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Imoto Y, Yamadera M, Ohno H, Okamoto K, Kajiwara Y, Kishi Y, Shimazaki H, Matsukuma S, Ueno H. Massive enteric necrosis caused by histiocytic sarcoma embolism: a case report. Surg Case Rep 2024; 10:228. [PMID: 39365380 DOI: 10.1186/s40792-024-02031-4] [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: 07/16/2024] [Accepted: 09/25/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND Histiocytic sarcoma (HS) is a rare disease characterized by the presence of neoplastic histiocytes. We herein report an unusual case of HS that caused massive tumor embolism-related transmural necrosis of the small intestine. CASE PRESENTATION A 64-year-old man presented with multiple nodules in the lungs, bone, mediastinum, and subcutaneous tissues that were incidentally detected on preoperative computed tomography for early transverse colon cancer. Approximately two months later, the patient presented with signs of peritoneal irritation suggestive of small intestinal necrosis. Emergency surgery was performed and the necrotic small intestine was resected. Pathological examination revealed small bowel necrosis due to multifocal HS embolism. The postoperative course was uneventful. The patient was unsuccessfully treated with chemotherapy for HS and died 122 days postoperatively. CONCLUSIONS HS can cause massive enteric necrosis due to tumor embolism. Clinicians should be aware of this rare presentation of HS.
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Affiliation(s)
- Yoshitaka Imoto
- Department of Surgery, National Defense Medical College, Namiki 3-2, Tokorozawa, Saitama, 359-8513, Japan
| | - Masato Yamadera
- Department of Surgery, National Defense Medical College, Namiki 3-2, Tokorozawa, Saitama, 359-8513, Japan.
| | - Hiroki Ohno
- Department of Surgery, National Defense Medical College, Namiki 3-2, Tokorozawa, Saitama, 359-8513, Japan
| | - Koichi Okamoto
- Department of Surgery, National Defense Medical College, Namiki 3-2, Tokorozawa, Saitama, 359-8513, Japan
| | - Yoshiki Kajiwara
- Department of Surgery, National Defense Medical College, Namiki 3-2, Tokorozawa, Saitama, 359-8513, Japan
| | - Yoji Kishi
- Department of Surgery, National Defense Medical College, Namiki 3-2, Tokorozawa, Saitama, 359-8513, Japan
| | - Hideyuki Shimazaki
- Department of Laboratory Medicine, National Defense Medical College Hospital, National Defense Medical College, Tokorozawa, Saitama, 359-8513, Japan
| | - Susumu Matsukuma
- Department of Laboratory Medicine, National Defense Medical College Hospital, National Defense Medical College, Tokorozawa, Saitama, 359-8513, Japan
- Department of Pathology and Laboratory Medicine, National Defense Medical College, Tokorozawa, Saitama, 359-8513, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Namiki 3-2, Tokorozawa, Saitama, 359-8513, Japan
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Vandermeersch D, Mahsouli A, Willemart M, Scoppettuolo P, Van de Wyngaert C, Van den Neste E, Camboni A, Lawson M, Onofrj V, Pothen L. Intravascular large cell B lymphoma presenting as central nervous system pseudo-vasculitis: A rare diagnostic challenge. Neuroradiol J 2024; 37:651-655. [PMID: 37933603 PMCID: PMC11444320 DOI: 10.1177/19714009231212351] [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] [Indexed: 11/08/2023] Open
Abstract
Intravascular large B cell lymphoma (IVLBCL) is a very rare subtype of aggressive non-Hodgkin B cell lymphoma characterized by intravascular proliferation of clonal B lymphocytes, classically associated with pulmonary and cutaneous disease and, less frequently, with central nervous system (CNS) involvement. Brain imaging findings are usually non-specific, with evidence of multiple vascular occlusions and stroke as non-specific multifocal abnormalities. We present an exceptionally rare case of IVLBCL in a patient with unexplained inflammatory syndrome with B symptoms and rapidly progressive neurological impairment, with multifocal hemorrhagic and tumefactive brain lesions seen on MRI. We suggest that in this clinical setting, the presence of tumefactive and hemorrhagic lesions should raise suspicion for IVLBCL and lead to the decision to perform a biopsy, which, nonetheless, remains the diagnostic gold standard.
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Affiliation(s)
- Denis Vandermeersch
- Internal Medicine and Infectious Disease Departement, Cliniques Universitaires Saint Luc-UCL, Bruxelles, Belgique
| | - Amin Mahsouli
- Radiology Departement, Cliniques Universitaires Saint Luc-UCL, Bruxelles, Belgique
| | - Mathilde Willemart
- Neurology Departement, Cliniques Universitaires Saint Luc-UCL, Bruxelles, Belgique
| | | | | | - Eric Van den Neste
- Hematology Departement, Cliniques Universitaires Saint Luc-UCL, Bruxelles, Belgique
| | - Alessandra Camboni
- Anatomopatholgy Departement, Cliniques Universitaires Saint Luc-UCL, Bruxelles, Belgique
| | - Morel Lawson
- Neurosurgery Departement, Cliniques Universitaires Saint Luc-UCL, Bruxelles, Belgique
| | - Valeria Onofrj
- Radiology Departement, Cliniques Universitaires Saint Luc-UCL, Bruxelles, Belgique
| | - Lucie Pothen
- Internal Medicine and Infectious Disease Departement, Cliniques Universitaires Saint Luc-UCL, Bruxelles, Belgique
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3
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Liu J, Cheng CL, Koh M. Intravascular Large B-cell Lymphoma in a Young Southeast Asian Male With Recurrent Strokes and Pulmonary Ground Glass Opacities With a Normal Chest Radiograph. Cureus 2024; 16:e66112. [PMID: 39100808 PMCID: PMC11298053 DOI: 10.7759/cureus.66112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2024] [Indexed: 08/06/2024] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare form of extranodal large B-cell lymphoma characterized by the growth of lymphoma cells within lumina of blood vessels, especially capillaries, which aggregate to form clots, resulting in organ ischemia. In Caucasians, it predominantly involves the central nervous system (CNS) and the skin, with the cutaneous variant carrying a better prognosis. Whereas in Asians it preferentially involves the bone marrow, liver, and spleen and is associated with hemophagocytic syndrome. We report a case of a young Asian male with neurological, pulmonary, and hepatosplenic involvement. He presented with recurrent strokes, chronic cough, and unintentional weight loss. The chest radiograph (CXR) on admission was clear. Magnetic resonance imaging (MRI) of the brain showed acute multifocal infarcts, and a whole-body computed tomography (CT) scan revealed upper-lobe predominant pulmonary ground glass opacities (GGOs) with mediastinal lymphadenopathy. Interestingly, a CXR performed one week after the CT scan remained clear. The positron emission tomography-computed tomography (PET-CT) showed hepatosplenic and adrenal involvement. The diagnosis was confirmed via a bronchoscopic approach. The patient received chemotherapy consisting of MR-CHOP (methotrexate, rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone), high-dose methotrexate, and intrathecal cytarabine, which led to complete remission. Subsequently, he underwent an autologous peripheral blood stem cell transplant. At the time of writing this case report, the patient is still in complete remission for three years after the initial diagnosis. As IVLBCL has a non-specific clinicoradiological presentation, it is important to suspect IVLBCL in patients with an atypical neurological and pulmonary presentation in the presence of raised serum lactate dehydrogenase (LDH) and to consider a CT scan of the thorax if CXR is normal.
