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Dědič K, Belada D, Žák P, Nožička Z. Intravascular Large B-Cell Lymphoma Presenting As Cutaneous Panniculitis. ACTA MEDICA (HRADEC KRÁLOVÉ) 2019. [DOI: 10.14712/18059694.2019.19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In this report the case of intravascular large B-cell lymphoma (angiotropic lymphoma, intravascular angioendotheliomatosis, malignant endotheliomatosis) with panniculitis features is present. The diagnosis was based on finding of typical CD20 positive tumorous cells within capillaries, veins, and small arteries in the biopsy of subcutaneous adipose tissue. An accurate and early diagnosis together with combined chemotherapy resulted in good response and remission of the disease.
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Abstract
There are 2 types of central nervous system lymphoma: primary and secondary. Both have variable imaging features making them diagnostic challenges. Furthermore, a patient's immune status significantly alters the imaging findings. Familiarity with typical appearances, variations, and common mimics aids radiologists in appropriately considering lymphoma in the differential diagnosis. Moreover, special types of lymphoma, such as lymphomatosis cerebri, intravascular lymphoma, and lymphomatoid granulomatosis, also are found. This article discusses uncommon types of lymphoma and the differential diagnosis for focal, multifocal, meningeal, and infiltrative lymphomas.
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Affiliation(s)
- Lara A Brandão
- Radiologic Department, Clínica Felippe Mattoso, Fleury Medicina Diagnóstica, Avenida das Américas 700, sala 320, Barra Da Tijuca, Rio De Janeiro, Rio De Janeiro CEP 22640-100, Brazil; Radiologic Department, Clínica IRM- Ressonância Magnética, Rua Capitão Salomão, Humaitá, Rio De Janeiro, Rio De Janeiro CEP 22271-040, Brazil.
| | - Mauricio Castillo
- Division of Neuroradiology, Department of Radiology, University of North Carolina, School of Medicine, Room 3326, Old Infirmary Building, Manning Drive, Chapel Hill, NC 27599-7510, USA
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A rare case of intravascular large T-cell lymphoma with an unusual T helper phenotype. Am J Dermatopathol 2012; 33:e99-102. [PMID: 22024573 DOI: 10.1097/dad.0b013e318221bc25] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although most cases of intravascular large cell lymphoma exhibit a B-cell phenotype, less than 50 cases in the literature describe a T-cell or natural killer cell phenotype and, of these, the majority are CD3+, CD4-, CD5-, CD30-, CD56+, TIA-1+, and EBER+. We present a case of a rare intravascular large T-cell lymphoma in a 59-year-old man with an unusual CD3+, CD4+, CD5-, CD30+, CD56-, TIA-1-negative and EBER-negative phenotype. This T helper or CD30 phenotype is particularly uncommon. To our knowledge, it has only been described once before and never in the absence of the cytotoxic marker TIA-1. This case exemplifies the particular diagnostic challenges raised by intravascular large cell lymphomas generally and should encourage the use of endothelial immunohistochemical staining in questionable cases. While evaluating skin punch biopsies, it is critical to keep this rare entity on the differential diagnosis along with the relatively more common intravascular large B-cell lymphoma and epithelial malignancies. Additionally, our understanding of intravascular large natural killer/T-cell lymphoma as a heterogeneous phenotypic entity continues to evolve. This case demonstrates that the degree of this phenotypic heterogeneity may be even greater than previously thought.
