1
|
Lee JC, Logan AC. Diagnosis and Management of Adult Malignancy-Associated Hemophagocytic Lymphohistiocytosis. Cancers (Basel) 2023; 15:1839. [PMID: 36980725 PMCID: PMC10046521 DOI: 10.3390/cancers15061839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 03/22/2023] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of severe, dysregulated inflammation driven by the inability of T cells to clear an antigenic target. When associated with malignancy (mHLH), the HLH syndrome is typically associated with extremely poor survival. Here, we review the diagnosis of secondary HLH (sHLH) syndromes in adults, with emphasis on the appropriate workup and treatment of mHLH. At present, the management of HLH in adults, including most forms of mHLH, is based on the use of corticosteroids and etoposide following the HLH-94 regimen. In some cases, this therapeutic approach may be cohesively incorporated into malignancy-directed therapy, while in other cases, the decision about whether to treat HLH prior to initiating other therapies may be more complicated. Recent studies exploring the efficacy of other agents in HLH, in particular ruxolitinib, offer hope for better outcomes in the management of mHLH. Considerations for the management of lymphoma-associated mHLH, as well as other forms of mHLH and immunotherapy treatment-related HLH, are discussed.
Collapse
Affiliation(s)
- Jerry C. Lee
- Hematology, Blood and Marrow Transplantation, and Cellular Therapy Program, Division of Hematology/Oncology, University of California, San Francisco, CA 94143, USA;
| | | |
Collapse
|
2
|
Fujikura K, Yamashita D, Yoshida M, Ishikawa T, Itoh T, Imai Y. Cytogenetic complexity and heterogeneity in intravascular lymphoma. J Clin Pathol 2020; 74:244-250. [PMID: 32763919 DOI: 10.1136/jclinpath-2020-206573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/26/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Abstract
AIMS To characterise the karyotypic abnormalities and heterogeneities in intravascular lymphoma (IVL). METHODS G-banded karyotyping was performed on biopsy specimens from a single-centre IVL cohort comprising intravascular large B-cell lymphoma (IVLBCL, n=12) and NK/T-cell lymphoma (IVNKTCL, n=1). RESULTS Five IVLBCL cases and one IVNKTCL case (total 46%) were found to have normal karyotypes, and the cytogenetic abnormalities observed in the other seven IVLBCL cases (54%) were investigated further. These seven karyotypes were uniformly complex with an average of 13 aberrations. The seven cases all had abnormalities involving chromosome 6, with 57% involving structural abnormalities at 6q13, and chromosome 8, with 43% involving abnormalities at 8p11.2. In addition, 71% had aberrations at 19q13. On average, 4.4 chromosomal gains and losses were detected per case. Cytogenetic heterogeneities were observed in six cases (86%) and tetraploidy in three cases (43%). There was no significant difference in progression-free survival (p=0.92) and overall survival (p=0.61) between the IVLBCL cases with complex and normal karyotypes. CONCLUSION Approximately half of IVLBCL cases had a highly heterogeneous pattern of karyotypes with different clonal numerical and structural chromosome aberrations.
Collapse
Affiliation(s)
- Kohei Fujikura
- Department of Pathology, Kobe City Medical Center General Hospital, Kobe, Japan .,Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Yamashita
- Department of Pathology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Makoto Yoshida
- Department of Pathology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takayuki Ishikawa
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yukihiro Imai
- Department of Pathology, Kobe City Medical Center General Hospital, Kobe, Japan
| |
Collapse
|
3
|
Klairmont MM, Cheng J, Martin MG, Gradowski JF. Recurrent Cytogenetic Abnormalities in Intravascular Large B-Cell Lymphoma. Am J Clin Pathol 2018; 150:18-26. [PMID: 29767679 DOI: 10.1093/ajcp/aqy023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Data characterizing the cytogenetic landscape of intravascular large B-cell lymphoma (ILBCL) are limited. Here, we developed a comprehensive karyotypic data set to identify recurrent cytogenetic abnormalities in ILBCL. METHODS Cases of ILBCL with complete cytogenetic analysis were identified from an institutional database and the literature. The combined data were systematically reviewed for the presence of recurrent abnormalities. RESULTS Four new cases were identified and combined with 25 karyotypes previously published in the literature. Karyotypes were uniformly complex with a median of 10 aberrations. In total, 72.4% had abnormalities involving chromosome 1, with 31.0% involving rearrangements of 1p13 or 1q21; 58.6% had abnormalities involving chromosome 6, which in almost all cases involved 6q; 34.5% had abnormalities involving chromosome 14, with 27.6% involving rearrangements of 14q32; and 55.2% had abnormalities of chromosome 18, with 37.9% harboring trisomy 18. CONCLUSIONS Recurrent cytogenetic abnormalities involving chromosomes 1, 6q, and 18 are present in greater than 50% of ILBCL.
Collapse
Affiliation(s)
- Matthew M Klairmont
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis
| | - Jinjun Cheng
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis
| | - Mike G Martin
- Department of Hematology/Oncology, West Cancer Center/University of Tennessee Health Science Center, Memphis
| | - Joel F Gradowski
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis
| |
Collapse
|
4
|
Çetin B, Akyürek N, Metin Y, Karaca F, Bilgetekin İ, Özet A. Intravascular Large B-Cell Lymphoma of the Gallbladder. Turk J Haematol 2018; 35:145-146. [PMID: 29391332 PMCID: PMC5972344 DOI: 10.4274/tjh.2017.0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Bülent Çetin
- Recep Tayyip Erdoğan University Faculty of Medicine, Department of Internal Medicine, Division of Medical Oncology, Rize, Turkey
| | - Nalan Akyürek
- Gazi University Faculty of Medicine, Department of Pathology, Ankara, Turkey
| | - Yavuz Metin
- Recep Tayyip Erdoğan University Faculty of Medicine, Department of Radiology, Rize, Turkey
| | - Feryal Karaca
- Adana Numune Training and Research Hospital, Clinic of Radiation Oncology, Adana, Turkey
| | - İrem Bilgetekin
- Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Clinic of Internal Medicine, Division of Medical Oncology, Ankara, Turkey
| | - Ahmet Özet
- Gazi University Faculty of Medicine, Department of Internal Medicine, Division of Medical Oncology, Ankara, Turkey
| |
Collapse
|
5
|
di Fonzo H, Contardo D, Carrozza D, Finocchietto P, Rojano Crisson A, Cabral C, de Los Angeles Juarez M. Intravascular Large B Cell Lymphoma Presenting as Fever of Unknown Origin and Diagnosed by Random Skin Biopsies: A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2017; 18:482-486. [PMID: 28461685 PMCID: PMC5421743 DOI: 10.12659/ajcr.903816] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Patient: Female, 66 Final Diagnosis: Intravascular B-cell lymphoma Symptoms: Fever of unknown origin Medication: — Clinical Procedure: — Specialty: Hematology
Collapse
Affiliation(s)
- Horacio di Fonzo
- Department of Internal Medicine, Hospital de Clinicas "Jose de San Martin", University of Buenos Aires, Buenos Aires, Argentina
| | - Damian Contardo
- Department of Internal Medicine, Hospital de Clinicas "Jose de San Martin", University of Buenos Aires, Buenos Aires, Argentina
| | - Diego Carrozza
- Department of Internal Medicine, Hospital de Clinicas "Jose de San Martin", University of Buenos Aires, Buenos Aires, Argentina
| | - Paola Finocchietto
- Department of Internal Medicine, Hospital de Clinicas "Jose de San Martin", University of Buenos Aires, Buenos Aires, Argentina
| | - Adriana Rojano Crisson
- Department of Internal Medicine, Hospital de Clinicas "Jose de San Martin", University of Buenos Aires, Buenos Aires, Argentina
| | - Cecilia Cabral
- Department of Pathology, Hospital de Clinicas "Jose de San Martin", University of Buenos Aires, Buenos Aires, Argentina
| | - Maria de Los Angeles Juarez
- Department of Pathology, Hospital de Clinicas "Jose de San Martin", University of Buenos Aires, Buenos Aires, Argentina
| |
Collapse
|
6
|
Su DW, Pasch W, Costales C, Siddiqi I, Mohrbacher A. Asian-variant intravascular large B-cell lymphoma. Proc (Bayl Univ Med Cent) 2017; 30:186-189. [PMID: 28405077 DOI: 10.1080/08998280.2017.11929579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare and deadly malignancy involving the growth of lymphoma cells within vessel lumina of all organ types. IVLBCL is further divided into the hemophagocytic Asian variant and a classical Western variant. Both variants are difficult to diagnose by imaging, and although diagnostic criteria have been developed to guide workup, histopathological examination remains imperative. Treatment of IVLBCL remains difficult given the high mortality of the disease, but rituximab has emerged as a promising therapeutic option when combined with various cytotoxic regimens. The two main variants of IVLBCL generally manifest in their respective Asian or Western populations, and crossover between ethnicities is rare. We present the second described case of Asian-variant IVLBCL in an African American individual.
