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Jackson NR. Intravascular Large B-cell Lymphoma Presenting as Sudden Death. Am J Forensic Med Pathol 2023:00000433-990000000-00072. [PMID: 37093884 DOI: 10.1097/paf.0000000000000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
ABSTRACT Intravascular large B-cell lymphoma is a rare subset of non-Hodgkin lymphoma composed of mature B lymphoma cells confined to the intravascular space. This disease remains elusive because it lacks a discrete tumor mass, can affect any part of the body, and has vague symptoms paired with heterogeneous clinical findings resulting in delayed or missed accurate diagnosis, even at postmortem examination. This is a case of a woman who died within hours of presenting to the emergency department with a diagnosis of intravascular large B-cell lymphoma made through autopsy examination, adding to the knowledge of this rare disease and bringing it to the attention of practicing autopsy and forensic pathologists.
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Gilbert S, Brooks-Brownlie H, Cardy T. MRI characteristics of ventral vertebral venous plexus occlusion due to lymphoma in a large breed dog. Vet Radiol Ultrasound 2023; 64:E6-E9. [PMID: 36305600 DOI: 10.1111/vru.13179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/24/2022] [Accepted: 08/24/2022] [Indexed: 01/25/2023] Open
Abstract
Intravascular lymphoma is a rare presentation of lymphoma with a predilection to the central nervous system (CNS). A 9-year-old male-neutered Collie presented with a 3-month history of lymphadenopathy and a 6-day history of an acute onset, progressive, painful, symmetrical L4-S3 myelopathy. Magnetic resonance imaging revealed multifocal extradural spinal cord compressions from L3 to L6 secondary to a bilaterally enlarged and occluded ventral vertebral venous plexus (VVVP). Histopathology revealed low-grade lymphoma within the venous plexus in the lumbar vertebral column, tracheobronchial lymph nodes, and tonsils. Intravascular lymphoma should be considered a differential diagnosis for enlarged VVVP causing compression of the spinal cord.
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Affiliation(s)
- Samantha Gilbert
- Cave Veterinary Specialists, Georges Farm, West Buckland, TA21 9LE, UK
| | | | - Thomas Cardy
- Cave Veterinary Specialists, Georges Farm, West Buckland, TA21 9LE, UK
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Itami H, Nakamine H, Kubo M, Ogawa K, Tani R, Nakamura S, Takeda M, Nitta Y, Uchiyama T, Fujii T, Hatakeyama K, Ohbayashi C. Diffuse large B-cell lymphoma (DLBCL) with significant intravascular invasion. Close resemblance of its clinicopathological features to intravascular large B-cell lymphoma, but not to DLBCL-not otherwise specified. J Clin Exp Hematop 2021; 61:152-161. [PMID: 34193753 PMCID: PMC8519243 DOI: 10.3960/jslrt.20066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is defined by the World Health Organization (WHO) Classification as one type of extranodal large B-cell lymphoma and it is characterized by the selective growth of lymphoma cells within blood vessels with minimal extravascular invasion. According to the criteria, however, several reported cases of IVLBCL with significant extravascular invasion cannot be classified as IVLBCL. The purpose of the present study was to assess the clinicopathological significance of the WHO criteria for IVLBCL. We characterized clinical, histopathological, and immunohistochemical features of 11 patients with extranodal diffuse large B-cell lymphoma (DLBCL) with significant intravascular invasion (DLBCL-IV), and statistically compared their features with those of 11 patients with IVLBCL and 15 patients with extranodal DLBCL with virtually no intravascular invasion (DLBCL-noIV). When compared with the DLBCL-noIV group, the DLBCL-IV group was characterized by significantly higher rates of splenomegaly, hemophagocytosis, advanced stage disease, and CD5 expression; higher average platelet count, serum lactate dehydrogenase level, and serum ferritin level. Progression-free survival was significantly shorter in the DLBCL-IV group than the DLBCL-noIV group. In contrast, there were no significant differences in clinicopathological features between the DLBCL-IV and the IVLBCL groups. Our study suggests that DLBCL-IV should be regarded as IVLBCL-related.