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Ardighieri L, Lonardi S, Vermi W, Medicina D, Cerroni L, Facchetti F. Intralymphatic atypical T-cell proliferation in a cutaneous hemangioma. J Cutan Pathol 2010; 37:497-503. [DOI: 10.1111/j.1600-0560.2009.01327.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Liu H, Koyanagi I, Chiba H, Wanibuchi M, Honmou O, Yamaki T, Houkin K. Spinal cord infarct as the initial clinical presentation of intravascular malignant lymphomatosis. J Clin Neurosci 2009; 16:570-3. [DOI: 10.1016/j.jocn.2008.04.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Revised: 04/21/2008] [Accepted: 04/23/2008] [Indexed: 10/21/2022]
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Nakamichi N, Fukuhara S, Aozasa K, Morii E. NK-cell intravascular lymphomatosis--a mini-review. Eur J Haematol 2008; 81:1-7. [PMID: 18462254 DOI: 10.1111/j.1600-0609.2008.01089.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The majority of cases of intravascular lymphomatosis (IVL) is derived from B cells. However, IVL may also arise from T cells, or more rarely NK cells. The clinicopathological findings in six cases of NK-cell IVL (NK-IVL), including one new case, were summarised and compared with B-cell IVL (B-IVL) and T-cell IVL (T-IVL). Earlier onset of disease and female predominance were found in NK-IVL. NK-IVL was typically Epstein-Barr virus (EBV)-positive, whereas EBV was rarely detected in B-IVL. Cutaneous manifestations were common in NK-IVL with constant EBV infection. B-IVL showed a more favourable prognosis than T- or NK-IVL. Irrespective of immunophenotype, however, IVL showed a less favourable prognosis than ordinary lymphomas within the same immunophenotype. In summary, IVL of the B-, T- and NK-cell phenotypes is clinicopathologically distinct and shows similarities to their more common counterparts, i.e. diffuse large B-cell lymphoma, peripheral T-cell lymphoma, unspecified and extranodal NK/T-cell lymphoma, nasal type.
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Affiliation(s)
- Naoto Nakamichi
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
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Röglin J, Böer A. Skin manifestations of intravascular lymphoma mimic inflammatory diseases of the skin. Br J Dermatol 2007; 157:16-25. [PMID: 17506787 DOI: 10.1111/j.1365-2133.2007.07954.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Intravascular lymphoma (IVL) is fatal when it is diagnosed late in the course. Sometimes skin lesions enable early diagnosis, but criteria for diagnosis are not well established. OBJECTIVES To demonstrate the clinical spectrum of skin lesions of IVL and to correlate it with clinical outcome; to identify features differentiating between B-cell and T-cell IVL with skin involvement. METHODS Review of 97 articles reporting on total of 224 patients with IVL. RESULTS Skin lesions were mentioned in 90 of 224 patients. They were nodules and/or plaques (49%) or macules (22.5%) of red (31%) or blue to livid (19%) colour on the leg (35%), the thigh (41%) and the trunk (31%). Telangiectases were present in only 20% of the patients. Oedema (27.5%) of the legs and pain (24%) were often accompanying. No criteria enabled distinction between lesions restricted to the skin and skin lesions concurrent with IVL in other organs, but when the disease was restricted to the skin, the prognosis was favourable (10% vs. 85% fatal outcome). Skin lesions of T-cell IVL are indistinguishable from those of B-cell IVL. CONCLUSIONS Forty per cent of all patients with IVL have skin lesions, these being red, sometimes painful plaques located typically on the lower extremities, accompanied by oedema. A clinician risks misinterpreting these changes as thrombophlebitis, erythema nodosum or erysipelas. Neither clinical course nor differentiation of the lymphoma can be predicted from the morphology of skin lesions, but involvement of other organs at the time of diagnosis indicates a poor prognosis.
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Affiliation(s)
- J Röglin
- DERMATOLOGIKUM Hamburg, Stephansplatz 5, 20354 Hamburg, Germany
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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.
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Affiliation(s)
- Sanya Sukpanichnant
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Takahashi E, Kajimoto K, Fukatsu T, Yoshida M, Eimoto T, Nakamura S. Intravascular large T-cell lymphoma: a case report of CD30-positive and ALK-negative anaplastic type with cytotoxic molecule expression. Virchows Arch 2005; 447:1000-6. [PMID: 16189700 DOI: 10.1007/s00428-005-0080-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Accepted: 08/25/2005] [Indexed: 02/07/2023]
Abstract
We reported a case of intravascular T-cell lymphoma (T-IVL) with anaplastic large cell morphology, the hemophagocytic syndrome, and an aggressive clinical course. Phenotypic analysis of the tumor cells revealed CD2+, CD3-, CD4+, CD5-, CD8-, CD30+, CD56-, T-cell receptor alpha/beta-, ALK-, TIA1+, granzyme B+, and perforin+. No association with Epstein-Barr virus was found by in situ hybridization. A review revealed that 25 cases of T-IVL have been reported in the available literature, only two of which were of CD30+ anaplastic large cell or cytotoxic T-cell type. The findings in the present case may highlight the unique clinicopathologic aspects of a subset of CD30-positive T-IVLs with an ALK-negative cytotoxic phenotype.