Collapse
Affiliation(s)
- Derrick W Su
- Jane Anne Nohl Division of Hematology (Su, Mohrbacher) and the Hematopathology Section, Department of Pathology (Pasch, Costales), Norris Comprehensive Cancer Center and Hospital, University of Southern California, Los Angeles, California
| | - Whitney Pasch
- Jane Anne Nohl Division of Hematology (Su, Mohrbacher) and the Hematopathology Section, Department of Pathology (Pasch, Costales), Norris Comprehensive Cancer Center and Hospital, University of Southern California, Los Angeles, California
| | - Cristina Costales
- Jane Anne Nohl Division of Hematology (Su, Mohrbacher) and the Hematopathology Section, Department of Pathology (Pasch, Costales), Norris Comprehensive Cancer Center and Hospital, University of Southern California, Los Angeles, California
| | - Imran Siddiqi
- Jane Anne Nohl Division of Hematology (Su, Mohrbacher) and the Hematopathology Section, Department of Pathology (Pasch, Costales), Norris Comprehensive Cancer Center and Hospital, University of Southern California, Los Angeles, California
| | - Ann Mohrbacher
- Jane Anne Nohl Division of Hematology (Su, Mohrbacher) and the Hematopathology Section, Department of Pathology (Pasch, Costales), Norris Comprehensive Cancer Center and Hospital, University of Southern California, Los Angeles, California
| |
Collapse
|
7
|
Brunet V, Marouan S, Routy JP, Hashem MA, Bernier V, Simard R, Petrella T, Lamarre L, Théorêt G, Carrier C, Knecht H, Fleury I, Pavic M. Retrospective study of intravascular large B-cell lymphoma cases diagnosed in Quebec: A retrospective study of 29 case reports. Medicine (Baltimore) 2017; 96:e5985. [PMID: 28151891 PMCID: PMC5293454 DOI: 10.1097/md.0000000000005985] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Intravascular large B-cell lymphoma (IVL) is an extremely rare malignancy, mainly studied through European and Asian series. Due to the low incidence of this condition, our understanding of the clinical presentation as well as the management of IVL relies on a limited number of patients.We report the largest North American study to date on IVL with 29 cases from Quebec hospital diagnosed between 1990 and 2016. The aim of our study is to describe the clinical presentations, diagnostic and staging procedures, therapeutic management and clinical outcomes of IVL patients in our population and compare the disease phenotype to European and Asian series reported.In our cohort, all patients had stage IV IVL at diagnosis, with a median age of 66.7 years (range 47.2-90.8). Clinical presentation was characterized by constitutional symptoms (100%), poor ECOG-PS (100% ≥ 2), cytopenias (93% anemia), and elevated lactate dehydrogenase (97%) and C-reactive protein (96%). Our cohort presented with mainly cutaneous and neurological symptoms. However, neurological involvement (75.9%) was predominant and no "cutaneous variant" was observed; this differs from European literature, where "classical" IVL is reported with mainly cutaneous involvement. Two of our Caucasian patients presented "Asian variant" IVL; this observation is not unusual, as cases of "classical" IVL have been reported in Asians and "Asian variant" IVL has been reported in Europeans. All patients were classified according to their immunophenotypic features in 3 different subgroups (CD5 or CD5CD10, CD5CD10, CD5CD10) with no difference in outcome. Finally, 62% of our cohort received anthracycline-based chemotherapy and 53% of them achieved a complete response. After a median follow-up of 328 days, OS at 3 years was 42.7% for the entire cohort and 47.4% for the cases with in vivo diagnosis. CONCLUSION Unlike European studies on "classical" IVL, our study showed that the French Canadian presentation of this subtype of IVL is more frequently observed with neurological rather than cutaneous involvement. Finally, an early diagnosis is of primary importance since almost a quarter of patients receive a post-mortem diagnosis. A prompt diagnosis allows the introduction of an early treatment, associated with a CR in 53% of patients.
Collapse
Affiliation(s)
- Vanessa Brunet
- Department of Hematology-Oncology at Sherbrooke University Hospital Center, CIUSSS Estrie, University of Sherbrooke, Sherbrooke
| | - Sofia Marouan
- Department of Pathology at Sherbrooke University Hospital Center, CIUSSS Estrie, University of Sherbrooke, Sherbrooke
| | - Jean-Pierre Routy
- Department of Hematology-Oncology at McGill University Health Centre, CIUSSS Centre-Ouest-de-l’Île-de-Montréal, McGill University, Montreal
| | - Mohamed Amin Hashem
- Department of Pathology at Laval University Hospital Center, CIUSSS Capitale Nationale, University Laval, Quebec
| | - Vincent Bernier
- Department of Pathology at Laval University Hospital Center, CIUSSS Capitale Nationale, University Laval, Quebec
| | - Raynald Simard
- Department of Hematology-Oncology at Chicoutimi Hospital, CIUSSS Saguenay-Lac-Saint-Jean, University of Sherbrooke, Chicoutimi
| | - Tony Petrella
- Department of Pathology at Montreal University Hospital Center, CIUSSS Est-de-l’Île-de-Montréal, University of Montreal, Montreal
| | - Louis Lamarre
- Department of Pathology at Charles-Lemoyne Hospital, CIUSSS Montérégie-Centre, University of Sherbrooke, Longueuil
| | - Gilles Théorêt
- Department of Pathology at Cité-de-la-Santé Hospital, CIUSSS Laval, Laval
| | - Christian Carrier
- Department of Hematology-Oncology at Montreal University Hospital Center in Trois-Rivières, CIUSSS Mauricie-et-du-Centre-du-Québec, Trois-Rivieres
| | - Hans Knecht
- Department of Hematology-Oncology at McGill University Health Centre, CIUSSS Centre-Ouest-de-l’Île-de-Montréal, McGill University, Montreal
| | - Isabelle Fleury
- Department of Hematology-Oncology at Maisonneuve-Rosemont Hospital, CIUSSS Est-de-l’Île-de Montréal, University of Montreal, Montreal, Quebec, Canada
| | - Michel Pavic
- Department of Hematology-Oncology at Sherbrooke University Hospital Center, CIUSSS Estrie, University of Sherbrooke, Sherbrooke
| |
Collapse
|
8
|
Hall JM, Meyers N, Andrews J. Hemophagocytosis-Related (Asian Variant) Intravascular Large B-Cell Lymphoma in a Hispanic Patient: A Case Report Highlighting a Micronodular Pattern in the Spleen. Am J Clin Pathol 2016; 145:727-35. [PMID: 27247375 DOI: 10.1093/ajcp/aqw027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES We report a case of hemophagocytosis-related (Asian variant) intravascular large B-cell lymphoma (IVLBCL) in a patient of Western origin initially diagnosed by splenectomy with diffuse large B-cell lymphoma (DLBCL) with a micronodular pattern. The clonal relationship between these two DLBCL subtypes is also investigated. METHODS Hemophagocytosis-related (Asian variant) IVLBCL was identified at autopsy in a 62-year-old Hispanic woman, in North America, following an antemortem diagnosis of massive splenic involvement by DLBCL with a micronodular pattern, a feature not expected of IVLBCL. RESULTS These two apparently distinct lymphoma types demonstrated similar immunophenotypic profiles and IgH gene rearrangements of identical size suggesting a clonal relationship. The 2008 WHO classification system describes IVLBCL in the spleen as having a sinusoidal pattern. CONCLUSIONS Our observations provide the first molecular genetic support for a seemingly underrecognized micronodular pattern of IVLBCL in the spleen and further support the proposal of a "mixed variant" of IVLBCL with concomitant "intravascular" and "solid" phases of disease.
