Ming Wu
- Department of Neurology, Longgang District People's Hospital of Shenzhen, China
| | - Yinyao Lin
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, China
| | - Xuehong Huang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, China
| | - Bingjun Zhang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, China
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Cabeçadas J, Nava VE, Ascensao JL, Gomes da Silva M. How to Diagnose and Treat CD5-Positive Lymphomas Involving the Spleen. Curr Oncol 2021; 28:4611-4633. [PMID: 34898558 PMCID: PMC8628806 DOI: 10.3390/curroncol28060390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/14/2022] Open
Abstract
Patients with CD5-expressing lymphomas presenting with splenomegaly are frequently diagnosed with chronic lymphocytic leukemia. The most important differential diagnosis is mantle cell lymphoma, both in its classical and leukemic, non-nodal forms, given its prognostic and therapeutic implications. Other small B-cell neoplasms that frequently involve the spleen and occasionally express CD5 include the splenic marginal zone lymphoma, hairy cell leukemia and, rarely, lymphoplasmacytic lymphoma. The frequency of CD5 positivity depends in part on the sensitivity of the detection methods employed. Usually, a combination of morphological, immunophenotypic and molecular findings allows for a precise sub-classification of CD5-positive, low-grade B-cell lymphomas of the spleen. Some of these tumors may display a mixture of small and larger B cells, raising the possibility of more aggressive lymphomas, such as diffuse large B-cell lymphomas (DLBCL). Approximately 5-10% of DLBCL are CD5-positive and some may manifest as primary splenic lesions. When available, the morphology of DLBCL in the splenic tissue is distinctive and a leukemic picture is very rare. In conclusion, the appropriate morphological and clinical context assisted by flow cytometry panels and/or immunohistochemistry allows the differential diagnosis of CD5-positive, non-Hodgkin, B-cell lymphomas involving the spleen.
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Affiliation(s)
- José Cabeçadas
- Department of Pathology, Portuguese Institute of Oncology Lisbon, 1099-023 Lisboa, Portugal;
| | - Victor E. Nava
- Department of Pathology, The George Washington University, Washington, DC 20037, USA;
- Department of Pathology, Veterans Health Administration Medical Center, Washington, DC 20422, USA
| | - Joao L. Ascensao
- School of Medicine, The George Washington University, Washington, DC 20037, USA;
| | - Maria Gomes da Silva
- Department of Hematology, Portuguese Institute of Oncology Lisbon, 1099-023 Lisboa, Portugal
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Barker JL, Swarup O, Puliyayil A. Intravascular large B-cell lymphoma: representative cases and approach to diagnosis. BMJ Case Rep 2021; 14:e244069. [PMID: 34728502 PMCID: PMC8565548 DOI: 10.1136/bcr-2021-244069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2021] [Indexed: 12/14/2022] Open
Abstract
Intravascular large B-cell lymphoma (ILBCL) is a subtype of non-Hodgkin's large B-cell lymphoma that is characterised by neoplastic lymphocyte proliferation within the lumen of small blood vessels, which may occur without an extracellular tumour mass or peripheral blood involvement. This report highlights some of the diagnostic issues for ILBCL, and how it can be approached. The two cases described below highlight two significantly different presentations, one with predominately neurological phenomena, and the other with fever of unknown origin for investigation. Both patients were managed with chemotherapy and intercalated intrathecal chemotherapy, with good clinical outcomes, without further evidence of clinical relapse. These cases along with a review of the literature highlight the key learning points in the difficulties in the diagnosis of this condition, and the appropriate use of random skin biopsy in patient suspected of having ILBCL, such as those with constitutional symptoms with otherwise negative malignancy screening, and unexplained neurological phenomena, especially if recurrent in nature.