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Affiliation(s)
- Hiroe Itami
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Hirokazu Nakamine
- Division of Pathology and Laboratory Medicine, The Japan Baptist Hospital, Kyoto, Japan
| | - Masayuki Kubo
- Department of Hematology, Nara Medical University, Kashihara, Japan
| | - Kohei Ogawa
- Department of Dermatology, Nara Medical University, Kashihara, Japan
| | - Rina Tani
- Department of Molecular Pathology, Nara Medical University, Kashihara, Japan
| | - Shinji Nakamura
- Department of Surgery, Takanohara Central Hospital, Nara, Japan
| | - Maiko Takeda
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Yuji Nitta
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Tomoko Uchiyama
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Kinta Hatakeyama
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan.,Department of Diagnostic Pathology, Minami-Nara General Medical Centre, Oyodo, Japan
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
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Matsue K, Abe Y, Narita K, Kobayashi H, Kitadate A, Miura D, Takeuchi M, Takeuchi K. Bone marrow infiltration pattern in patients with intravascular large B-cell lymphoma diagnosed by random skin biopsy. EJHAEM 2020; 1:281-285. [PMID: 35847692 PMCID: PMC9175664 DOI: 10.1002/jha2.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 12/14/2022]
Abstract
We retrospectively analyzed bone marrow (BM) infiltration pattern in consecutive 30 intravascular large B-cell lymphoma (IVLBCL) patients diagnosed by random skin biopsy (RSB). BM infiltration of lymphoma was observed in 18 patients (60.0%), including five patients with the intrasinusoidal pattern with minimal extravasation, eight patients with the mixed of intrasinusoidal and scattered/interstitial or nodular infiltration, and five patients with the nodular/diffuse pattern. Twelve patients were negative for lymphoma infiltration. BM histology of patients with IVLBCL were diverse and frequently discordant with those of other site of IVLBCL lesions. BM biopsy had a poorer diagnostic performance for detecting intravascular features.
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Affiliation(s)
- Kosei Matsue
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Yoshiaki Abe
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Kentaro Narita
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Hiroki Kobayashi
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Akihiro Kitadate
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Daisuke Miura
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Masami Takeuchi
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Kengo Takeuchi
- Division of PathologyThe Cancer InstituteJapanese Foundation for Cancer ResearchTokyoJapan
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Prognostic Value of Concurrent Expression of C-MYC and BCL2 in Intravascular Large B-Cell Lymphoma: A 10-Year Retrospective Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1350820. [PMID: 32566654 PMCID: PMC7273482 DOI: 10.1155/2020/1350820] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 05/11/2020] [Indexed: 11/17/2022]
Abstract
Background Intravascular large B-cell lymphoma (IVLBCL) is a variant of extranodal diffuse large B-cell lymphoma (DLBCL), characterized by the presence of a B-lymphoma cell in the lumina of small blood vessels or capillaries. Due to its extremely variable clinical manifestations, IVLBCL typically results in a delayed diagnosis and poor disease prognosis. Skin biopsy, particularly random skin biopsy, has shown a potential role in the diagnosis of IVLBCL. However, information of clinicopathological features in patients with IVLBCL diagnosed by skin biopsy is limited. Objectives To study the clinicopathological features in relation to immunohistochemical features and to identify prognostic factors in IVLBCL patients diagnosed by skin biopsy. Materials and Methods Clinical characteristics; laboratory, histological, and immunohistochemical findings; and therapeutic response of all biopsy-confirmed IVLBCL patients during the years 2008-2017 were retrospectively reviewed. Results The mean age was 67.4 (±9.8) years. Fever was the most common presenting symptom, accounting for 64.7%. Cutaneous and bone marrow involvement was found in 23.5% and 35.3% of patients, respectively. Patients receiving R-CHOP showed more favorable therapeutic outcome. C-MYC/BCL2 double expressors showed significantly higher incidence rate to mortality compared with nondouble expressors (p = 0.042). One-year and two-year overall survival rates were 67.2% and 53.8%, respectively. Conclusions Skin biopsy is an effective diagnostic method for IVLBCL. Concurrent expression of C-MYC and BCL2 may be a useful prognostic indicator and should be performed in order to predict the prognosis in IVLBCL patients.
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Abe Y, Usui Y, Narita K, Takeuchi M, Matsue K. Concomitant subcutaneous intravascular lymphoma lesions in a patient with cardiac diffuse large B-cell lymphoma: is intravascular lymphoma a distinct clinical entity? Int J Hematol 2018; 108:637-639. [PMID: 30196477 DOI: 10.1007/s12185-018-2532-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/05/2018] [Accepted: 09/05/2018] [Indexed: 11/25/2022]
Abstract
We describe a patient who presented with large cardiac diffuse large B-cell lymphoma (DLBCL) and adrenal masses. The patient also had subcutaneous intravascular lymphoma lesions which were detected by random skin biopsy. Although ambiguous, minimal extravascular location of lymphoma cells is permitted for the diagnosis of intravascular large B-cell lymphoma (IVLBCL) in the WHO definition, a number of rare cases have been reported as having concomitant tumours in other organs, such as the adrenal gland, brain, and penis. We assume that IVLBCL might be a peculiar feature of DLBCL characterised by preferential localisation of lymphoma cells within the capillaries rather than a distinct disease entity of DLBCL.