Collapse
Affiliation(s)
- Jordan M Hall
- From the San Antonio Military Medical Center, Fort Sam Houston, TX
| | | | | |
Collapse
|
9
|
Fonkem E, Dayawansa S, Stroberg E, Lok E, Bricker PC, Kirmani B, Wong ET, Huang JH. Neurological presentations of intravascular lymphoma (IVL): meta-analysis of 654 patients. BMC Neurol 2016; 16:9. [PMID: 26849888 PMCID: PMC4744383 DOI: 10.1186/s12883-015-0509-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 11/27/2015] [Indexed: 11/10/2022] Open
Abstract
Background Patients with intravascular lymphoma (IVL) frequently have neurological signs and symptoms. Prompt diagnosis and treatment is therefore crucial for their survival. However, the spectrum of neurological presentations and their respective frequencies have not been adequately characterized. Our aim is to document the spectrum of clinical symptoms and their respective frequencies and to create a clinical framework for the prompt diagnosis of IVL. Methods A comprehensive meta-analysis of 654 cases of IVL published between 1957 and 2012 was performed to provide better insight into the neurological presentations of this disease. Neurologic complications were mainly divided into central nervous system (CNS) and peripheral nervous system (PNS) presentations. Results There were no differences in occurrences of CNS IVL based on gender or geographic locations (Asian Vs non-Asian). However, most patients with CNS IVL were younger than 70 years of age (p < 0.05). Our limited data do not support the treatment efficacy of methotrexate. CNS symptoms were seen in 42 % of all cases. The most common CNS complications identified were cognitive impairment/dementia (60.9 %), paralysis (22.2 %), and seizures (13.4 %). PNS complications were seen in 9.5 % of cases. Out of these, muscle weakness (59.7 %), neurogenic bladder (37.1 %), and paresthesia (16.1 %) were the most common presentations. Conclusions CNS complications are more common among IVL patients. Out of these, dementia and seizures outnumber stroke-like presentations. Electronic supplementary material The online version of this article (doi:10.1186/s12883-015-0509-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ekokobe Fonkem
- Department of Neurosurgery, Baylor Scott & White Health, Temple, Texas, 76508, USA. .,Department of Neurology, Baylor Scott & White Health, Temple, Texas, 76508, USA.
| | - Samantha Dayawansa
- Department of Neurosurgery, Baylor Scott & White Health, Temple, Texas, 76508, USA.
| | - Edana Stroberg
- Department of Pathology, Baylor Scott & White Health, Temple, Texas, 76508, USA.
| | - Edwin Lok
- Department of Neurology, Brain Tumor Center and Neuro-Oncology Unit, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, Massachusetts, 02215, USA.
| | - Paul C Bricker
- Department of Neurology, Baylor Scott & White Health, Temple, Texas, 76508, USA.
| | - Batool Kirmani
- Department of Neurology, Baylor Scott & White Health, Temple, Texas, 76508, USA.
| | - Eric T Wong
- Department of Neurology, Brain Tumor Center and Neuro-Oncology Unit, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, Massachusetts, 02215, USA.
| | - Jason H Huang
- Department of Neurosurgery, Baylor Scott & White Health, Temple, Texas, 76508, USA.
| |
Collapse
|
10
|
Poullot E, Jacquet-Kammerer SF, Pagenault M, Llamas-Gutierrez F. [A terrible endoscopy]. Ann Pathol 2015; 35:174-6. [PMID: 25765141 DOI: 10.1016/j.annpat.2015.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Accepted: 01/05/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Elsa Poullot
- Service d'anatomie et cytologie pathologiques, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France
| | - Solène-Florence Jacquet-Kammerer
- Service d'anatomie et cytologie pathologiques, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France; Institut de développement et génétique de Rennes (IDGR), CNRS UMR 6290, faculté de médecine, université Rennes 1, 2, avenue du Professeur-Léon-Bernard, 35043 Rennes cedex, France
| | - Mael Pagenault
- Service d'hépato-gastro-entérologie CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France
| | - Francisco Llamas-Gutierrez
- Service d'anatomie et cytologie pathologiques, CHU Pontchaillou, 2, rue Henri-le-Guilloux, 35033 Rennes cedex 9, France.
| |
Collapse
|
11
|
Shimoyama Y, Sugimoto K, Kotake M, Uehara D, Kamide Y, Kuribayashi S, Kawamura O, Kusano M, Handa H, Hirato J, Yamada M. Two Cases of Intravascular Lymphoma Diagnosed by Gastrointestinal Endoscopic Biopsy. Intern Med 2015; 54:3145-9. [PMID: 26666601 DOI: 10.2169/internalmedicine.54.4764] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Two cases of intravascular lymphoma (IVL) were diagnosed by endoscopic biopsy. Both patients were admitted to our hospital with a fever of an unknown origin. An elevated serum level of soluble interleukin-2 receptor antibody suggested IVL. An upper gastrointestinal endoscopy was performed. A biopsy of both the reddened and normal gastroduodenal mucosa (Case 1) and a biopsy of a gastric antral ulcer, multiple polyploid lesions resembling submucosal tumors in the duodenum, and the patient's normal mucosa (Case 2) revealed vascular infiltration by CD20-positive atypical lymphocytes, confirming the diagnosis of IVL. The performance of a gastrointestinal biopsy for suspected IVL is important, even if there are no visible endoscopic abnormalities.
Collapse
Affiliation(s)
- Yasuyuki Shimoyama
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Chihara T, Wada N, Ikeda J, Fujita S, Hori Y, Ogawa H, Sugiyama H, Nomura S, Matsumura I, Hino M, Kanakura Y, Morii E, Aozasa K. Frequency of intravascular large B-cell lymphoma in Japan: study of the Osaka Lymphoma Study Group. J Hematol Oncol 2011; 4:14. [PMID: 21481222 PMCID: PMC3095575 DOI: 10.1186/1756-8722-4-14] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Accepted: 04/11/2011] [Indexed: 11/10/2022] Open
|
13
|
Yeh YM, Chang KC, Chen YP, Kao LY, Tsai HP, Ho CL, Wang JR, Jones D, Chen TY. Large B cell lymphoma presenting initially in bone marrow, liver and spleen: an aggressive entity associated frequently with haemophagocytic syndrome. Histopathology 2011; 57:785-95. [PMID: 21166693 DOI: 10.1111/j.1365-2559.2010.03709.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS To describe diffuse large B cell lymphoma (DLBCL) presenting initially in bone marrow, liver and spleen (BLS-type) without lymphadenopathy. METHODS AND RESULTS The clinicopathological and cytogenetic features of 11 such cases (eight men, three women; mean age: 62.7 years are described). Usually presenting with fever and haemophagocytic syndrome suggesting infection and complicating timely diagnosis, bone marrow examination showed patchy and interstitial infiltration of large tumour cells without sinusoidal involvement. All cases had a high Ki-67 index (≥90%), commonly a non-germinal centre/activated B cell immunophenotype and were negative for Epstein-Barr virus and human herpesvirus 6 and 8. The more frequent cytogenetic changes involved chromosomal loci 14q32 and 9p24, as well as del(3)(q21), add(7)(p22), t(3;6), del(8)(p22), +18 and add(19)(p13). Clinical behaviour was very aggressive, with a 2-year survival rate of 18% (45% of patients died within 3 weeks). High-dose chemotherapy with haematopoietic stem cell transplantation prolonged survival in one patient. CONCLUSIONS Although it shares with intravascular LBCL a subtle presentation and an aggressive clinical course, this primary BLS large cell lymphoma variant is distinguished by lacking an intravascular component and having different cytogenetic findings.