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Affiliation(s)
- Emiko Takahashi
- Department of Pathology, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan.
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Smoller BR, Santucci M, Wood GS, Whittaker SJ. Histopathology and genetics of cutaneous T-cell lymphoma. Hematol Oncol Clin North Am 2003; 17:1277-311. [PMID: 14710885 DOI: 10.1016/s0889-8588(03)00115-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There is emerging evidence that genomic and chromosomal instability are features of CTCL, including variants such as MF, Sézary syndrome, and primary cutaneous CD30+ LCAL, and that specific chromosomal abnormalities are common. Additional resolution of specific regions of chromosomal loss and gain are required to define putative genes that may be of fundamental pathogenetic importance in CTCL. Inactivation of well-defined cell cycle and TSG are common as for other types of NHL. The prognostic significance of these abnormalities in CTCL has yet to be determined. The dysregulation of specific transcription factors is of interest, but requires further study. It is hoped that greater understanding of these molecular abnormalities will permit the development of CTCL-specific therapies that alleviate suffering and prolong survival.
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MESH Headings
- Chromosome Aberrations
- Chromosomes, Human/genetics
- Chromosomes, Human/ultrastructure
- Genetic Techniques
- Humans
- Immunophenotyping
- Killer Cells, Natural/pathology
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/pathology
- Lymphoma, T-Cell, Cutaneous/classification
- Lymphoma, T-Cell, Cutaneous/diagnosis
- Lymphoma, T-Cell, Cutaneous/genetics
- Lymphoma, T-Cell, Cutaneous/pathology
- Mycosis Fungoides/diagnosis
- Mycosis Fungoides/pathology
- Neoplasm Staging
- Signal Transduction/genetics
- Skin Neoplasms/classification
- Skin Neoplasms/diagnosis
- Skin Neoplasms/genetics
- Skin Neoplasms/pathology
- T-Lymphocyte Subsets/pathology
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Affiliation(s)
- Bruce R Smoller
- Department of Pathology, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR 72205, USA.
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12
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Santucci M, Pimpinelli N, Massi D, Kadin ME, Meijer CJLM, Müller-Hermelink HK, Paulli M, Wechsler J, Willemze R, Audring H, Bernengo MG, Cerroni L, Chimenti S, Chott A, Díaz-Pérez JL, Dippel E, Duncan LM, Feller AC, Geerts ML, Hallermann C, Kempf W, Russell-Jones R, Sander C, Berti E. Cytotoxic/natural killer cell cutaneous lymphomas. Report of EORTC Cutaneous Lymphoma Task Force Workshop. Cancer 2003; 97:610-27. [PMID: 12548603 DOI: 10.1002/cncr.11107] [Citation(s) in RCA: 208] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Cutaneous lymphomas expressing a cytotoxic or natural killer (NK) cell phenotype represent a group of lymphoproliferative disorders for which there is currently much confusion and little consensus regarding the best nomenclature and classification. METHODS This study analyzes 48 cases of primary cutaneous lymphoma expressing cytotoxic proteins and/or the NK cell marker, CD56. These cases were collected for a workshop of the European Organization for Research and Treatment of Cancer Cutaneous Lymphoma Task Force, to better clarify the clinical, morphologic, and phenotypic features of these uncommon tumors. RESULTS Several categories with different clinical and pathologic features were delineated: 1) aggressive, CD8+, epidermotropic, cytotoxic T-cell lymphoma; 2) mycosis fungoides, cytotoxic immunophenotype variant; 3) subcutaneous panniculitis-like T-cell lymphoma; 4) NK/T-cell lymphoma, nasal type; 5) CD4+, NK cell lymphoma; 6) blastoid NK cell lymphoma; (7) intravascular NK-like lymphoma; and 8) cytotoxic, peripheral T-cell lymphoma. CONCLUSIONS Our data show that primary cutaneous cytotoxic/NK cell lymphomas include distinct groups of diseases, clinically, histologically, and biologically. Because the finding of a cytotoxic phenotype often has prognostic significance, the routine use of cytotoxic markers in the diagnosis and classification of cutaneous lymphomas should be expanded.