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Affiliation(s)
- James Llewellyn Barker
- Department of Medicine, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, Albury Wodonga Health, Albury, NSW, Australia
- Border Medical Oncology and Haematology, Albury Wodonga Regional Cancer Centre, Albury, NSW, Australia
| | - Oshi Swarup
- Department of Medicine, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, Albury Wodonga Health, Albury, NSW, Australia
| | - Anish Puliyayil
- Border Medical Oncology and Haematology, Albury Wodonga Regional Cancer Centre, Albury, NSW, Australia
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Sunohara K, Shimizu R, Yasuda K, Owaki A, Nagaya H, Kajiguchi T, Inaba S. Chronic systemic capillary leak syndrome associated with an intravascular large B-cell lymphoma in a patient undergoing hemodialysis: a case report with literature review. RENAL REPLACEMENT THERAPY 2021. [DOI: 10.1186/s41100-021-00371-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Systemic capillary leak syndrome (SCLS) is a rare disorder characterized by hypotension, hemoconcentration, and hypoalbuminemia associated with increased capillary endothelium permeability. Patients with a chronic form of SCLS present with persistent and progressive generalized edema. However, there have been no reports of chronic SCLS in patients undergoing hemodialysis. Herein, we report a case of chronic SCLS associated with an intravascular large B-cell lymphoma (IVLBCL) in a patient undergoing hemodialysis.
Case presentation
A 71-year-old male had been on hemodialysis for five years due to diabetic nephropathy. Difficulty in body fluid removal was observed during hemodialysis, and the patient was admitted to our hospital due to exacerbated weight gain and lower limb edema. He had elevated serum lactate dehydrogenase (LDH) levels and thrombocytopenia. His blood pressure was low, and his serum brain natriuretic peptide level was relatively low, despite the increase in body fluid volume. His clinical characteristics suggested a chronic form of SCLS. Random skin biopsy revealed IVLBCL; however, the association between IVLBCL and chronic SCLS remained unclear. He underwent chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone, followed by rituximab. After the treatment, his serum LDH level decreased, and the difficulty in body fluid removal during hemodialysis improved. The patient’s chronic SCLS seemed to be complicated by IVLBCL.
Conclusions
Patients with chronic SCLS who are undergoing hemodialysis seem to present with difficulties in fluid removal. The frequency of SCLS complications in cases with malignant lymphomas, including IVLBCL, is considered to be extremely low. However, clinicians should be aware of SCLS as a complication of malignant lymphomas.
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Dou L, Wu C, Zeng Z, Zhu J, Su L, Wang T. Hemophagocytic syndrome and neurological involvement in a case of intravascular large B-cell lymphoma. J Int Med Res 2021; 49:3000605211006644. [PMID: 34590922 PMCID: PMC8489774 DOI: 10.1177/03000605211006644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare form of non-Hodgkin's lymphoma, and is divided into Western and Asian variants. The latter is rarely found to have neurological system involvement. In China, there have only been a few diagnosed cases of IVLBCL. Here, we present a Chinese case of Asian-variant IVLBCL with neurological symptoms. A 32-year-old Chinese man presented with bilateral lower limb numbness and persistent fever. He also complained of difficulties in urination and defecation. In addition, splenomegaly and pancytopenia were observed. We identified 3% dysplastic lymphocytes in his peripheral blood film, and his bone marrow biopsy led to a diagnosis of Asian-variant IVLBCL. Lumbar spine magnetic resonance imaging, which revealed an edematous spinal cord, further confirmed neurological involvement. The patient refused treatment from the time of diagnosis, and died 2 months after being discharged. IVLBCL is a highly aggressive but nonspecific clinical manifestation that is difficult to diagnose; therefore, a greater understanding of the disease is needed. The current first-line therapy involves R-CHOP combination therapy (cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab); however, the overall prognosis of IVLBCL remains poor.