Collapse
Affiliation(s)
- Yu-Min Yeh
- Department of Internal Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Passarin MG, Wen PY, Vattemi E, Buffone E, Ghimenton C, Bontempini L, Ottaviani S, Musso AM, Pedersini R. Intravascular lymphomatosis and intracerebral haemorrhage. Neurol Sci 2010; 31:793-7. [PMID: 20517703 DOI: 10.1007/s10072-010-0284-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 04/07/2010] [Indexed: 11/27/2022]
Abstract
Intravascular lymphomatosis (IVL) is a rare, malignant B- or T-cell lymphoma with remarkable affinity for the endothelial cells of small vessels, particularly within the skin and central nervous system. It is a disease that mimics several neurological disorders, particularly those of cerebrovascular ischemic origin. The prognosis is generally poor, with a rapidly fatal outcome. As a result the diagnosis is often made at post-mortem. We report a rare case of a 73-year-old patient with IVL complicated by intracerebral haemorrhage. In literature two cases of systemic IVL complicated by intracerebral haemorrhage have been reported, but they presented initially with a disseminated intravascular coagulation (DIC). This is the first case of brain IVL complicated by intracerebral haemorrhage not associated to DIC. Increasing awareness of this disease as a differential diagnosis to a common clinical presentation may lead to more opportunities to evaluate new diagnostic and treatment approaches.
Collapse
Affiliation(s)
- Maria Grazia Passarin
- Division of Neurology, Department of Medicine, Bussolengo Hospital, Via Ospedale 2, Bussolengo, Verona, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Yamamoto T, Morita K, Iriyama N, Wakui K, Hiroi A, Sawada T, Masuda A, Kobayashi M. Intravascular large B-cell lymphoma of the uterus: a case with favorable clinical outcome. Int J Surg Pathol 2009; 19:672-6. [PMID: 19948641 DOI: 10.1177/1066896909346273] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intravascular lymphoma (IVL) of the uterus, a rare manifestation of malignant lymphoma, was diagnosed in a 71-year-old woman, who had fever, edema, and genital bleeding. Only 4 cases of uterine IVL have been reported in detail in the literature in English, to the author's knowledge. The patient was treated with total hysterectomy with bilateral salpingo-oophorectomy, accompanied by subsequent chemotherapy in combination with rituximab. Preoperative endometrial cytology and biopsy showed atypical lymphocytes intermingled with nonneoplastic epithelial cells. Intravascular proliferation of atypical lymphocytes was detected by histological examination of the resected materials, in which almost the entire uterine structure, including a large endometrial polyp, ovaries, and uterine tubes were involved. Immunohistochemically, tumor cells were positive for CD20 and CD79a and negative for CD5 and CD10. In situ hybridization for Epstein-Barr virus was negative. IVL generally has a poor prognosis. However, in the present case, the patient has been disease free for at least 51 months, and a favorable outcome can be expected.
Collapse
Affiliation(s)
- Tomoko Yamamoto
- Tokyo Women's Medical University, Shinjuku-ku, Tokyo, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare disease entity of non-Hodgkin lymphoma according to the current WHO classification. This rare form of B-cell lymphoma is characterised by selective growth of tumour cells in the lumina of small vessels of various organs. Strange characteristics of IVLBCL, including the absence of marked lymphoadenopathy and the usually aggressive clinical behaviour, result in the delay of timely and accurate diagnosis and fatal complications. Thus, the prognosis of IVLBCL is extremely poor. The success achieved with the anti-CD20 chimeric monoclonal antibody, rituximab, represents an important milestone in the clinical practice of B-cell lymphoma. An advantage of adding rituximab to conventional chemotherapies has been shown, in the process of increasing our understanding of the clinical and pathological manifestations for IVLBCL. This Review describes the cutting edge of research on IVLBCL, and discusses the unsolved issues from biological and clinical perspectives to provide a better understanding of this rare lymphoma.
Collapse
|
17
|
Narimatsu H, Morishita Y, Saito S, Shimada K, Ozeki K, Kohno A, Kato Y, Nagasaka T. Usefulness of Bone Marrow Aspiration for Definite Diagnosis of Asian Variant of Intravascular Lymphoma: Four Autopsied Cases. Leuk Lymphoma 2009; 45:1611-6. [PMID: 15370213 DOI: 10.1080/10428190410001683769] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The Asian variant of intravascular lymphoma (AIVL) is characterized by hemophagocytic syndrome, pancytopenia and hepatosplenomegaly but usually lacks any neurological abnormality and skin lesions, which are typical features of classical intravascular lymphoma (IVL). An ante-mortem diagnosis of AIVL is difficult due to the absence of visible lymphoma lesions and unspecific clinical manifestations. A definite diagnosis relies on the presence of neoplastic B cells in the lumina of small vessels. Paraffin block samples of aspirated bone marrow clots were obtained from 4 patients with clinically suspected IVL and subjected to immunohistopathological analysis. All samples exhibited CD 20+ or CD 79a+ lymphoma cells proliferating intravascularly as well as erythrocytic hemophagocytosis. The distribution of neoplastic cells in the structure of the bone marrow allowed IVL to be distinguished from bone marrow invasions due to other types of lymphoma. We demonstrated the successful establishment of a definite ante-mortem diagnosis of AIVL in 3 of 4 patients by the rapid and simple method of using aspirated bone marrow samples.
Collapse
Affiliation(s)
- Hiroto Narimatsu
- Department of Hematology and Oncology, JA Aichi Showa Hospital, Konan, Japan.
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Masaki Y, Dong L, Nakajima A, Iwao H, Miki M, Kurose N, Kinoshita E, Nojima T, Sawaki T, Kawanami T, Tanaka M, Shimoyama K, Kim C, Fukutoku M, Kawabata H, Fukushima T, Hirose Y, Takiguchi T, Konda S, Sugai S, Umehara H. Intravascular large B cell lymphoma: proposed of the strategy for early diagnosis and treatment of patients with rapid deteriorating condition. Int J Hematol 2009; 89:600-10. [PMID: 19363707 DOI: 10.1007/s12185-009-0304-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 03/10/2009] [Accepted: 03/15/2009] [Indexed: 12/14/2022]
Abstract
We summarize our experience and propose methods for early diagnosis and treatment of intravascular large B cell lymphoma (IVL). A total of 16 patients with IVL between 1994 and 2007 were included and analyzed in this study. Predicted survival durations were short until September 2003. However, there have been marked improvement since the introduction of rituximab, and all patients responded to treatment and survived for more than 1 year following diagnosis of IVL. We propose an early clinical diagnostic strategy for starting treatment for IVL patients with quite poor performance status (PS) and in whom time is a limiting factor: (1) age >40 years, (2) fever above 38 degrees C with poor PS (ECOG 2-4), (3) lactate dehydrogenase (LDH) more than twice the upper limit of the normal level and/or sIL2R >5,000 IU/ml in serum, (4) worsening PS and/or elevation of serum LDH on a daily basis, and (5) confirmation of pathological lymphoid cells in peripheral blood or bone marrow smear and/or flow cytometry. Although accurate pathological diagnosis is quite important, time is a limiting factor for most of IVL patients. In such cases, we can start chemotherapy based on early clinical diagnostic strategy with high sensitivity and obtain good clinical outcome.