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MESH Headings
- CD4-Positive T-Lymphocytes/immunology
- CD56 Antigen/immunology
- CD8-Positive T-Lymphocytes/immunology
- Humans
- Immunophenotyping
- Killer Cells, Natural/immunology
- Lymphoma/classification
- Lymphoma/immunology
- Lymphoma/pathology
- Lymphoma, T-Cell, Cutaneous/classification
- Lymphoma, T-Cell, Cutaneous/immunology
- Lymphoma, T-Cell, Cutaneous/pathology
- Lymphoma, T-Cell, Peripheral/classification
- Lymphoma, T-Cell, Peripheral/immunology
- Lymphoma, T-Cell, Peripheral/pathology
- Membrane Proteins/immunology
- Mycosis Fungoides/immunology
- Mycosis Fungoides/pathology
- Panniculitis/immunology
- Panniculitis/pathology
- Phenotype
- Poly(A)-Binding Proteins
- Proteins
- RNA-Binding Proteins/immunology
- Skin Neoplasms/classification
- Skin Neoplasms/immunology
- Skin Neoplasms/pathology
- T-Cell Intracellular Antigen-1
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Affiliation(s)
- Marco Santucci
- Department of Human Pathology and Oncology, University of Florence Medical School, Florence, Italy.
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13
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McDonough SP, Van Winkle TJ, Valentine BA, vanGessel YA, Summers BA. Clinicopathological and immunophenotypical features of canine intravascular lymphoma (malignant angioendotheliomatosis). J Comp Pathol 2002; 126:277-88. [PMID: 12056776 DOI: 10.1053/jcpa.2002.0553] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Intravascular lymphoma (IVL) is a rare angiotropic large-cell lymphoma in which neoplastic lymphocytes proliferate within the lumina of blood vessels in the absence of a primary extravascular mass or leukaemia. A retrospective review of veterinary medical records identified 17 cases of canine IVL. Spinal cord ataxia (seven dogs), posterior paralysis (one dog), seizures (four dogs) and vestibular disease (three dogs) dominated the clinical presentation. Haemorrhage, ischaemia, and occasional foci of vascular proliferation were found in tissue sections from affected dogs. Vessels, predominantly veins, throughout the body were frequently filled with neoplastic lymphocytes. Splenic involvement occurred in only one of 10 cases examined and bone marrow involvement was absent in four cases examined. Formalin-fixed paraffin wax-embedded tissues from 15 cases were examined immunohistochemically with streptavidin-biotin-horseradish peroxidase and a catalysed signal amplification system. The neoplastic cells were classified in eight cases as T cells (CD3+/IgG-/CD79a-), in one case as B cells (CD3-/CD79a.dim/IgG+), and in the remaining six cases as non-T, non-B (CD3-/IgG-/CD79a-). The clinical and pathological features of canine IVL closely resembled those of the human disease. In striking contrast to human cases, which are most often B-cell lymphomas, the immunophenotypes of the canine IVLs in this series were heterogeneous. The canine IVLs were derived primarily from T cells and non-T, non-B lymphocytes, B cells being found in only a single instance.
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MESH Headings
- Animals
- Antigens, CD/metabolism
- Biomarkers, Tumor/metabolism
- Dog Diseases/metabolism
- Dog Diseases/pathology
- Dogs
- Female
- Immunoenzyme Techniques/veterinary
- Immunophenotyping/veterinary
- Lymphoma, Large B-Cell, Diffuse/classification
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/veterinary
- Male
- Retrospective Studies
- T-Lymphocytes/pathology
- Vascular Neoplasms/classification
- Vascular Neoplasms/metabolism
- Vascular Neoplasms/pathology
- Vascular Neoplasms/veterinary
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Affiliation(s)
- S P McDonough
- Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Upper Tower Road, Ithaca, NY14853-6401, USA
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Al-Shahi R, Warlow CP, Jansen GH, Frijns CJ, van Gijn J. A 59 year old man with progressive spinal cord and peripheral nerve dysfunction culminating in encephalopathy: Edinburgh advanced clinical neurology course, 1999. J Neurol Neurosurg Psychiatry 2001; 71:696-703. [PMID: 11606689 PMCID: PMC1737602 DOI: 10.1136/jnnp.71.5.696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- R Al-Shahi
- Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK
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15
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Ellison DW, Wilkins BS. Lymphoma and the nervous system. CURRENT TOPICS IN PATHOLOGY. ERGEBNISSE DER PATHOLOGIE 2001; 95:239-65. [PMID: 11545056 DOI: 10.1007/978-3-642-59554-7_8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- D W Ellison
- Cancer Research Unit, Medical School, University of Newcastle, Newcastle-upon-Tyne NE2 4HH, UK
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17
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Vieren M, Sciot R, Robberecht W. Intravascular lymphomatosis of the brain: a diagnostic problem. Clin Neurol Neurosurg 1999; 101:33-6. [PMID: 10350202 DOI: 10.1016/s0303-8467(98)00074-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intravascular lymphomatosis (of B- or T-cell origin) is a rare lymphoproliferative disorder characterised by neoplastic proliferation of lymphoid cells within the lumen of capillaries, small veins and arteries with no or minimal involvement of the parenchyma. Its predilection sites are the skin and the brain. We studied a 44-year-old man who presented with a 2 year history of unexplained LDH elevation followed by a neurological syndrome without systemic involvement. Brain biopsy showed an intravascular lymphoma of the B-cell lineage. This report illustrates the diagnostic challenge of this rare disorder with a grim prognosis.