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Affiliation(s)
- Jiaxuan Liu
- Respiratory Medicine, Sengkang General Hospital, Singapore, SGP
| | | | - Mariko Koh
- Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, SGP
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4
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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 2024; 32:869-876. [PMID: 36745689 DOI: 10.1080/09273948.2022.2103712] [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: 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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5
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Bagnoli F, Pini G, Ziccheddu B, Bonometti A, Alberti-Violetti S, Venegoni L, Isimbaldi G, Da Vià MC, Ferrari A, Baldini L, Neri A, Onida F, Bolli N, Berti E. Whole-exome sequencing is feasible on a fresh-frozen skin sample of intravascular large B cell lymphoma. Clin Exp Med 2024; 24:51. [PMID: 38441683 PMCID: PMC10914893 DOI: 10.1007/s10238-024-01308-0] [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: 06/12/2023] [Accepted: 02/08/2024] [Indexed: 03/07/2024]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare aggressive extranodal non-Hodgkin lymphoma. The predominant, if not exclusive, growth of neoplastic cells within the lumina of small-sized vessels represents the hallmark of the disease. Diagnosis is challenging due to the absence of marked lymphadenopathy, the highly heterogeneous clinical presentation, and the rarity of the condition. Clinical presentation is characterized by variable combinations of nonspecific signs and symptoms (such as fever and weight loss), organ-specific focal manifestations due to altered perfusion, and hemophagocytic syndrome. The rarity of this entity and the paucity of neoplastic cells in biopsy samples hamper the study of recurrent molecular abnormalities. The purpose of this study was to explore the feasibility of a different approach to recover a sufficient amount of DNA of acceptable quality to perform next-generation sequencing studies. Here, we report the findings of whole-exome next-generation sequencing performed on a fresh-frozen cutaneous sample of IVLBCL, paired with the patient saliva used as germline DNA. To increase the cancer cell fraction, only the subcutaneous tissue was selected. With this approach, we obtained high-quality DNA and were able to identify oncogenic mutations specific for this entity and recapitulating its post-germinal center origin, even if the tumor fraction was low. Molecular studies performed on fresh-frozen cutaneous sample are feasible in IVLBCL, especially when analysis is restricted to the subcutaneous tissue. Wide adoption of this reproducible and cost-effective approach may foster further studies, which may be of help in supporting diagnosis, providing pathogenetic insights, and guiding treatment decisions.
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Affiliation(s)
- Filippo Bagnoli
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Building Marcora, Via F. Sforza, 35, 20122, Milan, Italy
- Department of Oncology and Onco-Hematology, University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy
| | - Giuditta Pini
- Department of Oncology and Onco-Hematology, University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy
| | - Bachisio Ziccheddu
- Division of Hematology, Department of Medicine, University of Miami Miller School of Medicine, 1600 NW 10 Ave #1140, Miami, FL, 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12 Ave, Miami, FL, 33136, USA
| | - Arturo Bonometti
- Pathology Unit, Humanitas Clinical and Research Center IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, Italy
| | - Silvia Alberti-Violetti
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Pace, 9, 20122, Milan, Italy
- Department of Pathophysiology and Organ Transplantation, University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy
| | - Luigia Venegoni
- Department of Pathophysiology and Organ Transplantation, University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy
| | - Giuseppe Isimbaldi
- Pathology Unit, Deparment of Hematology, Oncology, and Molecular Medicine, Niguarda Cancer Center, ASST Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore, 3, 20162, Milan, Italy
| | - Matteo Claudio Da Vià
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Building Marcora, Via F. Sforza, 35, 20122, Milan, Italy
- Department of Oncology and Onco-Hematology, University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy
| | - Angela Ferrari
- Hematology Unit, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola, 2, 42122, Reggio Emilia, Italy
| | - Luca Baldini
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Building Marcora, Via F. Sforza, 35, 20122, Milan, Italy
- Department of Oncology and Onco-Hematology, University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy
| | - Antonino Neri
- Hematology Unit, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola, 2, 42122, Reggio Emilia, Italy
- Scientific Directorate, Azienda USL-IRCCS di Reggio Emilia, Via Giovanni Amendola, 2, 42122, Reggio Emilia, Italy
| | - Francesco Onida
- Department of Oncology and Onco-Hematology, University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy
- Oncoematologia, Ospedale Fatebenefratelli e Oftalmico, Milan, Italy
| | - Niccolò Bolli
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Building Marcora, Via F. Sforza, 35, 20122, Milan, Italy.
- Department of Oncology and Onco-Hematology, University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy.
| | - Emilio Berti
- Department of Pathophysiology and Organ Transplantation, University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy
- Inter-Hospital Division of Pathology, IRCCS MultiMedica, Via Milanese, 300, 20099, Sesto San Giovanni, Italy
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6
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Huang X, Wu X, Wang S, Mei C, Xu Y, Ren Y, Jin J, Tong H, Qian J. Effective management of a rare case of primary renal intravascular large B-cell lymphoma with modified R-CHOP regimen: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241232259. [PMID: 38362227 PMCID: PMC10868483 DOI: 10.1177/2050313x241232259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024] Open
Abstract
Intravascular large B-cell lymphoma, known for its diverse organ involvement, presents significant diagnostic challenges, particularly when it affects the kidneys. This report highlights a rare case of primary renal intravascular large B-cell lymphoma in a 60-year-old male patient, who presented with persistent fever and renal dysfunction. The case underscores the intricacy of diagnosis and the efficacy of personalized treatment. Following the identification of primary renal intravascular large B-cell lymphoma, a modified R-CHOP regimen was administered, resulting in notable amelioration of symptoms and renal function following the initial treatment cycle. The patient achieved sustained complete remission without any complications after completing five subsequent R-CHOP cycles and two additional cycles of rituximab monotherapy, as confirmed by recent assessments. He is currently under regular follow-up for ongoing monitoring and improvement. This case adds to the limited yet expanding pool of knowledge concerning intravascular large B-cell lymphoma, emphasizing the necessity for personalized therapeutic strategies in atypical presentations. It also highlights the importance of early detection and customized intervention in managing rare lymphoma subtypes with unique organ involvement.
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Affiliation(s)
- Xianbo Huang
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Xianhui Wu
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Shasha Wang
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Chen Mei
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Yu Xu
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Yanling Ren
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Jie Jin
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Hongyan Tong
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Jiejing Qian
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
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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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8
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Hatano K, Ishibashi K, Kondo S, Ishii K, Iwata A. 18 F-THK5351 PET Can Evaluate Tumor Extension in Intravascular Large B-Cell Lymphoma : Comparison With 11C-Methionine PET and 18F-FDG PET. Clin Nucl Med 2023; 48:e204-e206. [PMID: 36727871 DOI: 10.1097/rlu.0000000000004568] [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: 02/03/2023]
Abstract
ABSTRACT A 79-year-old man presenting with gait disturbance and cognitive decline was diagnosed with intravascular large B-cell lymphoma (IVLBCL) by random skin biopsy. Some IVLBCL lesions were identified by PET examinations using 11 C-methionine, 18 F-FDG, and 18 F-THK5351. 11 C-methionine and 18 F-FDG uptake, which likely reflects the presence of the lymphoma cells themselves, increased clearly in the left putamen but weakly in the left deep white matter. 18 F-THK5351 uptake increased in all lesions, likely reflecting perivascular astrogliosis caused by IVLBCL. Hence, 18 F-THK5351 PET can evaluate tumor extension in IVLBCL lesions where 11 C-methionine and 18 F-FDG PET may fail in its visualization.
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Affiliation(s)
- Keiko Hatano
- From the Department of Neurology, TokyoMetropolitan Geriatric Hospital, Tokyo, Japan
| | | | - Soichiro Kondo
- From the Department of Neurology, TokyoMetropolitan Geriatric Hospital, Tokyo, Japan
| | | | - Atsushi Iwata
- Research Team for Neuroimaging, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
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9
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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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10
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Rastogi P, Alrwashdeh A, Caza T, Lin M, Obeidat M, Giannini G, Larsen C, Dai DF. Characteristics of Renal Intravascular Large B-cell Lymphoma. Kidney Int Rep 2023; 8:575-583. [PMID: 36938088 PMCID: PMC10014346 DOI: 10.1016/j.ekir.2022.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/13/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Renal intravascular large B-cell lymphoma (IVLBCL) is a rare, aggressive B-cell lymphoma with neoplastic cells occupying the vascular lumina with only 53 patients reported to date. Here, we present the largest case series to characterize this rare disease. Methods We performed a multi-institutional, retrospective review of kidney biopsies and autopsies with a diagnosis of kidney IVLBCL and report our findings. Results We identified 20 patients with an average age of 65.7 ± 7.8 years (55% males) with IVLBCL on kidney biopsy. The most common clinical presentation was fever and anemia. Acute kidney injury (AKI) was noted in 70% to 90%, proteinuria in 70% to 84.1%, hematuria in 45%, and nephrotic-range proteinuria in 10% to 26.1% of cases. The median (interquartile range) of serum creatinine was 1.75 (1.14, 3.3) mg/dl. Neoplastic lymphoid cells were present in glomeruli, peritubular capillaries, and arteries or veins. Of the patients, 44.3% showed extrarenal infiltration into bone marrow, liver, spleen, central vervous system, lung and skin. Neoplastic cells express CD20, CD79a, PAX-5, and MUM1+, and were CD10-negative. Available follow-up data showed a median survival of 21 months after diagnosis. Extrarenal involvement is a significant and independent predictor of mortality with a hazard ratio of 4.975 (95% confidence interval:1.38, 17.88) after controlling for age and gender. Serum creatinine, age, sex, and infiltration of intrarenal arteries or veins did not affect survival. Conclusion Kidney IVLBCL is a rare disease that is unexpectedly diagnosed by kidney biopsy, presenting with fever, anemia, mild AKI, and proteinuria. Median survival is 21 months and extrarenal involvement is associated with worse outcome.