Collapse
Affiliation(s)
- Yasufumi Masaki
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Ishikawa, Japan.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Ferreri AJ, Dognini GP, Govi S, Crocchiolo R, Bouzani M, Bollinger CR, D'Incan M, Delaporte E, Hamadani M, Jardin F, Martusewicz-Boros M, Montanari M, Szomor A, Zucca E, Cavalli F, Ponzoni M. Can Rituximab Change the Usually Dismal Prognosis of Patients With Intravascular Large B-Cell Lymphoma? J Clin Oncol 2008; 26:5134-6; author reply 5136-7. [DOI: 10.1200/jco.2008.19.1841] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Andrés J.M. Ferreri
- Unit of Lymphoid Malignancies, Department of Oncology, San Raffaele Scientific Institute, Milan, Italy; International Extranodal Lymphoma Study Group, Bellinzona, Switzerland
| | - Giuseppina P. Dognini
- Unit of Lymphoid Malignancies, Department of Oncology, San Raffaele Scientific Institute, Milan, Italy; International Extranodal Lymphoma Study Group, Bellinzona, Switzerland
| | - Silvia Govi
- Unit of Lymphoid Malignancies, Department of Oncology, San Raffaele Scientific Institute, Milan, Italy; International Extranodal Lymphoma Study Group, Bellinzona, Switzerland
| | - Roberto Crocchiolo
- Unit of Lymphoid Malignancies, Department of Oncology, San Raffaele Scientific Institute, Milan, Italy; International Extranodal Lymphoma Study Group, Bellinzona, Switzerland
| | - Maria Bouzani
- Department of Hematology and Lymphoma, Evangelismos Hospital, Athens, Greece
| | | | - Michel D'Incan
- Centre Hospitalier Universitaire Hôtel-Dieu, Clermont-Ferrand, France
| | | | | | | | | | - Mauro Montanari
- Clinica di Ematologia, Azienda Ospedali Riuniti di Ancona, Ancona, Italy
| | - Arpad Szomor
- First Department of Medicine, University of Pecs, Pecs, Hungary
| | - Emanuele Zucca
- International Extranodal Lymphoma Study Group, Bellinzona, Switzerland; Division of Medical Oncology, Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - Franco Cavalli
- International Extranodal Lymphoma Study Group, Bellinzona, Switzerland; Division of Medical Oncology, Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland
| | - Maurilio Ponzoni
- Unit of Lymphoid Malignancies and Pathology Unit, Department of Oncology, San Raffaele Scientific Institute, Milan, Italy; International Extranodal Lymphoma Study Group, Bellinzona, Switzerland
| |
Collapse
|
20
|
Ferreri AJM, Dognini GP, Bairey O, Szomor A, Montalbán C, Horvath B, Demeter J, Uziel L, Soffietti R, Seymour JF, Ambrosetti A, Willemze R, Martelli M, Rossi G, Candoni A, De Renzo A, Doglioni C, Zucca E, Cavalli F, Ponzoni M. The addition of rituximab to anthracycline-based chemotherapy significantly improves outcome in ‘Western’ patients with intravascular large B-cell lymphoma. Br J Haematol 2008; 143:253-7. [DOI: 10.1111/j.1365-2141.2008.07338.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
21
|
|
22
|
Pallure V, Dandurand M, Stoebner PE, Habib F, Colonna G, Meunier L. [Intravascular B-cell lymphoma with febrile inflammatory lymphoedema of the lower limbs and lower back]. Ann Dermatol Venereol 2008; 135:299-303. [PMID: 18420078 DOI: 10.1016/j.annder.2007.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Accepted: 07/20/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Intravascular lymphomas are diffuse large-cell lymphomas belonging to a group of high-grade non-Hodgkin's lymphomas and are generally of phenotype B. They are rare and carry a severe prognosis. Clinical polymorphism is dominated by neurological and cutaneous involvement. PATIENTS AND METHODS We report the case of an 80-year-old woman with cutaneous intravascular B-cell lymphoma as revealed by an isolated episode of febrile bilateral inflammatory lymphoedema. Following combined chemotherapy with rituximab and mini-CHOP (cyclophosphamide, adriamycin, oncovin and prednisone), complete remission was obtained rapidly, with no relapse at two years. DISCUSSION Diagnosis of these tumours is rendered difficult by the clinical polymorphism and multifocal nature of lymphocytic proliferations. In the present case, diagnosis was based on histology results since presentation of the disease in the form of bilateral inflammatory oedema of the lower limbs is not sufficient to establish lymphoma. Combined rituximab and polychemotherapy comprising a CHOP regimen appears to yield the best results.
Collapse
Affiliation(s)
- V Pallure
- Service de dermatologie, groupe hospitalo-universitaire Carémeau, rue du Professeur-Robert-Debré, 30900 Nîmes, France
| | | | | | | | | | | |
Collapse
|
23
|
Lee JY, Kim JH, Shin JH, Kim HR, Lee JN, Kim KH, Lee WS, Joo YD, Sohn CH, Kim CH. Primary Isolated Bone Marrow Diffuse Large B-cell Lymphoma with Hemolytic Anemia as the First Manifestation. THE KOREAN JOURNAL OF HEMATOLOGY 2008. [DOI: 10.5045/kjh.2008.43.1.48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Ja Young Lee
- Department of Laboratory Medicine, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Jae Hyun Kim
- Department of Laboratory Medicine, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Jeong Hwan Shin
- Department of Laboratory Medicine, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Hye Ran Kim
- Department of Laboratory Medicine, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Jeong Nyeo Lee
- Department of Laboratory Medicine, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Ki Hyang Kim
- Department of Hemato-oncology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Won Sik Lee
- Department of Hemato-oncology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Young Don Joo
- Department of Hemato-oncology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Chang Hak Sohn
- Department of Hemato-oncology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Chan-Hwan Kim
- Department of Pathology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| |
Collapse
|
24
|
Xanthopoulos V, Galanopoulos AG, Paterakis G, Apessou D, Argyrakos T, Goumakou E, Papadhimitriou SI, Savvidou I, Georgiakaki M, Anagnostopoulos NI. Intravascular B-cell lymphoma with leukemic presentation: case report and literature review. Eur J Haematol 2007; 80:177-81. [PMID: 18076638 DOI: 10.1111/j.1600-0609.2007.00984.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Intravascular lymphoma is an extremely rare, disseminated, and aggressive extranodal CD20+ non-Hodgkin's lymphoma characterized by the presence of lymphoma cells only in the lumina of small vessels. We report a 72-year-old woman with a diagnosis of intravascular lymphoma presented with splenomegaly and leukemic appearance in the peripheral blood smear. Her clinical course was rapidly deteriorated before the initiation of specific chemotherapy and finally died due to multiorgan insufficiency. Bone marrow biopsy revealed a characteristic infiltration of CD5, CD10 B-cell lymphoma. To our knowledge, this is the first reported case of a CD5, CD10 intravascular B-cell lymphoma with leukemic presentation in peripheral blood with multiple cytogenetic aberrations.