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Affiliation(s)
- Yoshiaki Abe
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa-shi, Chiba, 296-8602, Japan
| | - Yoshiaki Usui
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa-shi, Chiba, 296-8602, Japan
| | - Kentaro Narita
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa-shi, Chiba, 296-8602, Japan
| | - Masami Takeuchi
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa-shi, Chiba, 296-8602, Japan
| | - Kosei Matsue
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, 929 Higashi-chou, Kamogawa-shi, Chiba, 296-8602, Japan.
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7
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Inespecific Macules in Legs: Answer. Am J Dermatopathol 2017; 39:e138-e139. [PMID: 28820768 DOI: 10.1097/dad.0000000000000594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Puckrin R, Pop P, Ghorab Z, Keith J, Chodirker L, Lin Y, Callum J. Intravascular large B-cell lymphoma presenting as Richter's syndrome with cerebral involvement in a patient with chronic lymphocytic leukemia. Clin Case Rep 2017; 5:1444-1449. [PMID: 28878900 PMCID: PMC5582220 DOI: 10.1002/ccr3.1087] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/21/2017] [Accepted: 06/17/2017] [Indexed: 11/08/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is an aggressive non-Hodgkin's lymphoma which can present with B symptoms, rash, and neurological deterioration. Up to 10% of cases of IVLBCL are associated with other hematological neoplasms, including this extremely rare presentation of IVLBCL as Richter's transformation in chronic lymphocytic leukemia.
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Affiliation(s)
- Robert Puckrin
- Postgraduate Medical Education University of Toronto Toronto Ontario Canada
| | - Paula Pop
- Postgraduate Medical Education University of Toronto Toronto Ontario Canada
| | - Zeina Ghorab
- Department of Anatomic Pathology Sunnybrook Health Sciences Centre Toronto Ontario Canada
| | - Julia Keith
- Department of Anatomic Pathology Sunnybrook Health Sciences Centre Toronto Ontario Canada
| | - Lisa Chodirker
- Department of Hematology Sunnybrook Health Sciences Centre Toronto Ontario Canada
| | - Yulia Lin
- Department of Clinical Pathology Sunnybrook Health Sciences Centre Toronto Ontario Canada
| | - Jeannie Callum
- Department of Clinical Pathology Sunnybrook Health Sciences Centre Toronto Ontario Canada
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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.
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Affiliation(s)
- Jordan M Hall
- From the San Antonio Military Medical Center, Fort Sam Houston, TX
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10
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Mansueto G, Di Vito A, Belluomo C, Murino P, Natella V, Camastra C, Presta I, Malara N, de Rosa G, Donato G, Mignogna C. A case of intravascular large B cell lymphoma: New clinical and immunohistochemical findings. Neuropathology 2016; 36:496-503. [DOI: 10.1111/neup.12300] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 02/27/2016] [Accepted: 02/28/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Gelsomina Mansueto
- Advanced Biomedical Sciences, Pathology Section; University of Naples “Federico II”; Italy
| | - Anna Di Vito
- Department of Clinical and Experimental Medicine; University “Magna Graecia” of Catanzaro; Italy
| | - Clara Belluomo
- Department of Anesthesiologic, Surgical and Emergency Science; Second University of Naples; Italy
| | - Patrizia Murino
- Department of Anesthesiologic, Surgical and Emergency Science; Second University of Naples; Italy
| | - Valentina Natella
- Advanced Biomedical Sciences, Pathology Section; University of Naples “Federico II”; Italy
| | - Caterina Camastra
- Department of Health Science; University “Magna Graecia” of Catanzaro; Italy
| | - Ivan Presta
- Department of Health Science; University “Magna Graecia” of Catanzaro; Italy
| | - Natalia Malara
- Department of Health Science; University “Magna Graecia” of Catanzaro; Italy
| | - Gaetano de Rosa
- Advanced Biomedical Sciences, Pathology Section; University of Naples “Federico II”; Italy
| | - Giuseppe Donato
- Department of Health Science; University “Magna Graecia” of Catanzaro; Italy
| | - Chiara Mignogna
- Department of Health Science; University “Magna Graecia” of Catanzaro; Italy
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11
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Thomas CA, Guileyardo JM, Krause JR. An intravascular lymphoma with extravascular tendencies. Proc (Bayl Univ Med Cent) 2014; 27:341-3. [PMID: 25484506 DOI: 10.1080/08998280.2014.11929153] [Citation(s) in RCA: 4] [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 (IVL) is rare and characterized by selective growth of neoplastic cells within the lumina of small blood vessels. We present the case of a 69-year-old woman who died of a widespread IVL with extravascular involvement of the lymph nodes, liver, bladder, and adrenal gland. This report discusses the unique features of IVL with concurrent extravascular components.