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Affiliation(s)
- Prerna Rastogi
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Audai Alrwashdeh
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | - Mercury Lin
- Department of Pathology and Laboratory Medicine, Cedars Sinai, Los Angeles, California, USA
| | - Mohammad Obeidat
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | | | | | - Dao-Fu Dai
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
- Correspondence: Dao-Fu Dai, Department of Pathology, University of Iowa Carver College of Medicine, Room MRC106C, 501 Newton Road, Iowa City, Iowa 52242, USA.
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11
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Prostate primary intravascular large B-cell lymphoma: A case report. Urol Case Rep 2022; 45:102276. [DOI: 10.1016/j.eucr.2022.102276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/02/2022] [Indexed: 11/05/2022] Open
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12
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MacGillivary ML, Purdy KS. Recommendations for an Approach to Random Skin Biopsy in the Diagnosis of Intravascular B-Cell Lymphoma. J Cutan Med Surg 2022; 27:44-50. [PMID: 36205174 PMCID: PMC9902969 DOI: 10.1177/12034754221130257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Intravascular B-Cell Lymphoma (IVBCL) is a rare type of extranodal large B-cell lymphoma where clonal B-cells selectively home to and replicate in the lumen of small vessels. Random skin biopsy (RSB) of uninvolved skin is a reputable tool to diagnose this protean entity and thus dermatologists are involved in its diagnosis. A literature review was completed to derive an approach to RSB in these patients to maximize diagnostic yield of IVBCL and minimize morbidity. Based on this review, data from 27 patients where clinical signs and symptoms and results of investigations were able to be linked to a positive diagnosis of IVBCL from RSB from 11 papers from 2003 to 2021 were analyzed. Following this analysis, RSB should be considered when there are no clinical skin findings and there is an elevated lactate dehydrogenase in the absence of lymphadenopathy and presence of fever of unknown origin, thrombocytopenia, anemia, and ferritinemia. Three to four RSBs from the thigh, abdomen and/or posterior upper arm should be performed via either incisional or telescoping punch biopsies and should include senile/cherry angioma(s) if present. If RSB results in a diagnosis of IVBCL, hematology should be consulted for further management. Consideration of a false negative biopsy or alternative diagnoses should be explored if RSB is negative for IVBCL. Following a standard approach for RSB in these patients will increase diagnostic yield of IVBCL while decreasing the risk of harm to the patient.
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Affiliation(s)
- Michael L. MacGillivary
- Division of Dermatology, Dalhousie University, Halifax, Canada,Michael L. MacGillivary, Division of Dermatology, Dalhousie University, Suite 4-193 Dickson Building, 5820 University Avenue, Halifax, NS B3H 2Y9, Canada;
| | - Kerri S. Purdy
- Division of Dermatology, Dalhousie University, Halifax, Canada
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13
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Kaji FA, Martinez‐Calle N, Sovani V, Fox CP. Rare central nervous system lymphomas. Br J Haematol 2022; 197:662-678. [PMID: 35292959 PMCID: PMC9310777 DOI: 10.1111/bjh.18128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 11/29/2022]
Abstract
Central nervous system (CNS) lymphomas are rare malignancies characterised by lymphoid infiltration into the brain, spinal cord, cranial nerves, meninges and/or eyes in the presence or absence of previous or concurrent systemic disease. Most CNS lymphomas are of the diffuse large B-cell lymphoma (DLBCL) subtype for which treatment strategies, particularly the use of high-dose methotrexate-based protocols and consolidation with autologous stem cell transplantation, are well established. Other histopathological subtypes of CNS lymphoma are comparatively less common with published data on these rare lymphomas dominated by smaller case series and retrospective reports. Consequently, there exists little clinical consensus on the optimal methods to diagnose and manage these clinically and biologically heterogeneous CNS lymphomas. In this review article, we focus on rarer CNS lymphomas, summarising the available clinical data on incidence, context, diagnostic features, reported management strategies, and clinical outcomes.
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Affiliation(s)
- Furqaan Ahmed Kaji
- Clinical HaematologyNottingham University Hospitals NHS TrustNottinghamUK
| | | | - Vishakha Sovani
- Department of HistopathologyNottingham University Hospitals NHS TrustNottinghamUK
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14
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Bailleux S, Collins P, Nikkels AF. The Relevance of Skin Biopsies in General Internal Medicine: Facts and Myths. Dermatol Ther (Heidelb) 2022; 12:1103-1119. [PMID: 35430724 PMCID: PMC9110592 DOI: 10.1007/s13555-022-00717-x] [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: 01/11/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Non-dermatology medical specialties may refer patients for skin biopsies, searching for a particular diagnosis. However, the diagnostic impact of the skin biopsy is not clearly established. This article aims to assess the indications for, and evaluate the clinical relevance of, skin biopsies in non-dermatology medical specialties. METHODS A questionnaire was sent to 23 non-dermatology specialty departments in a university medical center, requesting a list of indications for skin biopsies, as well as to 10 staff dermatologists to collect the indications of skin biopsies requested by non-dermatology specialties. Once the indications were collected, a literature search was performed to evaluate their clinical value and relevance. RESULTS Eleven non-dermatology specialties provided a list of skin biopsy indications, to which staff dermatologists added seven more indications. A literature search revealed evidence-based medicine data for six diseases, that is, amyloidosis, peripheral autonomic neuropathy, Sneddon's syndrome, intravascular lymphoma, sarcoidosis, and chronic graft-versus-host disease. Results were questionable concerning infectious endocarditis, acute graft-versus-host-disease, and the lupus band test. Skin biopsy were not evidenced as useful for the diagnosis of calciphylaxis, systemic scleroderma, Behçet's disease, or hypermobile Ehlers-Danlos syndrome. For the diagnosis of Alport's syndrome, pseudoxanthoma elasticum, and vascular Ehlers-Danlos syndrome, skin biopsy is currently outperformed by genetic analyses. For diagnoses such as Henoch-Schönlein purpura and Sjögren's syndrome, skin biopsy represents an additional item among other diagnostic criteria. CONCLUSION The usefulness of skin biopsy as requested by non-dermatology specialties is only evidenced for amyloidosis, peripheral autonomic neuropathy, Sneddon's syndrome, intravascular lymphoma, sarcoidosis, chronic graft-versus-host-disease, Henoch-Schönlein purpura, and Sjögren's syndrome.
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Affiliation(s)
- Sophie Bailleux
- Department of Dermatology, University Hospital Centre, CHU du Sart Tilman, University of Liège, 4000, Liège, Belgium
| | - Patrick Collins
- Department of Dermatopathology, University Hospital Centre, CHU du Sart Tilman, Liège, Belgium
| | - Arjen F Nikkels
- Department of Dermatology, University Hospital Centre, CHU du Sart Tilman, University of Liège, 4000, Liège, Belgium.
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15
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Primary angiitis of central nervous system – A challenging diagnosis. J Neuroimmunol 2022; 366:577844. [DOI: 10.1016/j.jneuroim.2022.577844] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 02/26/2022] [Accepted: 03/06/2022] [Indexed: 12/14/2022]
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16
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Lasocki A, Seymour J. Central nervous system manifestations of systemic haematological malignancies and key differentials. Clin Radiol 2022; 77:328-336. [DOI: 10.1016/j.crad.2022.01.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 01/11/2022] [Indexed: 02/08/2023]
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17
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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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18
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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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19
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Belli E, Milano C, Pesaresi I, Trivelli I, Tavoni A, Ciancia E, Alì G, Zampa V, Pizzanelli C, Siciliano G, Ricci G. A case of intravascular large B cell lymphoma with brain involvement mimicking progressive multifocal leukoencephalopathy. Int J Neurosci 2021:1-5. [PMID: 34425062 DOI: 10.1080/00207454.2021.1972418] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a very rare form of extranodal lymphoma, characterized by the proliferation of neoplastic B cells within the lumen of small vessels. Due to its high aggressivity, for years the prognosis had been really poor with only anectodical cases of remission after traditional chemotherapy. More recently, new therapeutic protocols allowed a significant increase in overall survival. It can virtually involve every organ, being skin and central nervous system the most affected. The clinical presentation is often unspecific and insidious; therefore, diagnosis can be challenging. Tissue biopsy, in particular random deep skin biopsy, is the gold standard for definitive diagnosis. We describe the case of a 58-year-old woman with a previous diagnosis of myelofibrosis, who presented with a rapidly progressive neurological deterioration and a brain MRI suggestive of Progressive Multifocal Leukoencephalopathy. Due to the absence of BK and JC viruses in cerebrospinal fluid and the presence of severe myalgias and subcutaneous nodules, a skin and muscle biopsy was performed, allowing diagnosis of IVLBCL. We describe the diagnostic pitfalls of this case, briefly reviewing existing literature about IVLBCL.