Collapse
|
25
|
Ponzoni M, Ferreri AJM. Intravascular lymphoma: a neoplasm of 'homeless' lymphocytes? Hematol Oncol 2006; 24:105-12. [PMID: 16721900 DOI: 10.1002/hon.776] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Intravascular lymphoma (IVL) is an extremely rare form of non-Hodgkin lymphoma characterized by almost exclusive growth of neoplastic lymphocytes within blood vessel lumen. IVL is morphologically characterized in most instances by large cells with B-cell lineage. IVL is an aggressive and usually disseminated disease that predominantly affects elderly patients, resulting in poor PS, B-symptoms, anemia, and high lactate dehydrogenase serum level. The brain and skin are the most commonly involved sites; nodal disease is rare. Survival after conventional chemotherapy is disappointing, with a relevant impact of diagnostic delay and lethal complications. Notwithstanding these results, IVL limited to the skin (cutaneous variant) is a favorable presentation with distinctive clinical characteristics. Moreover, differences in clinical presentation with Eastern Countries IVL cases, mostly associated with hemophagocytic syndrome, do exist. Intensive combinations containing drugs with higher central nervous system bioavailability are needed in cases with brain involvement; the role of high-dose chemotherapy with autologous stem cell transplantation should be investigated in younger patients with unfavorable features. The present review will discuss the most recent acquisitions related either to diagnosis and immunophenotypic/biologic characteristics as well as clinical/therapeutic issues of IVL.
Collapse
Affiliation(s)
- Maurilio Ponzoni
- Pathology Unit, San Raffaele H Scientific Institute, Milan, Italy.
| | | |
Collapse
|
26
|
Abstract
Intravascular lymphoma (IVL) is a rare subtype of extranodal diffuse large B-cell lymphoma with a distinct presentation. Anatomically the disease is characterized by the proliferation of clonal lymphocytes within small vessels with relative sparing of the surrounding tissue. The clinical symptoms of the disease are dependent on the specific organ involvement, which most often includes the central nervous system and skin. Because of the various modes of presentation and the rarity of IVL, the diagnosis is often made postmortem. The diagnosis is almost exclusively made by surgical biopsy of a suspected site of involvement. Advances in imaging and immunohistochemistry have led to increasing antemortem diagnosis of this lymphoma. Although some patients with this disease may be curable with aggressive therapy, further research into novel treatment strategies is needed to improve outcome. Some potential insights into future therapies may be drawn from the small amount of basic science literature relevant to this entity. This review provides a concise, up-to-date summary of IVL.
Collapse
Affiliation(s)
- Dan Zuckerman
- Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
| | | | | |
Collapse
|
27
|
Sukpanichnant S, Visuthisakchai S. Intravascular Lymphomatosis: A Study of 20 Cases in Thailand and a Review of the Literature. ACTA ACUST UNITED AC 2006; 6:319-28. [PMID: 16507210 DOI: 10.3816/clm.2006.n.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND According to the World Health Organization classification (2001), intravascular large B-cell lymphoma (IVLBCL) is characterized by the presence of lymphoma cells only in the lumina of small vessels. It has not been proven whether IVLBCL is a specific clinicopathologic entity. Intravascular large B-cell lymphoma and other intravascular lymphomatoses (IVLs), including IVL with B-cell phenotype and extravascular growth (B-IVL) and IVL with T-cell phenotype (T-IVL), were compared in a series of cases diagnosed at a single institution and in cases reported in the literature. PATIENTS AND METHODS Twenty cases of IVL diagnosed among 1826 consecutive cases of non-Hodgkin's lymphoma (NHL,1.1%) at Siriraj Hospital included 3 cases of IVLBCL, 14 cases of B-IVL, and 3 cases of T-IVL. In the literature, 102 cases of IVLBCL, 88 cases of B-IVL, and 18 cases of T-IVL were described in sufficient detail to be analyzed. RESULTS All 3 groups were quite similar in clinical manifestations and outcome. Contrary to the previous review of 79 cases of IVL in 1989, blood, marrow, and nodal involvement could be detected in approximately 30% of cases. Patients who received chemotherapy had better survival than patients without treatment (statistically significant in IVLBCL and B-IVL; P < 0.05). Cases with skin involvement had better survival than cases without skin involvement (statistically significantly in T-IVL; P < 0.05). CONCLUSION These results indicate that IVLBCL is not different from B-IVL or T-IVL in a biologic sense, and IVL seems to be better terminology than IVLBCL because it includes the T-cell phenotype that constitutes approximately 9% of cases. Early diagnosis is very important because chemotherapy significantly prolongs survival.
Collapse
Affiliation(s)
- Sanya Sukpanichnant
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | | |
Collapse
|
28
|
Ko CJ. The New World Health Organization–European Organization for Research and Treatment of Cancer Classification of Cutaneous Lymphomas. ACTA ACUST UNITED AC 2006; 22:259-77. [PMID: 17249305 DOI: 10.1016/j.yadr.2006.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The WHO-EORTC classification of cutaneous lymphomas is a good start to unifying nomenclature, a necessity before coherent consensus diagnoses can be made. There are three provisional diagnoses in this new classification that are not covered in detail in this review because they are rare diseases that still require further study for definitive classification. Much remains to be elucidated about cutaneous lymphomas, but understanding of the major entities within the new classification is an important first step in understanding these diverse diseases.
Collapse
Affiliation(s)
- Christine J Ko
- Yale University, 15 York Street, LMP 5031, New Haven, CT 06510, USA.
| |
Collapse
|
29
|
Sawamoto A, Narimatsu H, Suzuki T, Kurahashi S, Sugimoto T, Sugiura I. Long-term remission after autologous peripheral blood stem cell transplantation for relapsed intravascular lymphoma. Bone Marrow Transplant 2005; 37:233-4. [PMID: 16284609 DOI: 10.1038/sj.bmt.1705220] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
30
|
Terrier B, Aouba A, Vasiliu V, Charlier C, Delarue R, Buzyn A, Hermine O. Intravascular lymphoma associated with haemophagocytic syndrome: a very rare entity in western countries. Eur J Haematol 2005; 75:341-5. [PMID: 16146541 DOI: 10.1111/j.1600-0609.2005.00519.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Intravascular lymphoma (IVL) is a rare and aggressive disorder, characterised by frequent cutaneous and neurological involvement and medullary infiltration. In rare cases particularly in Asia, IVL can be associated with haemophagocytic syndrome (IVL-HS). Here, we report the case of a 61-year-old Caucasian female who presented with IVL-HS. Bone marrow biopsy showed haemophagocytic features and medullary localisation of a diffuse large B-cell lymphoma. Liver biopsy showed exclusive sinusoidal infiltration by large B cells. Treatment by polychemotherapy associated with rituximab induced a rapid complete remission. Unfortunately, death occurred as a consequence of septic shock. Early recognition of IVL-HS by performing bone marrow biopsy is critical to start rapidly appropriate treatment. The role of rituximab in the management of IVL-HS remains to be established.
Collapse
Affiliation(s)
- Benjamin Terrier
- Department of Adult Haematology, Necker Hospital, 149-161 rue de Sevres, 75743 Paris Cedex 15, France
| | | | | | | | | | | | | |
Collapse
|
31
|
Ferreri AJM, Campo E, Seymour JF, Willemze R, Ilariucci F, Ambrosetti A, Zucca E, Rossi G, López-Guillermo A, Pavlovsky MA, Geerts ML, Candoni A, Lestani M, Asioli S, Milani M, Piris MA, Pileri S, Facchetti F, Cavalli F, Ponzoni M. Intravascular lymphoma: clinical presentation, natural history, management and prognostic factors in a series of 38 cases, with special emphasis on the ‘cutaneous variant’1. Br J Haematol 2004; 127:173-83. [PMID: 15461623 DOI: 10.1111/j.1365-2141.2004.05177.x] [Citation(s) in RCA: 389] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite its recognition as a distinct, extremely rare entity, no large studies of intravascular lymphoma (IVL) have been reported. The clinico-pathological characteristics of 38 human immunodeficiency virus-negative patients with IVL diagnosed in Western countries were reviewed to better delineate clinical presentation, clinical variants, natural history and optimal therapy. The IVL is an aggressive and usually disseminated disease (Ann Arbor stage IV in 68% of cases) that predominantly affects elderly patients (median age 70 years, range: 34-90; male:female ratio 0.9), resulting in poor Eastern Cooperative Oncology Group Performance Status (ECOG-PS >1 in 61%), B symptoms (55%), anaemia (63%) and high serum lactate dehydrogenase level (86%). The brain and skin are the most common sites of disease. In contrast to previous reports, hepatosplenic involvement (26%) and bone marrow infiltration (32%) were found to be common features in IVL, while nodal disease was confirmed as rare (11% of cases). Patients with disease limited to the skin ('cutaneous variant'; 26% of cases) were invariably females with a normal platelet count, and exhibited a significantly better outcome than the remaining patients, which deserves further investigation. Overall survival was usually poor; however, the early use of intensive therapies could improve outcome in young patients with unfavourable features. ECOG-PS >1, 'cutaneous variant', stage I and chemotherapy use were independently associated with improved survival.