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Affiliation(s)
- M Vieren
- Department of Neurology and Neuropathology, University Hospital Gasthuisberg, Leuven, Belgium
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18
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Amagasaki K, Yamazaki H, Ohmori K, Koizumi H, Hashizume K, Sasaguchi N. Malignant intravascular lymphomatosis associated with venous stenosis. Case report. J Neurosurg 1999; 90:355-8. [PMID: 9950508 DOI: 10.3171/jns.1999.90.2.0355] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This 55-year-old man presented with malignant intravascular lymphomatosis, a rare vascular disorder of the central nervous system characterized by proliferation of malignant lymphoma cells. The clinical manifestations were focal neurological signs and progressive dementia. Angiography demonstrated stenoses of the cortical veins. Postmortem examination revealed infiltration of tumor cells into the lumen and vascular wall, although the stenoses were caused primarily by fibrin thrombi. To the authors' knowledge this is the first case of malignant intravascular lymphomatosis associated with venous stenosis.
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Affiliation(s)
- K Amagasaki
- Department of Neurosurgery, Yamanashi Prefectural Central Hospital, Kofu, Japan
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19
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Chang A, Zic JA, Boyd AS. Intravascular large cell lymphoma: a patient with asymptomatic purpuric patches and a chronic clinical course. J Am Acad Dermatol 1998; 39:318-21. [PMID: 9703143 DOI: 10.1016/s0190-9622(98)70380-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Intravascular large cell lymphoma (malignant angioendotheliomatosis) is a rare, multifocal, intravascular neoplasm of lymphoid cells that preferentially involves the vasculature of the skin and central nervous system. We describe a 54-year-old man with asymptomatic purpuric patches on the lower extremities for 10 years duration and a more recent lesion on the right arm. A biopsy specimen showed intravascular collections of tumor cells with irregular nuclear contours and prominent nucleoli. These cells were leukocyte common antigen (CD45), CD20, and CDW75 positive, but CD3, CD43, CD45RO, and cytokeratin negative. Polymerase chain reaction analysis of the skin for immunoglobulin heavy chain gene rearrangement detected a clonal population of B cells, supporting the diagnosis of a B-cell lymphoma. Peripheral blood showed no abnormal circulating cells. This case of malignant angioendotheliomatosis is unusual for its prolonged clinical course and presence of purpuric patches.
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MESH Headings
- Antigens, CD/analysis
- Antigens, CD20/analysis
- Humans
- Leukocyte Common Antigens/analysis
- Lymphoma, B-Cell/chemistry
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Purpura/complications
- Purpura/pathology
- Sialyltransferases
- Skin Diseases, Vascular/complications
- Skin Diseases, Vascular/pathology
- Vascular Neoplasms/complications
- Vascular Neoplasms/immunology
- Vascular Neoplasms/pathology
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Affiliation(s)
- A Chang
- Department of Dermatology, Vanderbilt University, Nashville, Tennessee, USA
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20
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Sokol DK, Azzarelli B, Smith RR, Kassing LC, Roos KL, Pascuzzi RM, Blinkhorn RJ. Primary intravascular lymphomatosis associated with Mycobacterium marinum. J Neuroimaging 1998; 8:47-9. [PMID: 9442593 DOI: 10.1111/jon19988147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Intravascular lymphomatosis (i.v.l.) is a rare condition in which neoplastic cells preferentially infiltrate blood vessels of the central nervous system. Nonspecific symptoms associated with i.v.l. include dementia, seizures, and multifocal cerebrovascular events. i.v.l. was discovered at autopsy of a patient whose neurological deficits were predated by a particularly aggressive form of Mycobacterium marinum soft-tissue infection. It is speculated that i.v.l. may have had an occult effect on the patient's cell-mediated immunity that predisposed him to this normally innocuous mycobacteria.