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Affiliation(s)
- Elisabetta Belli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Milano
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ilaria Pesaresi
- Neuroradiology Unit, Department of Diagnostic and Interventional Radiology, AOUP, Pisa, Italy
| | - Ilaria Trivelli
- Neuroradiology Unit, Department of Diagnostic and Interventional Radiology, AOUP, Pisa, Italy
| | - Antonio Tavoni
- Clinical Immunology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Greta Alì
- Second Division of Pathology, AOUP, Pisa, Italy
| | - Virna Zampa
- Radiology Unit, Department of Diagnostic and Interventional Radiology, AOUP, Pisa, Italy
| | - Chiara Pizzanelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Ricci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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20
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Samuel A, Elodie L, Audrey G, Come S, Jean-Philippe M, Marie P. Intravascular large B-cell lymphoma involving pleural solitary fibrous tumor: A case report and literature review. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2021.200530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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21
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Rozenbaum D, Tung J, Xue Y, Hoang MP, Kroshinsky D. Skin biopsy in the diagnosis of intravascular lymphoma: A retrospective diagnostic accuracy study. J Am Acad Dermatol 2021; 85:665-670. [PMID: 31541748 DOI: 10.1016/j.jaad.2019.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 08/26/2019] [Accepted: 09/09/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The yield of skin biopsies in the evaluation of intravascular lymphoma (IVL) is largely unknown in Western patients. Most data supporting this test come from Asian populations, in which both prevalence and disease presentation seem to differ. OBJECTIVE To determine the yield and diagnostic properties of skin biopsy in the evaluation of IVL. METHODS We reviewed skin biopsy pathology reports of 50 patients being evaluated for IVL to calculate the diagnostic yield of this test. An additional 6 patients, who underwent skin biopsies after the diagnosis of IVL was made by other means, were included to calculate the sensitivity and specificity of our index test. RESULTS Skin biopsy samples were positive for 5 of the 50 patients being investigated for IVL. Sensitivity was 50% and specificity was 100%. LIMITATIONS Only pathology reports containing IVL as an indication for the biopsy were retrieved. This might have excluded patients in whom the disease was considered but was not deemed likely enough to be listed as the indication for the test, inflating our estimative of skin biopsy yield. CONCLUSION A relatively high diagnostic yield was found in the evaluation of IVL among patients with a diverse presentation in a Western hospital.
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Affiliation(s)
| | - Joe Tung
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Yun Xue
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Mai P Hoang
- Harvard Medical School, Boston, Massachusetts; Department of Pathology, Massachusetts General Hospital, Boston, Massachusetts
| | - Daniela Kroshinsky
- Harvard Medical School, Boston, Massachusetts; Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts.
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22
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Minish JM, Kelkar AH, Mehta AR, Gaffar M, Dang NH. Intravascular Large B-Cell Lymphoma Presenting as Acute Axonal Polyneuropathy: A Case Report and Literature Review. J Investig Med High Impact Case Rep 2021; 8:2324709620959997. [PMID: 32935589 PMCID: PMC7498961 DOI: 10.1177/2324709620959997] [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] [Indexed: 11/25/2022] Open
Abstract
Intravascular large B-cell lymphoma (ILBL) is a rare and difficult to diagnose
subtype of large B-cell lymphoma. The most common locations of presentation are
in the central nervous system and the skin, but there are reports of other organ
involvement. Due to the indolence, nonspecific symptoms, and rarity of the
disease, this form of lymphoma is most often diagnosed postmortem. In this
article, we describe a case of ILBL that presented as a rapidly progressive
acute axonal polyneuropathy. Acute axonal polyneuropathy is a common disease
process with a wide differential diagnosis, but there is limited literature on
its prevalence as the presenting symptom of ILBL. This patient was treated with
R-EPOCH and intrathecal methotrexate with significant improvement in his
polyneuropathy after 1 cycle, and complete remission after 6 cycles. Data on
chemotherapy regimens and their success rates for this disease are lacking.
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Affiliation(s)
- Jordan M Minish
- University of Florida, University of Florida Health Shands Hospital, Gainesville, FL, USA
| | - Amar H Kelkar
- University of Florida, University of Florida Health Shands Hospital, Gainesville, FL, USA
| | - Amol R Mehta
- University of Florida, University of Florida Health Shands Hospital, Gainesville, FL, USA
| | - Maira Gaffar
- University of Florida, University of Florida Health Shands Hospital, Gainesville, FL, USA
| | - Nam H Dang
- University of Florida, University of Florida Health Shands Hospital, Gainesville, FL, USA
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23
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Hakroush S, Lehnig LY, Wallbach M, Schanz J, Koziolek MJ. Renal involvement of intravascular large B-cell lymphoma: a challenging diagnosis. J Nephrol 2021; 35:1295-1297. [PMID: 34228321 DOI: 10.1007/s40620-021-01109-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 06/21/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Samy Hakroush
- Institute of Pathology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
| | - Luca-Yves Lehnig
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Manuel Wallbach
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany
| | - Julie Schanz
- Department of Haematology and Oncology, University Medical Center Göttingen, Goettingen, Germany
| | - Michael Johann Koziolek
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
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24
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Episodic Visual Distortions and Stroke-Like Symptoms in a 56-Year-Old Man With Intravascular Lymphoma. J Neuroophthalmol 2021; 40:265-270. [PMID: 32028452 DOI: 10.1097/wno.0000000000000900] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A healthy 56-year-old man presented with vision changes and left upper extremity motor and sensory changes. MRI of the brain without contrast was significant for multifocal areas of restricted diffusion in multiple vascular territories. Neuro-Ophthalmic evaluation revealed an inferonasal visual field defect in the left eye, thickened choroid on optical coherence tomography, and bilateral delayed arteriovenous and choroidal filling on fluorescein angiogram. Repeat MRI demonstrated interval enlargement of many of the same foci of abnormal diffusion-weighted imaging signal. Computed tomography of the abdomen and pelvis revealed 3 distinct lobulated retroperitoneal masses that were biopsied and found to be consistent with diffuse large B-cell lymphoma. Brain biopsy specimens showed intravascular lymphocytes, confirming a diagnosis of intravascular lymphoma (IVL). In this diagnostically challenging case, a link was established between the presence of multiple strokes (some of which showed slow evolution over time) and retinochoroidal hypoperfusion, which provided a critical clue to the ultimate diagnosis of IVL.
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25
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Maiese A, La Russa R, De Matteis A, Frati P, Fineschi V. Post-mortem diagnosis of intravascular large B-cell lymphoma. J Int Med Res 2021; 48:300060520924262. [PMID: 32485117 PMCID: PMC7273565 DOI: 10.1177/0300060520924262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare (<1%), typically aggressive
extranodal variant of mature non-Hodgkin B-cell lymphoma. IVLBCL is characterized by
malignant lymphoid cells lodged within blood vessels, particularly capillary channels.
Herein, we present a case of a 50-year-old man with a history of myeloradiculitis (∼1
year) and paraparesis requiring hospitalization. During the course of his hospital stay,
computed tomography (CT), magnetic resonance imaging, CT-positron emission tomography, and
biopsy failed to establish a diagnosis. The patient died 2 months later from bilateral
pneumonia. Postmortem examination was undertaken to determine the cause of death.
Histologic sections of the patient’s brain, heart, lung, and liver showed aggregates of
highly atypical cells bearing enlarged, pleomorphic, and hyperchromatic nuclei. Strong
intravascular positivity for CD45 and CD20 markers indicated the cells were of B-cell
origin, supporting a diagnosis of IVLBCL.