Collapse
Affiliation(s)
- Andrés J M Ferreri
- Department of Radiochemotherapy, San Raffaele H Scientific Institute, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Bhagwati NS, Oiseth SJ, Abebe LS, Wiernik PH. Intravascular lymphoma associated with hemophagocytic syndrome: a rare but aggressive clinical entity. Ann Hematol 2004; 83:247-50. [PMID: 14658009 DOI: 10.1007/s00277-003-0757-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2002] [Accepted: 10/23/2002] [Indexed: 11/26/2022]
Abstract
We report a 55-year-old male with a diagnosis of intravascular lymphoma and hemophagocytosis. He initially presented with hemolytic anemia and splenomegaly and was successfully treated with oral steroids. His clinical course was later complicated by fever, cytopenias, hypoalbuminemia, disseminated intravascular coagulation, gastrointestinal bleeding and acute tubular necrosis. Results of an extensive investigation for fever of unknown origin were negative. Although the patient was treated aggressively with antimicrobials, transfusion support and dialysis, he expired 3 weeks after hospitalization. Post-mortem analysis revealed large CD30- and CD45-positive lymphoma cells in an intravascular distribution in most of the organs studied. Histopathology of the spleen and bone marrow was significant for fulminant hemophagocytosis.
Collapse
Affiliation(s)
- Niyati S Bhagwati
- Comprehensive Cancer Center, Our Lady of Mercy Medical Center, 600 E 233rd Street, Bronx, NY 10466, USA.
| | | | | | | |
Collapse
|
33
|
Khoury H, Lestou VS, Gascoyne RD, Bruyere H, Li CH, Nantel SH, Dalal BI, Naiman SC, Horsman DE. Multicolor karyotyping and clinicopathological analysis of three intravascular lymphoma cases. Mod Pathol 2003; 16:716-24. [PMID: 12861069 DOI: 10.1097/01.mp.0000077515.68734.85] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Intravascular lymphoma (IVL) is a rare neoplastic disease characterized by the presence of large malignant lymphoid cells in small vessels. It is often diagnosed at autopsy. Clinical manifestations are typically neurologic and dermatologic. Karyotypic abnormalities have been described in a small number of cases and have revealed complex alterations in the majority of cases. We have identified three cases of IVL with varied clinicopathological findings. Karyotypic analysis was undertaken by standard G-banding and supplemented by multi-colored karyotyping (M-FISH) to decipher the chromosomal content of marker chromosomes and undefined additions. M-FISH clarified the chromosomal abnormalities in two cases and unveiled cryptic translocations der(10)t(10;22), der(17)t(17;22), and balanced t(11;14). Comparison with previously published karyotypes revealed prominent involvement of chromosomes 1, 3, 6, 11, 14, and 18, similar to the pattern of clonal evolution in other B-cell lymphomas. The most frequent alterations seen were -6 or 6q- and +18 or dup(18q), with a minimally deleted region located at 6q21-q23 and a commonly amplified region located at 18q13-q23, respectively. Few differences between the classical and Asian variant of this disease were apparent at the karyotypic level. Cytogenetic analysis of additional cases supplemented by multicolor karyotyping may help identify the full spectrum of genetic alterations associated with IVL and assist in the delineation of the critical mutations associated with initiation and progression of this disease.
Collapse
Affiliation(s)
- Haytham Khoury
- Leukemia/BMT Program of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Shaknovich R, Francois DJ, Cattoretti G, D'Agati VD, Markowitz GS. A rare cause of nephrotic syndrome. Am J Kidney Dis 2002; 39:892-5. [PMID: 11920359 DOI: 10.1053/ajkd.2002.32012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rita Shaknovich
- Department of Pathology, Columbia Presbyterian Medical Center, New York, NY 10032, USA
| | | | | | | | | |
Collapse
|
35
|
Tsukadaira A, Okubo Y, Ogasawara H, Urushibata K, Honda T, Miura I, Kubo K. Chromosomal aberrations in intravascular lymphomatosis. Am J Clin Oncol 2002; 25:178-81. [PMID: 11943898 DOI: 10.1097/00000421-200204000-00015] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Intravascular lymphomatosis (IVL) is a unique, disseminated type of malignant lymphoma. However, no detailed comparative study limited to the chromosomal aberrations of IVL has been reported, because IVL is extremely rare and difficult to diagnose while the patient is alive. We present here a case of IVL, and compare its karyotype with those of five cases of previously reported IVL. The accumulation of structural aberrations in chromosomes 1, 6, and 18, especially 1p (4 of 6 cases) and trisomy 18 (4 of 6 cases), were found in our comparative study of the B-cell lineage typical IVL. These chromosomal rearrangements must provide important information regarding the characteristics of cytogenetically associated with the cellular genetics of IVL.
Collapse
Affiliation(s)
- Akihiro Tsukadaira
- First Department of Internal Medicine, Shinshu University School of Medicine, Nagano, Japan
| | | | | | | | | | | | | |
Collapse
|
36
|
Yamamoto K, Nakamura Y, Arai H, Aoyagi M, Saito K, Furusawa S, Mitani K. Translocation (14;19)(q32;q13) detected by spectral karyotyping and lack of BCL3 rearrangement in CD5-positive B-cell lymphoma associated with hemophagocytic syndrome. CANCER GENETICS AND CYTOGENETICS 2001; 130:38-41. [PMID: 11672772 DOI: 10.1016/s0165-4608(01)00466-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
It has been shown that some cases of B-cell non-Hodgkin lymphoma associated with a hemophagocytic syndrome (B-LAHS) have chromosomal abnormalities at 14q32 or 19q13. We report here a 64-year-old woman with B-LAHS and a complex karyotype including add(14)(q32). We applied spectral karyotyping and revealed that the add(14)(q32) was derived from a der(14)t(14;19)(q32;q13). However, rearrangement of the BCL3 gene at 19q13 could not be detected by Southern blot analysis. Our results indicate that the translocation involving 19q13 may be one of the recurrent aberrations in B-LAHS and that the molecular mechanism of t(14;19)(q32;q13) in B-LAHS appear to be different from that observed in chronic lymphocytic leukemia.