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Affiliation(s)
- Cody A Thomas
- Department of Pathology, Baylor University Medical Center at Dallas and the Charles A. Sammons Cancer Center, Dallas, Texas
| | - Joseph M Guileyardo
- Department of Pathology, Baylor University Medical Center at Dallas and the Charles A. Sammons Cancer Center, Dallas, Texas
| | - John R Krause
- Department of Pathology, Baylor University Medical Center at Dallas and the Charles A. Sammons Cancer Center, Dallas, Texas
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12
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Gan LP, Ooi WS, Lee HY, Ng WH. A case of large B-cell intravascular lymphoma in the brain. Surg Neurol Int 2013; 4:99. [PMID: 23956942 PMCID: PMC3740612 DOI: 10.4103/2152-7806.115709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 05/29/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Intravascular lymphoma is a rare and fatal disease that can have central nervous system (CNS) manifestations. It is usually a diagnosis made postmortem. This is partly due to its varied presentation, which lends itself to the complexity of diagnosis. CASE DESCRIPTION We report a rare case of intravascular lymphoma in the brain found antemortem. CONCLUSION Review of the literature shows that a timely diagnostic tissue biopsy together with aggressive combination chemotherapy treatment can improve patient outcome.
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Affiliation(s)
- Lee Ping Gan
- Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - Wei Seong Ooi
- Department of Medical Oncology, National Cancer Centre, Singapore
| | - Hwei Yee Lee
- Department of Histopathology, Tan Tock Seng Hospital, Singapore
| | - Wai Hoe Ng
- Department of Neurosurgery, National Neuroscience Institute, Singapore
- Department of Neurosurgery, Duke-NUS Graduate Medical School, Singapore
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McKelvie PA, Wools C, Roberts L, Cook M. Intravascular large B-cell lymphoma occurring 25 years after treatment of ALK-positive anaplastic large cell lymphoma. Leuk Lymphoma 2013; 54:2745-7. [DOI: 10.3109/10428194.2013.786071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
A rare type of diffuse large B-cell lymphoma, intravascular large B-cell lymphoma primarily affects the middle-aged to elderly population, with a slight predominance in men. By the time of presentation, most patients have advanced, disseminated disease, and often the diagnosis is made at autopsy. Patients may present with any of a myriad of symptoms, with any tissue potentially being infiltrated. Central nervous system and cutaneous involvement is common, as is the presence of B symptoms including fever, weight loss, and night sweats. Morphologically, growth of neoplastic cells is restricted to the lumen of small vessels. The cells are large, with 1 or more prominent nucleoli, scant cytoplasm, and frequent mitotic figures, and are commonly positive for cluster of differentiation markers 79a, 20, and 19, as well as MUM1/IRF4 and Bcl-2. Intravascular large B-cell lymphoma is aggressive, and without treatment is rapidly fatal.
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Affiliation(s)
- Dennis E Orwat
- Department of Pathology, Medical University of South Carolina, Charleston, 29425, USA
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15
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Chroboczek T, Lazaro E, Greib C, Parrens M, Dilhuydi MS, Pellegrin JL, Viallard JF. [Intravascular large B cell lymphoma: a case series of three patients and update]. Rev Med Interne 2012; 33:250-8. [PMID: 22305635 DOI: 10.1016/j.revmed.2011.12.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 11/06/2011] [Accepted: 12/21/2011] [Indexed: 01/29/2023]
Abstract
PURPOSE Intravascular large B cell lymphoma (IVLBCL) is a rare and aggressive variant of non-Hodgkin's lymphoma, characterized by multifocal proliferation of lymphoma cells exclusively within small and medium blood vessels. IVLBCL can be systemic and quite polymorphic, which often makes it difficult to diagnose, thus delaying appropriate treatment. PATIENTS AND METHODS We report three patients of atypical IVLBCL, through the study of which we overview recent knowledge about IVLBCL. RESULTS The first patient initially presented with peripheral thrombocytopenia and splenic destruction of platelets, later completed with an interstitial pulmonary syndrome. The second patient, of African origin, we believe is the first case of a black patient with IVLBCL described in the medical literature. The third belongs to the rare group of occidental patients that present an IVLBCL associated with a hemophagocytic syndrome. CONCLUSION Intravascular large B cell lymphoma is a systemic and polymorphic disease. Awareness of this entitiy should allow rapid and appropriate management.