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Affiliation(s)
- Aniello Maiese
- Section of Legal Medicine, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa, Pisa, Italy
| | - Raffaele La Russa
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessandra De Matteis
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
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26
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Kampf L, Bouveret C, Tronnier M, Lommel K. [A rare cause of livid skin lesions]. Hautarzt 2021; 72:830-833. [PMID: 33687480 DOI: 10.1007/s00105-021-04782-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 11/25/2022]
Affiliation(s)
- L Kampf
- Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Deutschland.
- Dermatologikum Berlin, Berlin, Deutschland.
| | - C Bouveret
- Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Deutschland
| | - M Tronnier
- Helios Klinikum Hildesheim, Hildesheim, Deutschland
| | - K Lommel
- Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Deutschland
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27
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Liu Z, Zhang Y, Zhu Y, Zhang W. Prognosis of Intravascular Large B Cell Lymphoma (IVLBCL): Analysis of 182 Patients from Global Case Series. Cancer Manag Res 2020; 12:10531-10540. [PMID: 33122951 PMCID: PMC7591067 DOI: 10.2147/cmar.s267825] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/08/2020] [Indexed: 01/10/2023] Open
Abstract
Purpose This study provides an overview of the prognosis of intravascular large B cell lymphoma (IVLBCL) over the past 10 years and analyzes the possible relevant factors. Patients and Methods We conducted a literature search of case reports, case series, and retrospective studies of IVLBCL published from January 2008 to July 2018. After excluding inappropriate data, 103 publications were selected for the analysis. Statistical analyses of different treatment modalities, the effect of blood–brain barrier (BBB)-penetrating drugs, and prognostic factors for outcomes were performed. Results In total, 182 pathologically confirmed cases of IVLBCL were included in our study. The results revealed that the 1- and 3-year overall survival rates were 42.3 and 11.5%, respectively, whereas the median overall survival was 340 days. Overall survival (450 days vs 180 days) and progression-free survival (420 days vs 150 days) were significantly longer in patients who received rituximab-containing regimens than in those treated with other regimens. For IVLBCL involving the CNS, regimens containing BBB-penetrating drugs failed to provide an additional survival benefit. In addition, lactic dehydrogenase levels ≥700 U/L, CNS involvement, and hemophagocytic syndrome were identified as unfavorable risk factors in patients with IVLBCL, whereas skin involvement appeared to be a protective factor. Conclusion Rituximab-containing chemotherapy can improve the outcomes of patients with IVLBCL, but the prognosis remains unsatisfactory. Treatment regimens containing BBB-penetrating drugs failed to improve outcomes in patients with CNS-involved IVLBCL. Several factors affect the prognosis of patients with IVLBCL, and further research on the underlying mechanisms is needed.
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Affiliation(s)
- Ziyue Liu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yuelun Zhang
- Central Research Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yicheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Wei Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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28
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Kawahigashi T, Teshima S, Tanaka E. Intravascular lymphoma with hypopituitarism: A case report. World J Clin Oncol 2020; 11:673-678. [PMID: 32879852 PMCID: PMC7443836 DOI: 10.5306/wjco.v11.i8.673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/07/2020] [Accepted: 06/27/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intravascular lymphoma (IVL) is a rare subtype of lymphoma involving the growth of lymphoma cells within the vessel lumina without lymphadenopathy. Because of various modes of presentation and its rarity, IVL is often diagnosed postmortem. Herein, we report a case of intravascular B-cell lymphoma with hypopituitarism, an extremely rare complication, that was successfully treated with chemotherapy.
CASE SUMMARY An 80-year-old Japanese woman presented with a 7-mo history of a tingling sensation in the lower limbs. She also presented with various other symptoms such as pancytopenia, high fever daily, and unconsciousness with hypoglycemia. Although the doctor who previously treated her diagnosed hypoglycemia as being due to hypopituitarism, the cause of the other symptoms remained uncertain despite a 7-mo evaluation period. We performed bone marrow aspiration to evaluate pancytopenia and found that she had hemophagocytic lymphohistiocytosis (HLH). On the basis of a random skin biopsy for assessing the cause of HLH, she was diagnosed with intravascular B-cell lymphoma. HLH and hypopituitarism were considered secondary to IVL. All her clinical findings matched the presentations of IVL. She was immediately treated with chemotherapy and achieved complete response. She was relapse free two years after treatment.
CONCLUSION IVL should be included in the differential diagnosis of hypopituitarism, which although life-threatening, is treatable through prompt diagnosis and appropriate chemotherapy.
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Affiliation(s)
- Teiko Kawahigashi
- Department of General Internal Medicine, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Shinichi Teshima
- Department of Histopathology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
| | - Eri Tanaka
- Department of Hematology, Shonan Kamakura General Hospital, Kanagawa 247-8533, Japan
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29
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Kim M, Chung H, Yang WI, Jeong HJ. Renal intravascular large B cell lymphoma: the first case report in Korea and a review of the literature. J Pathol Transl Med 2020; 54:426-431. [PMID: 32781826 PMCID: PMC7483029 DOI: 10.4132/jptm.2020.06.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/18/2020] [Indexed: 12/03/2022] Open
Abstract
Herein, we describe the first case of renal intravascular large B cell lymphoma in Korea occurring in a 66-year-old female. She presented with mild fever and dyspnea. On physical and laboratory evaluations, hemophagocytic lymphohistiocytosis was suspected, but the bone marrow biopsy results were unremarkable. During the work-up, massive proteinuria developed, which led to a renal biopsy. The renal architecture was relatively well-preserved, but the glomeruli were hypercellular with the infiltration of atypical, large lymphoid cells with increased nucleus-cytoplasm ratio and clumped chromatin. Similar cells were also present in the peritubular capillaries. The tumor cells exhibited membranous staining for CD20 and CD79a. After the diagnosis of intravascular large B cell lymphoma, the patient received rituximab-based chemotherapy under close follow-up.
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Affiliation(s)
- Moonsik Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Haerim Chung
- Division of Hematology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woo Ick Yang
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeon Joo Jeong
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
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30
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Goyal A, Totoraitis K, Toama W, He F, Bohjanen K, Williams S, Miller DD. Concurrent mycosis fungoides and intravascular large B-cell lymphoma in a single patient. J Cutan Pathol 2020; 47:643-648. [PMID: 32087036 DOI: 10.1111/cup.13669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 12/07/2019] [Accepted: 12/14/2019] [Indexed: 12/12/2022]
Abstract
Mycosis fungoides (MF) is an indolent, uncommon, non-Hodgkin T-cell lymphoma of the skin. It classically presents with patches, plaques, and tumors and may rarely show spread to internal organs or bone marrow. Up to 7.5% of MF patients may be diagnosed with a second malignancy. Intravascular large B-cell lymphoma (IVLBCL) is an exceedingly rare non-Hodgkin B-cell lymphoma characterized by predominant growth of large neoplastic cells in the lumina of blood vessels. This case presents with an unusual confluence of two rare diagnoses, MF and IVLBCL, made more remarkable by the presence of both diagnoses on a single skin biopsy sample.
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Affiliation(s)
- Amrita Goyal
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kristin Totoraitis
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Wael Toama
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Fiona He
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kimberly Bohjanen
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sarah Williams
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel D Miller
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
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31
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Krause MA, English SW, Zalewski NL. Clinical Reasoning: A 70-year-old man with rapid stepwise paraparesis and sensory loss. Neurology 2020; 94:e651-e655. [PMID: 31992685 DOI: 10.1212/wnl.0000000000008925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Monica A Krause
- From the Department of Neurology, Mayo Clinic, Rochester, MN
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32
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D’Angelo CR, Ku K, Gulliver J, Chang J. Intravascular large B-cell lymphoma presenting with altered mental status: A case report. World J Clin Oncol 2019; 10:402-408. [PMID: 31890649 PMCID: PMC6935686 DOI: 10.5306/wjco.v10.i12.402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 08/21/2019] [Accepted: 11/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intravascular large B-cell lymphoma (IVLBCL) is a rare and aggressive subtype of non-Hodgkin lymphoma with a varied presentation and no pathognomonic findings. Early diagnosis is critical to altering the disease course as early treatment with chemoimmunotherapy is required to prevent a rapidly fatal outcome. Strategies including improved awareness of this clinical entity through publication of cases with unique presentations are essential to prompt consideration of IVLBCL early in the disease workup. Here, we present a case of IVLBCL presenting with altered mental status and systemic organ dysfunction.