Collapse
Affiliation(s)
- K Yamamoto
- Department of Hematology, Dokkyo University School of Medicine, 880 Kitakobayashi, Mibu-machi, Shimotsuga-gun, 321-0293, Tochigi, Japan.
| | | | | | | | | | | | | |
Collapse
|
37
|
Allory Y, Challine D, Haioun C, Copie-Bergman C, Delfau-Larue MH, Boucher E, Charlotte F, Fabre M, Michel M, Gaulard P. Bone marrow involvement in lymphomas with hemophagocytic syndrome at presentation: a clinicopathologic study of 11 patients in a Western institution. Am J Surg Pathol 2001; 25:865-74. [PMID: 11420457 DOI: 10.1097/00000478-200107000-00004] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Hemophagocytic syndrome (HPS) is a clinicopathologic syndrome that can reveal a non-Hodgkin's lymphoma. The pathologic features of lymphoma associated with HPS remain ill defined. We studied 11 lymphomas associated with HPS on initial bone marrow biopsies, consecutively diagnosed during a 6-year period in a Western institution. There were seven diffuse large B-cell lymphomas (DLBCLs), three T-cell lymphomas (one peripheral T-cell lymphoma unspecified, two hepatosplenic gammadelta T-cell lymphomas [HS gammadeltaTLs]), and one aggressive NK-cell lymphoma/leukemia (NKL). These lymphomas shared common clinicopathologic features with a systemic presentation, a poor outcome (nine patients died within 2 years), and a mild interstitial lymphoid infiltrate of the bone marrow at presentation in nine patients. This equivocal lymphoma infiltrate was blending with normal hematopoietic cells, and CD20 and CD3 immunolabelings were essential for its detection. A high number of reactive T (CD3+) cells, most often with a predominant cytotoxic (CD8+ TiA1+) phenotype, was present in all DLBCLs. By in situ hybridization, Epstein-Barr virus was detected in neoplastic cells of three cases (one DLBCL, one HS gammadeltaTL, and one NKL), which also showed serum viral DNA. Polymerase chain reaction studies disclosed HHV6 DNA sequences in tumor tissues of two DLBCLs, whereas HHV8 DNA was not detected. Because tumor mass indicative of lymphoma was not striking in most patients, bone marrow biopsy appears to be of great value for the diagnosis of an HPS-associated lymphoma, which may be, in Western patients, of B- as well as T- or NK-cell type. Immunostaining for CD3 and CD20 is essential to identify the common subtle lymphoma involvement. Together with a better understanding of the pathogenic processes, an early diagnosis may improve the prognosis of HPS-associated lymphoma.
Collapse
MESH Headings
- Adolescent
- Adult
- Aged
- Bone Marrow/pathology
- Female
- Herpesvirus 4, Human/isolation & purification
- Herpesvirus 6, Human/isolation & purification
- Herpesvirus 8, Human/isolation & purification
- Histiocytosis, Non-Langerhans-Cell/complications
- Humans
- Immunohistochemistry
- Lymphoma, B-Cell/complications
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/virology
- Lymphoma, T-Cell/complications
- Lymphoma, T-Cell/metabolism
- Lymphoma, T-Cell/pathology
- Lymphoma, T-Cell/virology
- Male
- Middle Aged
- Retrospective Studies
Collapse
Affiliation(s)
- Y Allory
- Département de Pathologie and EA 2348, Hôpital Henri Mondor, AP-HP, Créteil, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Murase T, Nakamura S, Kawauchi K, Matsuzaki H, Sakai C, Inaba T, Nasu K, Tashiro K, Suchi T, Saito H. An Asian variant of intravascular large B-cell lymphoma: clinical, pathological and cytogenetic approaches to diffuse large B-cell lymphoma associated with haemophagocytic syndrome. Br J Haematol 2001. [PMID: 11122144 DOI: 10.1111/j.1365-2141.2000.02426.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Diffuse large B-cell lymphoma with haemophagocytic syndrome (BCL-HS) has been reported mainly in Asia and is regarded as a distinct variant of intravascular lymphoma (IVL). However, it is unclear whether all cases of BCL-HS fall within the framework of IVL and available clinical information is limited. We analysed 25 cases with BCL-HS, including 11 autopsied cases (median, 66 years; male-female ratio, 1.1:1). The patients presented with fever, anaemia, thrombocytopenia, hepatosplenomegaly, haemophagocytosis, bone marrow invasion, respiratory disturbance and disseminated intravascular coagulopathy, but usually lacked lymphadenopathy, mass formation, neurological abnormalities and skin lesions. The clinical course was aggressive with a median survival of 7 months. The morphological findings were uniform: large lymphoid cells infiltrated vessels and/or sinusoids of the liver, marrow, lung, kidney and other organs. They were positive for CD19, CD20, CD79a and HLA-DR, but negative for CD10, CD23 and CD30. CD5 was positive in five out of 17 cases. Our critical review indicates that BCL-HS is the equivalent of the Asian variant of IVL.
Collapse
Affiliation(s)
- T Murase
- Department of Pathology and Clinical Laboratories, Aichi Cancer Centre Hospital, Nagoya, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
|
40
|
Abstract
Until recently, malignant histiocytosis was a clearly defined clinical entity marked by fever, progressive wasting, lymphadenopathy, hepatosplenomegaly, and pancytopenia. However, for many years the morphologic findings in this disease continued to cause a great deal of controversy. Now it seems clear that most cases of malignant histiocytosis represent anaplastic large cell lymphoma (ALCL) with Ki 1 expression, and they are not related to the monocyte/macrophage system. This conclusion is based on histopathologic and immunohistochemical findings, and more recently, on results from genotypic studies. Thus, malignant histiocytosis is a "vanishing disease."
Collapse
Affiliation(s)
- D Schmidt
- Institute of Pathology, Mannheim, Germany.
| |
Collapse
|
41
|
Murase T, Nakamura S, Kawauchi K, Matsuzaki H, Sakai C, Inaba T, Nasu K, Tashiro K, Suchi T, Saito H. An Asian variant of intravascular large B-cell lymphoma: clinical, pathological and cytogenetic approaches to diffuse large B-cell lymphoma associated with haemophagocytic syndrome. Br J Haematol 2000. [DOI: 10.1046/j.1365-2141.2000.02426.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
42
|
Ichikawa N, Kobayashi H, Ito T, Saito H. Chromosomal aberrations detected after stimulation with lipopolysaccharide in a patient with Asian variant intravascular lymphomatosis. CANCER GENETICS AND CYTOGENETICS 2000; 120:83-4. [PMID: 10939843 DOI: 10.1016/s0165-4608(99)00241-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
43
|
Abstract
B-cell lymphoma-associated hemophagocytic syndrome (B-LAHS) is extremely rare in Western countries but has recently been increasingly reported in Asian countries, especially Japan. Here, we reviewed 25 previously reported Japanese cases of B-LAHS and summarized its clinicopathologic features and therapeutic outcome. The median age of onset was 63 years old with initial presentation of fever, hepatomegaly, and splenomegaly without associated lymphadenopathy. Laboratory findings showed increased levels of lactate dehydrogenase, C-reactive protein, ferritin and soluble interleukin-2 receptor. Histopathologically, hemophagocytosis was often seen in the bone marrow and spleen. Various percentages of lymphoma cells were seen in the bone marrow, positive for CD19, CD20 and surface immunoglobulin. and some were also positive for CD5. Cytogenetic analysis showed a complex structural abnormality including chromosome 14q32, 19q13 and deletion of the terminal part of 8p21. Some patients had histological features of intravascular lymphomatosis (IVL). The prognosis was poor with a median survival period of 9 months. We treated five patients using autologous peripheral blood stem cell transplantation (PBSCT), and four are still in complete remission nine to 24 months after PBSCT, suggesting that high-dose chemotherapy followed by PBSCT might improve the survival rate.
Collapse
MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- CD5 Antigens/immunology
- Chromosome Aberrations
- Chromosome Disorders
- Chromosomes, Human, Pair 14
- Chromosomes, Human, Pair 19
- Chromosomes, Human, Pair 8
- Combined Modality Therapy
- Female
- Hematopoietic Stem Cell Transplantation
- Histiocytosis, Non-Langerhans-Cell/etiology
- Histiocytosis, Non-Langerhans-Cell/genetics
- Histiocytosis, Non-Langerhans-Cell/immunology
- Histiocytosis, Non-Langerhans-Cell/therapy
- Humans
- Lymphoma, B-Cell/complications
- Lymphoma, B-Cell/therapy
- Male
- Middle Aged
- Transplantation, Autologous
Collapse
Affiliation(s)
- C Shimazaki
- Second Department of Medicine, Kyoto Prefectural University of Medicine, Kamigyoku, Japan
| | | | | |
Collapse
|