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Affiliation(s)
- T Chroboczek
- Service de médecine interne et maladies infectieuses, hôpital Haut-Lévèque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac cedex, France
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KASUYA A, HASHIZUME H, TAKIGAWA M. Early diagnosis of recurrent diffuse large B-cell lymphoma showing intravascular lymphoma by random skin biopsy. J Dermatol 2010; 38:571-4. [DOI: 10.1111/j.1346-8138.2010.01127.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Bozzoli V, Chiara Tisi M, D'Alò F, Massini G, Mansueto G, Vannata B, Arena V, Larocca LM, Teofili L, Leone G, Hohaus S. Intravascular large B cell lymphoma: when lymphoma is suspected but routine diagnostic work-up is negative. Leuk Lymphoma 2009; 50:1900-3. [DOI: 10.3109/10428190903234005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Zhao MY, Auerbach A, D'Costa AM, Rapoport AP, Burger AM, Sausville EA, Stass SA, Jiang F, Sands AM, Aguilera N, Zhao XF. Phospho-p70S6K/p85S6K and cdc2/cdk1 Are Novel Targets for Diffuse Large B-Cell Lymphoma Combination Therapy. Clin Cancer Res 2009; 15:1708-20. [DOI: 10.1158/1078-0432.ccr-08-1543] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Zlotnick DM, Merrens EJ, Petras ML, Tsongalis GJ, Bentley H, Fingar EL, Levy NB. Intravascular lymphoma as a recurrence of testicular Non-Hodgkin's lymphoma confirmed by polymerase chain reaction. Am J Hematol 2008; 83:681-2. [PMID: 18442061 DOI: 10.1002/ajh.21193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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20
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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.
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Affiliation(s)
- V Pallure
- Service de dermatologie, groupe hospitalo-universitaire Carémeau, rue du Professeur-Robert-Debré, 30900 Nîmes, France
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Matsue K, Asada N, Takeuchi M, Yamakura M, Kimura SI, Odawara J, Aoki T. A clinicopathological study of 13 cases of intravascular lymphoma: experience in a single institution over a 9-yr period. Eur J Haematol 2008; 80:236-44. [DOI: 10.1111/j.1600-0609.2007.01008.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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22
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Ponzoni M, Ferreri AJM, Campo E, Facchetti F, Mazzucchelli L, Yoshino T, Murase T, Pileri SA, Doglioni C, Zucca E, Cavalli F, Nakamura S. Definition, diagnosis, and management of intravascular large B-cell lymphoma: proposals and perspectives from an international consensus meeting. J Clin Oncol 2007; 25:3168-73. [PMID: 17577023 DOI: 10.1200/jco.2006.08.2313] [Citation(s) in RCA: 355] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare form of diffuse LBCL characterized by preferential intravascular growth of malignant lymphocytes, aggressive behavior, and an often fatal course. IVLBCL usually affects elderly patients with poor performance status, elevated lactic dehydrogenase serum levels, anemia, and B symptoms. It displays some differences in clinical presentation among diverse geographical areas, mostly between patients diagnosed in Western countries and Japan. In addition, data from the literature suggest that pathologic diagnostic criteria as well as clinical features of this disease may be broader than described in current classification scheme(s). Under the sponsorship of the International Extranodal Lymphoma Study Group, clinicians and pathologists with interest in IVLBCL, coming from Western and Eastern countries, joined to reach a consensus on defining features as well as to focus on the most urgent unresolved issues in IVLBCL. To this end, a representative group of IVLBCL patients coming from both the aforementioned geographical areas were collectively analyzed. Additional features of IVLBCL were proposed both under clinical and pathologic stand points. At the meeting, it emerged that IVLBCL may have additional histopathologic/cytologic definition criteria with respect to those currently recommended, some clinical features are not randomly distributed worldwide, recent therapeutic approaches, such as anti-CD20-containing regimens, may improve outcome, and kidney, spleen, and liver involvement may show peculiar histopathologic features. Finally, a provisional practical diagnostic approach to hemophagocytosis-associated patients and a proposal for the most useful criteria in the settings of differential diagnosis are included.
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Affiliation(s)
- Maurilio Ponzoni
- Unit of Lymphoma Malignancies, Pathology and Oncology Units, Department of Oncology, San Raffaele Scientific Institute, Milan, Italy.
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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.
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Affiliation(s)
- Dan Zuckerman
- Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
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