CASE SUMMARY A 61-year-old male patient presented with flu-like symptoms and a high fever. He experienced rapid clinical deterioration with liver, kidney failure, and shock despite rapid antibiotic administration and supportive care. A broad infectious workup was negative. Intracranial imaging revealed nonspecific changes to the corpus callosum suspicious for vasculitis. Renal biopsy was non-diagnostic. After further progression of his symptoms, the family elected to withdraw care and the patient died shortly thereafter. Post-mortem analysis revealed clear multi-organ involvement by IVLBCL, prompting re-examination of the ante-mortem renal biopsy that also identified IVLBCL involvement.
CONCLUSION IVLBCL is a rare disease. Communication with specialties and early biopsy is critical to establishing the diagnosis and initiating therapy.
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Affiliation(s)
- Christopher Robert D’Angelo
- Department of Medicine, Section of Hematology/Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, United States
| | - Kimberly Ku
- Department of Medicine, Section of Hematology/Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, United States
| | - Jessica Gulliver
- Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, United States
| | - Julie Chang
- Department of Medicine, Section of Hematology/Oncology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, United States
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33
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Rayfield C, Mertz L, Kelemen K, Aslam F. Vasculitis on brain angiography is not always vasculitis: intravascular large B-cell lymphoma mimicking central nervous system vasculitis. BMJ Case Rep 2019; 12:12/8/e230753. [PMID: 31451471 DOI: 10.1136/bcr-2019-230753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
A 68-year-old man, with a history of non-Hodgkin's lymphoma in remission, was admitted for homonymous hemianopsia, headaches and subacute progressive cognitive decline. Imaging revealed brain infarcts and angiography suggested vasculitis. A brain biopsy, however, revealed an intravascular large B-cell lymphoma (IVLBL). Central nervous system (CNS) vasculitis and IVLBL of the brain are extremely rare diseases that can have an almost identical clinical presentation. Angiographic findings are very similar but usually are reported as compatible with vasculitis. Brain biopsy or a random skin biopsy are crucial in diagnosing IVLBL as the accuracy of angiographic findings for CNS vasculitis is low.
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34
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Barranco R, Caputo F, Bedocchi D, Frigiolini FME, Castelletti L, Fraternali Orcioni G, Ventura F. Unusual and Fatal Case of an Undiagnosed Intravascular Large B-cell Lymphoma: The Oncologist's Great Imitator †. J Forensic Sci 2019; 65:314-317. [PMID: 31361917 DOI: 10.1111/1556-4029.14141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/04/2019] [Accepted: 07/10/2019] [Indexed: 12/18/2022]
Abstract
Intravascular lymphoma (IVL) is a rare subtype of extranodal lymphomas that is characterized by the selective growth of neoplastic cells within the lumen of small vessels. Authors document the case of an unexpected death caused by an undiagnosed intravascular large B-cell lymphoma with multi-organ involvement, which had initially manifested as an infection and then as an unclarified central nervous system pathology. Histological examination showed a diffuse intravascular large B-cell brain lymphoma with prominent cerebral involvement. The relevance of the case report reveals the importance of an autopsy of an extremely rare and threatening pathology that in most cases is diagnosed only postmortem. As a result, the role of the forensic pathologist becomes particularly important. When specifically performing an in-depth autopsy evaluation with a specific histologic analysis, it is possible to identify the intravascular lymphoma and declare a more accurate cause of death.
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Affiliation(s)
- Rosario Barranco
- Department of Legal and Forensic Medicine, University of Genova, Via De Toni 12, 16132, Genova, Italy
| | - Fiorella Caputo
- Department of Legal and Forensic Medicine, University of Genova, Via De Toni 12, 16132, Genova, Italy
| | - Davide Bedocchi
- Department of Legal and Forensic Medicine, University of Genova, Via De Toni 12, 16132, Genova, Italy
| | | | - Lara Castelletti
- Department of Neuroradiology, San Martino Hospital, Largo R. Benzi 10, 16132, Genova, Italy
| | - Giulio Fraternali Orcioni
- Department of Clinical Pathology, S. Croce e Carle Hospital, Via Michele Coppino 26, 12100, Cuneo, Italy
| | - Francesco Ventura
- Department of Legal and Forensic Medicine, University of Genova, Via De Toni 12, 16132, Genova, Italy
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35
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Pothen L, Yildiz H, Aydin S, Camboni A, Lambert M, Hainaut P, Ebbo M. [Dyspnea in a 64 year-old woman]. Rev Med Interne 2019; 41:58-61. [PMID: 31311673 DOI: 10.1016/j.revmed.2019.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 06/23/2019] [Indexed: 10/26/2022]
Affiliation(s)
- L Pothen
- Service de médecine interne, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Bruxelles, Belgique.
| | - H Yildiz
- Service de médecine interne, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Bruxelles, Belgique
| | - S Aydin
- Service d'anatomopathologie, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Bruxelles, Belgique
| | - A Camboni
- Service d'anatomopathologie, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Bruxelles, Belgique
| | - M Lambert
- Service de médecine interne, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Bruxelles, Belgique
| | - P Hainaut
- Service de médecine interne, Cliniques Universitaires Saint-Luc, avenue Hippocrate 10, 1200 Bruxelles, Belgique
| | - M Ebbo
- Département de médecine interne, hôpital de la Timone, AP-HM, Aix-Marseille Université, 278, rue Saint-Pierre, 13005 Marseille
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36
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Pothen L, Aydin S, Camboni A, Hainaut P. Nephrotic syndrome without kidney injury revealing intravascular large B cell lymphoma. BMJ Case Rep 2019; 12:12/6/e229359. [PMID: 31196971 DOI: 10.1136/bcr-2019-229359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We describe the case of a 64-year-old woman admitted for fever of unknown origin, who developed nephrotic syndrome during hospitalisation and pulmonary infiltrates. Renal biopsy disclosed intracapillary glomerular invasion by intravascular large B cell lymphoma. Clinical and biological evolution was favourable after rituximab, cyclophosphamide, doxorubicine, vincristine and prednisone (R-CHOP) treatment and autologous stem cell transplant. Two years after diagnosis the patient was considered in remission.
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Affiliation(s)
- Lucie Pothen
- Service de Médecine interne et Maladies Infectieuses, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Selda Aydin
- Service d'Anatomie Pathologique, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Alessandra Camboni
- Service d'Anatomie Pathologique, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | - Philippe Hainaut
- Service de Médecine interne et Maladies Infectieuses, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
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37
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Share M, Giannini G, Kim S, Singh S. Intravascular B-cell lymphoma: case report of a rare cause of pulmonary arterial hypertension. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:yty150. [PMID: 31020226 PMCID: PMC6439388 DOI: 10.1093/ehjcr/yty150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 01/02/2019] [Indexed: 12/14/2022]
Abstract
Background Intravascular large B-cell lymphoma (IVLBCL) is a rare disease characterized by proliferation of malignant lymphoid cells within the small vessels of various organs resulting in diffuse thrombosis. It most commonly affects the central nervous system and the skin, but if it involves the pulmonary arteries it can cause acute severe pulmonary hypertension (PH) and right heart failure. Early diagnosis is essential as the clinical course is extremely aggressive. In this report, we present a case of rapidly progressive PH and subsequent right ventricular (RV) failure secondary to IVLBCL. We review the important differential diagnoses and diagnostic evaluation needed to make a correct and early diagnosis. Case summary A 53-year-old, previously healthy man developed 2 months of progressive shortness of breath. After being treated for presumptive pneumonia, he was admitted with hypoxic respiratory failure, altered mental status, and severe PH. He developed RV failure and subsequent liver failure. He was ruled out for pulmonary embolism. Despite aggressive management with inhaled nitric oxide and epoprostenol, inotropes, and continuous renal replacement therapy, the patient passed away. Post-mortem examination revealed the presence of IVLBCL with extensive involvement notable of the brain, heart, lungs, and pulmonary arteries. Discussion The acute development of severe PH and RV failure in the absence of pulmonary emboli is uncommon and represents a challenging diagnostic and management clinical scenario. When accompanied by altered mental status, constitutional symptoms and an elevated lactate dehydrogenase, clinicians should have a high index of suspicion for intravascular lymphoma, as early diagnosis is critical to maintain a reasonable chance of survival.