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Affiliation(s)
- Liwen Dou
- Department of Emergency, Peking University People's Hospital, Beijing, China
| | - Chunbo Wu
- Department of Emergency, Peking University People's Hospital, Beijing, China
| | - Zhi Zeng
- Department of Emergency, Peking University People's Hospital, Beijing, China
| | - Jihong Zhu
- Department of Emergency, Peking University People's Hospital, Beijing, China
| | - Lina Su
- Department of Emergency, Peking University People's Hospital, Beijing, China
| | - Tianbing Wang
- Department of Trauma Center, Peking University People's Hospital, Beijing, China
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Lim CH, Yoon SE, Kim WS, Lee KH, Kim SJ. Imaging Features and Prognostic Value of FDG PET/CT in Patients with Intravascular Large B-Cell Lymphoma. Cancer Manag Res 2021; 13:7289-7297. [PMID: 34584455 PMCID: PMC8464312 DOI: 10.2147/cmar.s330308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/09/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose The clinical value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in intravascular large B-cell lymphoma (IVLBCL) is unknown. This study investigated the association between PET/CT features and prognosis in IVLBCL patients. Patients and Methods Subjects were 30 newly diagnosed Asian variant IVLBCL patients at a single institution. Baseline PET/CT was analyzed for the distribution and intensity of FDG lesions, and PET/CT pattern groups were compared for the outcome. Results Eight patients had hypermetabolic lymph node (LN) lesions (Nodal group). The remaining 22 patients with extranodal (EN) involvement were categorized into Deauville score 3–4 (EN/DS3-4; n = 14) and DS5 groups (EN/DS5; n = 8). First-line therapy resulted in a complete or partial response in 75.0%, 64.3%, and 100% of the respective groups. Treatment-related deaths occurred in one nodal group and three EN/DS3-4 group cases, but none among the EN/DS5 group. During 56 months of follow-up, disease progression or relapse occurred in five, four, and one case of respective groups. Cancer-related death occurred more frequently in the Nodal (n = 6) and EN/DS3-4 groups (n = 7) than the EN/DS5 group (n = 1; P = 0.041). Nodal and EN/DS3-4 groups had worse 5-year event-free survival (EFS; 25.0% and 49.0%, respectively, P = 0.010 and 0.076) and overall survival (OS; 33.3% and 48.2%, P = 0.010 and 0.068) compared to the EN/DS5 group (87.5% EFS and 87.5% OS). Conclusion In patients with Asian variant IVLBCL, the distribution and intensity of FDG uptake lesions on PET/CT can be useful for predicting treatment outcomes and survival.
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Affiliation(s)
- Chae Hong Lim
- Department of Nuclear Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Sang Eun Yoon
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Seog Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Han Lee
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
| | - Seok Jin Kim
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Korea
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Storandt MH, Koponen MA. Intravascular large B-cell lymphoma presenting with fever and refractory acidosis. AUTOPSY AND CASE REPORTS 2021; 11:e2021324. [PMID: 34540728 PMCID: PMC8432357 DOI: 10.4322/acr.2021.324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/21/2021] [Indexed: 01/14/2023] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare form of diffuse large B-cell lymphoma, characterized by malignant B-cells primarily localized to the lumina of small- and medium-sized blood vessels without lymphadenopathy. Two patients initially presented with fever of unknown origin and persistent lactic acidosis without evidence of tissue hypoxia. Neither patient had an identifiable source of infection and both underwent peripheral blood smear demonstrating leukocytosis with a neutrophilic predominance and thrombocytopenia without evidence of hematologic malignancy. One had previously had a bone marrow biopsy which was unremarkable. Both patients’ condition deteriorated rapidly, progressing to multiorgan failure requiring pressors and mechanical ventilation, which ultimately resulted in cardiopulmonary arrest. At autopsy, each patient demonstrated malignant lymphocytoid cells, staining positive for CD20, localized to the lumina of small- and medium-sized vessels in multiple organs, including the lungs, liver, spleen, and kidneys, among others, allowing for the diagnosis of IVLBCL. IVLBCL is exceedingly rare, which in combination with significant variability in presentation, can make identification and diagnosis challenging. Diagnosis requires biopsy, therefore a high index of suspicion is needed to obtain an adequate tissue sample, whether pre- or postmortem. In the presented cases, both patients exhibited type B lactic acidosis with an unknown etiology that was ultimately determined at autopsy.
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Affiliation(s)
- Michael Harrison Storandt
- University of North Dakota School of Medicine and Health Sciences (UNDSMHS), Department of Pathology, Grand Forks, ND, USA
| | - Mark Alan Koponen
- University of North Dakota School of Medicine and Health Sciences (UNDSMHS), Department of Pathology, Grand Forks, ND, USA
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