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Affiliation(s)
- D K Sokol
- Department of Neurology, Indiana University Medical Center, Indianapolis, USA
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21
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Snowden JA, Angel CA, Winfield DA, Pringle JH, West KP. Angiotropic lymphoma: report of a case with histiocytic features. J Clin Pathol 1997; 50:67-70. [PMID: 9059361 PMCID: PMC499717 DOI: 10.1136/jcp.50.1.67] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Angiotropic lymphoma, also known as intravascular lymphomatosis, is characterised by widespread intravascular proliferation of malignant lymphoid cells, usually without evidence of focal disease. A case of a 52 year old man referred for investigation of a two year history of pyrexia of unknown origin, skin rash and multiple organ failure is described. Angiotropic lymphoma was seen in gastric, colonic and skin biopsy specimens, and review of an earlier skin biopsy specimen showed similar morphological features. In contrast to previous cases which showed B or T cell differentiation, immunohistochemical examination was positive for histiocyte markers. Molecular studies showed no evidence of immunoglobulin heavy chain gene or T cell receptor gene rearrangement. The patient responded to combination chemotherapy, comprising cyclophosphamide, doxorubicin, etoposide, and prednisolone. This case highlights the fact that advanced lymphoma may be present without evidence of focal disease and that the diagnosis may be missed easily both clinically and histologically.
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Affiliation(s)
- J A Snowden
- Department of Haematology, Royal Hallamshire Hospital, Central Sheffield University Hospitals Trust
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Liszka U, Drlicek M, Hitzenberger P, Machacek E, Mayer H, Stockhammer G, Grisold W. Intravascular lymphomatosis: a clinicopathological study of three cases. J Cancer Res Clin Oncol 1994; 120:164-8. [PMID: 8263013 DOI: 10.1007/bf01202196] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In patients with intravascular lymphomatosis (IL) a broad spectrum of neuro-psychiatric disorders including dementia, focal neurological signs and seizures has been reported. Clinical diagnosis is difficult since neuroimaging findings are nonspecific. The clinical histories, biopsy and autopsy findings of three patients with IL, one with brain biopsy, are described. Two of them presented with rapidly progressive, fluctuating dementia. The third patient suffered from seizures followed by aphasia. Histology revealed large-cell lymphoma of the B cell type. The prognosis of IL, in general, is poor.
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Affiliation(s)
- U Liszka
- Department of Pathology and Bacteriology, Psychiatric Hospital Baumgartner Hoehe, Vienna, Austria
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Abstract
BACKGROUND Intravascular lymphomatosis (IL) is a systemic neoplasm that often involves the nervous system, inducing progressive neurologic deficits in the setting of undiagnosed or quiescent extranodal non-Hodgkin lymphoma. METHODS The clinical and pathologic files of the Massachusetts General Hospital and New York University Medical Center and the English language literature were reviewed to identify all reports of intravascular lymphomatosis (angioendotheliomatosis) or other examples of a diffuse proliferation of neoplastic cells filling capillaries, arterioles, and venules. RESULTS The authors report seven patients with IL and note 114 patients reported in the literature. Almost two-thirds (63%) of patients had neurologic manifestations, without abnormalities on bone marrow biopsy, chest and abdominal tomographic examinations for adenopathy, and cerebrospinal fluid (CSF) analysis. All patients had one or more of four syndromes, each reflecting a vascular occlusive process: progressive, multifocal cerebrovascular events; paraparesis, pain, and incontinence; a subacute encephalopathy; and peripheral or cranial neuropathies. CONCLUSIONS The unexplained presence of any one or more of these neurologic syndromes should alert the physician to the possible presence of this disease.