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Affiliation(s)
- Michael Share
- Department of Cardiology, Cedars Sinai Heart Institute, Cedars Sinai Medical Center, 127 S. San Vicente Blvd, Suite A3308, Los Angeles, CA, USA
| | - Gabriel Giannini
- Department of Pathology, Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, USA
| | - Stacey Kim
- Department of Pathology, Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA, USA
| | - Siddharth Singh
- Department of Cardiology, Cedars Sinai Heart Institute, Cedars Sinai Medical Center, 127 S. San Vicente Blvd, Suite A3308, Los Angeles, CA, USA
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38
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Devitt KA, Gardner JA. Intravascular large B-cell lymphoma: The Great Imitator. Autops Case Rep 2019; 8:e2018055. [PMID: 30775328 PMCID: PMC6360824 DOI: 10.4322/acr.2018.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 10/08/2018] [Indexed: 11/23/2022]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of diffuse large B-cell lymphoma with an estimated incidence of less than one per million. Unlike other hematopoietic malignancies, lymphadenopathy and hepatosplenomegaly are uncommon, and patients typically present with nonspecific symptoms. IVLBCL presents a diagnostic challenge and patients are usually diagnosed late in the disease course, if at all, and the prognosis is poor. The differential diagnosis is broad, and physicians often pursue multiple diagnostic possibilities during patient workup. We present a case of IVLBCL discovered at autopsy in an 80-year-old male who presented with history and symptoms pointing to the tick-borne illness ehrlichiosis.
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Affiliation(s)
- Katherine Ann Devitt
- University of Vermont Medical Center, Department of Pathology and Laboratory Medicine. Burlington, Vermont, USA
| | - Juli-Anne Gardner
- University of Vermont Medical Center, Department of Pathology and Laboratory Medicine. Burlington, Vermont, USA
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39
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CD5-Positive Intravascular Large B-Cell Lymphoma in a Patient with Wilson's Disease: Case Report and Review of the Literature. Case Rep Pathol 2019; 2018:5140586. [PMID: 30643658 PMCID: PMC6311313 DOI: 10.1155/2018/5140586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/24/2018] [Accepted: 10/08/2018] [Indexed: 12/14/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare extra-nodal B-cell lymphoma that proliferates within small/intermediate blood vessels and capillaries while sparing large blood vessels and organ parenchyma. Clinical presentation is highly variable and may include B symptoms, neurological deficits, and/or cutaneous findings. The diagnosis of IVLBCL is difficult due to multiorgan involvement and nonspecific symptoms. We describe the case of a 68-year-old male who presented with progressive weakness, confusion, and falls. He had a past medical history of liver cirrhosis secondary to Wilson's disease. Physical exam and laboratory results revealed a lethargic man with jaundice, hepatic encephalopathy, and abnormal liver/kidney function tests. He expired after a short hospital course in the setting of hepatic and renal failure. Postmortem examination revealed large neoplastic lymphoid cells involving multiple organ blood vessels; however skin and neurologic involvement was absent. The neoplastic cells demonstrated B-cells positive for CD5, rendering a diagnosis of IVLBCL. Our case represents the occurrence of IVLBCL with CD5-positivity in a patient with Wilson's disease, diagnosed at autopsy demonstrating the challenging nature of diagnosing IVLBCL.
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40
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Woo KA, Yoo D, Jung KH. Intravascular lymphoma as a Potential Cause of Recurrent Embolic Stroke of Undetermined Source. J Clin Neurol 2019; 15:415-417. [PMID: 31286720 PMCID: PMC6620460 DOI: 10.3988/jcn.2019.15.3.415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/02/2019] [Accepted: 04/02/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kyung Ah Woo
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Dallah Yoo
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
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41
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Mortality in intravascular large B-cell lymphoma: A SEER analysis. J Am Acad Dermatol 2018; 79:1163-1165. [DOI: 10.1016/j.jaad.2018.07.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 06/23/2018] [Accepted: 07/18/2018] [Indexed: 12/23/2022]
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42
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Spencer J, Dusing R, Yap W, Hill J, Walter C. Intravascular large B-cell lymphoma presenting with diffusely increased pulmonary fluorodeoxyglucose uptake without corresponding CT abnormality. Radiol Case Rep 2018; 14:260-264. [PMID: 30510608 PMCID: PMC6260434 DOI: 10.1016/j.radcr.2018.10.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/30/2018] [Accepted: 10/30/2018] [Indexed: 12/14/2022] Open
Abstract
A 60-year-old male presented with complaints of dyspnea, intermittent fever, and 40 pounds of weight loss over the previous 9 months and was admitted for acute hypoxemic respiratory failure. Labs demonstrated elevated inflammatory markers, mild anemia, and thrombocytopenia. Fluorodeoxyglucose-positron emission tomography scan demonstrated diffusely increased pulmonary fluorodeoxyglucose uptake without corresponding abnormality on CT images. Excisional lung biopsy demonstrated intravascular large B-cell lymphoma (IV-LBCL). Presentation, imaging findings, and diagnosis of IV-LBCL will be discussed, as well as differential considerations for pulmonary involvement by IV-LBCL.
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Affiliation(s)
- Jayden Spencer
- Department of Radiology, Kansas University Hospital, 3901 Rainbow Blvd, MS 4032, Kansas City, KS, USA
| | - Reginald Dusing
- Department of Radiology, Kansas University Hospital, 3901 Rainbow Blvd, MS 4032, Kansas City, KS, USA
| | - Wendell Yap
- Department of Radiology, Kansas University Hospital, 3901 Rainbow Blvd, MS 4032, Kansas City, KS, USA
| | - Jacqueline Hill
- Department of Radiology, Kansas University Hospital, 3901 Rainbow Blvd, MS 4032, Kansas City, KS, USA
| | - Carissa Walter
- Department of Radiology, Kansas University Hospital, 3901 Rainbow Blvd, MS 4032, Kansas City, KS, USA
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43
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Degl'Innocenti S, Camera ND, Falzone C, Cantile C. Canine Cerebral Intravascular Lymphoma: Neuropathological and Immunohistochemical Findings. Vet Pathol 2018; 56:239-243. [PMID: 30286705 DOI: 10.1177/0300985818806059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Intravascular lymphoma (IVL) is a rare angiotropic large-cell lymphoma in which neoplastic lymphocytes proliferate within the lumina of small blood vessels in the absence of a primary extravascular mass or leukemia. This study included 10 cases of canine IVL restricted to the CNS. Dogs had an average age of 8 years and neurological signs mainly referred to brain involvement such as depression, seizures, and ambulatory deficits. Gross examination at necropsy showed focal extensive or multiple hemorrhagic areas mainly distributed in the telencephalon and diencephalon. Histopathologically, numerous veins and capillaries were filled with neoplastic lymphoid cells, accompanied by edema, hemorrhage, and thrombosis. Immunohistochemistry (IHC) for CD3, CD20, and PAX5 was performed to phenotype the neoplastic lymphocytes. IHC for CD44 and CD29 were used to investigate the pathogenetic mechanism leading to the intravascular aggregation of the neoplastic lymphocytes. The same IHC panel was applied to 8 cases of primary and metastatic canine CNS lymphoma in order to compare IVL immunoreactivity. Three IVLs were typified as T-cell, 3 as B-cell, and 4 as non-T non-B. Neoplastic lymphocytes showed marked expression of CD44 in all IVL cases, and CD29-immunolabeled cells were observed in 4 IVLs. CD44 immunoreactivity was consistent with the findings reported in human IVL, suggesting a predisposition to the formation of lymphocyte aggregates. CD29 was inconsistently immunonegative in canine IVL, confirming only partially the pathogenetic mechanism suggested for the human counterpart.
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Affiliation(s)
| | | | | | - Carlo Cantile
- 1 Department of Veterinary Science, University of Pisa, Pisa, Italy
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44
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Yomo S, Tsutsumi K, Yako T, Sato H, Hashimoto T, Oguchi K. Accurate Detection of Tumor Infiltration by 11C-Methionine Positron Emission Tomography in a Patient with Central Nervous System Intravascular Lymphoma: A Case Report. Case Rep Oncol 2018; 11:577-584. [PMID: 30186143 PMCID: PMC6120372 DOI: 10.1159/000492465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 07/26/2018] [Indexed: 12/22/2022] Open
Abstract
Intravascular lymphoma (IVL) is a rare and clinically devastating subtype of extranodal diffuse large B-cell lymphoma with a distinct presentation. Diagnostic difficulty derives from marked variability in clinical presentations and nonspecific laboratory and radiological findings, especially when central nervous system (CNS) symptoms are the only manifestation. Establishing the diagnosis premortem thus remains a major challenge. We describe a 70-year-old male with CNS IVL. He presented with acute onset of neurocognitive impairments. Diffusion-weighted magnetic resonance imaging (MRI) showed multiple high-intensity areas suggesting occlusive cerebrovascular disease due to emboli, but extensive investigations detected no embolic sources. Intracranial neoplasm was included in a differential diagnosis based on elevated serum lactate dehydrogenase and interleukin 2 receptor levels. Gadolinium-enhanced MRI or 18-fluorodeoxyglucose positron emission tomography (PET) failed to demonstrate specific findings leading to a definite diagnosis, while 11C-methionine PET (MET-PET) distinctively demonstrated an area of focally increased MET uptake in the frontal cortex, suggesting the extent of tumor infiltration. Stereotactic biopsy was conducted under MET-PET imaging guidance and immunohistological examinations confirmed the proliferation and aggregation of CD20-positive lymphoma cells within the lumina of small blood vessels. The findings of the present case first suggest that MET-PET may provide important information on the diagnosis of CNS IVL and on the selection of the optimal site for brain biopsy. Further investigation is necessary to clarify whether positive findings on MET-PET are truly specific and pathognomonic for CNS IVL.
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Affiliation(s)
- Shoji Yomo
- Jisenkai Brain Imaging Research Center, Aizawa Hospital, Matsumoto, Japan
| | - Keiji Tsutsumi
- Department of Neurosurgery, Aizawa Hospital, Matsumoto, Japan
| | - Takehiro Yako
- Department of Neurosurgery, Aizawa Hospital, Matsumoto, Japan
| | - Hiromasa Sato
- Department of Neurology, Aizawa Hospital, Matsumoto, Japan
| | - Takao Hashimoto
- Jisenkai Brain Imaging Research Center, Aizawa Hospital, Matsumoto, Japan.,Department of Neurology, Aizawa Hospital, Matsumoto, Japan
| | - Kazuhiro Oguchi
- Jisenkai Brain Imaging Research Center, Aizawa Hospital, Matsumoto, Japan.,Positron Imaging Center, Aizawa Hospital, Matsumoto, Japan
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Abstract
Intravascular lymphoma (IVL) is a rare subtype of diffuse large B-cell lymphoma characterized by a clonal proliferation of lymphocytes restricted to the intravascular space. We present the case of a 60-year-old man with hemophagocytic syndrome secondary to IVL. F-FDG PET/CT demonstrated hepatosplenomegaly with marked diffuse hepatic, splenic, and bone marrow hypermetabolism. The case report illustrates the imaging findings of this uncommon variant of IVL.
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46
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Kailas A, Elston DM, Crater SE, Cerruto CA. Cutaneous intravascular CD30+ T-cell pseudolymphoma occurring in a regressing keratoacanthoma. J Cutan Pathol 2018; 45:296-298. [DOI: 10.1111/cup.13111] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 12/21/2017] [Accepted: 01/21/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Ajay Kailas
- University of Central Florida College of Medicine; Orlando Florida
| | - Dirk M. Elston
- Department of Dermatology; Medical University of South Carolina; Charleston South Carolina
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47
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Leelayuwatanakul N, Kongpolprom N. Orthodeoxia as a presentation of intravascular large B cell lymphoma. Respirol Case Rep 2018; 6:e00299. [PMID: 29796279 PMCID: PMC5961509 DOI: 10.1002/rcr2.299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 12/23/2017] [Accepted: 01/09/2018] [Indexed: 12/02/2022] Open
Abstract
Intravascular large B cell lymphoma (IVLBCL) is a rare and aggressive subtype of diffuse large B cell lymphoma, of which clinical presentations are highly variable among geographical areas. A case series of IVLBCL patients from Asian countries reported the disease to be more aggressive and associated with hemophagocytic syndrome than in cases from Western countries. Although published articles recently revealed hypoxemia as a presentation in IVLBCL patients, orthodeoxia has never been documented. A 71‐year‐old man presented with prolonged fever, cough, exertional dyspnoea, and orthodeoxia, later developing hypoxemic respiratory failure and refractory septic shock. Eventually, IVLBCL was diagnosed by random skin biopsy and bone marrow biopsy because of a high index of suspicion. We demonstrated the first case of orthodeoxia as an initial presentation of IVLBCL, clinically compatible with Asian‐variant IVLBCL, which is commonly fatal and diagnostically challenging.
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Affiliation(s)
- Nophol Leelayuwatanakul
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine Chulalongkorn University Thai Red Cross Society Thailand
| | - Napplika Kongpolprom
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine Chulalongkorn University Thai Red Cross Society Thailand
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Maiolo C, Ibbetson SJ, Sidhu SK, Kearney D. Intravascular large B-cell lymphoma presenting as panniculitis. JAAD Case Rep 2018; 3:536-538. [PMID: 29296641 PMCID: PMC5728488 DOI: 10.1016/j.jdcr.2017.06.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Corinne Maiolo
- Department of Dermatology, Royal Adelaide Hospital, Adelaide, Australia
- Correspondence to: Corinne Maiolo, MBBS, Department of Dermatology, Women's and Children's Hospital, 72 King William Road, North Adelaide 5006, South Australia, Australia.Department of DermatologyWomen's and Children's Hospital72 King William RoadNorth AdelaideSouth Australia5006Australia
| | - S. Jan Ibbetson
- Department of Anatomical Pathology, SA Pathology, Adelaide, Australia
| | - Shireen K. Sidhu
- Department of Dermatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Daniel Kearney
- Department of Anatomical Pathology, SA Pathology, Adelaide, Australia
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Chan AM, Huttner A, Baehring J. Disappearing Leukoencephalopathy : A Case of Relapsing-Remitting Intravascular Large B‑Cell Lymphoma with Transient Spontaneous Radiographic Regression. Clin Neuroradiol 2017; 28:455-459. [PMID: 29196778 DOI: 10.1007/s00062-017-0650-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/14/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Amy M Chan
- Department of Neurology, Medicine and Neurosurgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, 1137, 10029, New York, USA.
| | - Anita Huttner
- Department of Pathology, Yale School of Medicine, 310 Cedar Street, 06520, New Haven, CT, USA
| | - Joachim Baehring
- Department of Neurology and Neurosurgery, Yale School of Medicine, 15 York Street, LLCI Room 920, 06520, New Haven, CT, USA
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Winegarner A, Hashida N, Koh S, Nishida K. Hemorrhagic hypopyon as presenting feature of intravascular lymphoma, a case report. BMC Ophthalmol 2017; 17:195. [PMID: 29070018 PMCID: PMC5657083 DOI: 10.1186/s12886-017-0591-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 10/20/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Herpes uveitis has been previously reported to present with hyphema, but hemorrhagic hypopyon is rarely reported as a herpetic uveitis manifestation. We report a case of herpes simplex virus (HSV) presenting with hemorrhagic hypopyon, and speculate on the underlying pathophysiology with relation to an intravascular lymphoma which was subsequently diagnosed as a result. CASE PRESENTATION We present a case wherein a 62-year-old Japanese rheumatoid arthritis woman, with HSV uveitis, presented with hemorrhagic hypopyon in the anterior chamber and a fever with photophobia. Patient was treated with antiviral drugs which improved the hyphema and corneal lesions, but lesions recurred 3 months later. This rare presentation of HSV induced uveitis, and its subsequent recurrence, aroused suspicion of an additional hypopyon-inducing pathology. On account of previous history of lung opacities and elevated LDH, intravascular lymphoma was eventually diagnosed via lung biopsy. She was treated for the lymphoma which also completely resolved all ocular symptoms without any recurrence as of 1.5 years later. CONCLUSION The exceedingly rare presentation of hemorrhagic hypopyon may have been enabled by an interaction of the HSV with the intravascular lymphoma. HSV involvement was indicated by the dendritic lesions, IgG assay, and response to anti-viral drugs. The ocular involvement of the intravascular lymphoma seems to be indicated by virtue of the anti-tumor drugs completely resolving all ocular symptoms.
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Affiliation(s)
- Andrew Winegarner
- Department of Ophthalmology, Osaka University Medical School, E7, 2-2 Yamadaoka, Suita, Osaka, 565-0871 Japan
| | - Noriyasu Hashida
- Department of Ophthalmology, Osaka University Medical School, E7, 2-2 Yamadaoka, Suita, Osaka, 565-0871 Japan
| | - Shizuka Koh
- Department of Ophthalmology, Osaka University Medical School, E7, 2-2 Yamadaoka, Suita, Osaka, 565-0871 Japan
| | - Kohji Nishida
- Department of Ophthalmology, Osaka University Medical School, E7, 2-2 Yamadaoka, Suita, Osaka, 565-0871 Japan
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