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Affiliation(s)
- J Glass
- Department of Neurology, Temple University Health Sciences Center, Philadelphia, Pennsylvania 19140
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Lacomis D, Smith TW, Long RR. Angiotropic lymphoma (intravascular large cell lymphoma) presenting with cauda equina syndrome. Clin Neurol Neurosurg 1992; 94:311-5. [PMID: 1335859 DOI: 10.1016/0303-8467(92)90180-b] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
A 50-year-old man developed cauda equina syndrome of unknown etiology that was stable for 20 months. Two months prior to sudden death, he experienced new back pain, confusion, seizures, and multiple cranial nerve palsies. Neuropathologic examination revealed angiotropic lymphoma without parenchymal involvement or infarcts in the brain, spinal cord, and muscle. In addition, nerve roots in the cauda equina contained angiotropic lymphoma and infarcts of various ages. Angiotropic lymphoma should be considered as a cause of cauda equina syndrome and of disorders that affect the central and peripheral nervous systems concurrently.
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Affiliation(s)
- D Lacomis
- Department of Pathology (Neuropathology), University of Massachusetts Medical Center, Worcester 01655
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Abstract
Primary central nervous system lymphomas (PCNSL) are uncommon neoplasms accounting for less than 2% of brain tumours. Their incidence appears to be increasing across a wide age range, in both immunocompetent and immunosuppressed populations. Particular risk groups include those with congenital and acquired immunodeficiencies and transplant recipients. The spread of the AIDS epidemic has seen large numbers of complicating PCNSL develop. Epstein-Barr virus infection appears to play a role in the development of these lymphomas in the immunosuppressed population. The aetiology of these tumours in the immunocompetent is uncertain. Their tendency to remain within the nervous system is not well understood but may be a function of CNS binding molecules carried by lymphocytes. Clinically PCNSL may present with a wide variety of signs and symptoms and has a capacity to mimic many other neurological conditions. Radiologically they appear as hyperdense homogenous deposits in subcortical white matter. Although most lesions are intermediate or high grade B cell lymphomas, T cell lymphomas are being recognised with increasing frequency. Immunohistochemistry and genotypic analysis have an important role in accurately characterising PCNSL, particularly in stereotactic biopsies. Involvement of multiple areas of the neuraxis, the eye and multiple intracranial sites can occur in the absence of obvious systemic lymphoma. The role of surgery in their treatment is uncertain. A combination of radiotherapy and chemotherapy can increase the length of survival. The prognosis, however, remains poor in comparison with nodal lymphomas, and particularly so in those with AIDS.
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Affiliation(s)
- J W Grant
- Department of Histopathology, Addenbrooke's Hospital, Cambridge, U.K
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Abstract
Primary CNS lymphomas (PCNSL), until recently representing about 1% of all brain tumors, show dramatically increased incidence both in high-risk groups (immunocompromised, AIDS) and in the general population. They are extranodal diffuse non-Hodgkin's lymphomas, the morphology and classification of which are identical to those of systemic lymphomas, although PCNSL show different biological behavior and diagnosis according to the New Working Formulation and updated Kiel classification may be difficult. The majority are large B cell variants of high-grade malignancy; low-grade subtypes and T cell lymphomas are rare. Sixty per cent occur in the supratentorial space (hemispheres, periventricular) and 12% in the posterior fossa; 30% are multiple (50%-70% in AIDS). PCNSL show a male preponderance with a peak incidence in the 5th-7th decade (3rd-4th in AIDS). The duration of diffuse or focal clinical symptoms averages 1-2 months. Computed tomography and magnetic resonance imaging scans show single or multiple or diffuse, often typical lesions. Diagnosis is achieved by evaluation of stereotactic biopsy material or cerebrospinal fluid cytology using immunocytological markers. Current therapy in immunocompetent patients, radiation plus corticosteroids and pre- or postradiation polychemotherapy, shows response rates of 85% with a median survival of 17-44 months, a prognosis similar to that for glioblastoma. Meningeal PCNSL is treated with intrathecal methotrexate or cytosine arabinoside. Transliquoral seeding of PCNSL is frequent, distant metastases occurring in 6%-8%. Therapy of AIDS-related PCNSL makes use of radiation and corticosteroids, and rarely of chemotherapy. The pathogenesis of PCNSL is unknown, but Epstein-Barr virus may be a contributory factor.
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