1
|
Pan C, Ma X, Yao Y, Wang C. EBV-Positive Intravascular Large B-Cell Lymphoma of the Small Intestine: A Case Report and Literature Review. Int J Surg Pathol 2024; 32:586-593. [PMID: 37431259 DOI: 10.1177/10668969231183637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare lymphoma that affects the brain, skin, and bone marrow. We describe the case of a 75-year-old man who was admitted to the hospital after 4 h of stomach aches. A thorough physical examination indicated stomach discomfort and skin discoloration. Laboratory tests revealed thrombocytopenia and elevated lactate dehydrogenase levels. A computed tomography scan of the abdomen revealed that the small intestine wall was thickened, edematous, and necrotic. The necrotic small bowel was surgically removed, revealing many little round, homogenous, and unusual cells in the mesenteric vein. In-situ hybridization revealed that these cells were positive for PAX5, CD20, CD79a, CD10, and BCL2, as well as Epstein-Barr virus-encoded small RNA. After 1 week of hospitalization without treatment, the patient was diagnosed with IVLBCL and died of multiple organ dysfunction syndrome. IVLBCL is a rare illness that affects the small intestine and possibly the gastrointestinal system. It has an insidious start, a fast development, and a dismal prognosis. Knowing its clinicopathologic traits helps in understanding the illness, making an early diagnosis, and preventing rapid worsening.
Collapse
Affiliation(s)
- Chenglong Pan
- Department of Pathology, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Xiaoling Ma
- Department of Pathology, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Yanfei Yao
- Department of Pathology, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Chunyan Wang
- Department of Pathology, Kunming Medical University First Affiliated Hospital, Kunming, China
| |
Collapse
|
2
|
Ueda Y, Sakai T, Yamada K, Arita K, Ishige Y, Hoshi D, Yanagisawa H, Iwao-Kawanami H, Kawanami T, Mizuta S, Fukushima T, Yamada S, Yachie A, Masaki Y. Fatal hemophagocytic lymphohistiocytosis with intravascular large B-cell lymphoma following coronavirus disease 2019 vaccination in a patient with systemic lupus erythematosus: an intertwined case. Immunol Med 2024:1-8. [PMID: 38619098 DOI: 10.1080/25785826.2024.2338594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/31/2024] [Indexed: 04/16/2024] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) has been recognized as a rare adverse event following the coronavirus disease 2019 (COVID-19) vaccination. We report a case of neuropsychiatric symptoms and refractory HLH in a woman with systemic lupus erythematosus (SLE) after receiving her COVID-19 vaccine treated with belimumab, later found to have intravascular large B-cell lymphoma (IVLBCL) at autopsy. A 61-year-old woman with SLE was referred to our hospital because of impaired consciousness and fever. One month prior to consulting, she received her second COVID-19 vaccine dose. Afterward, her consciousness level decreased, and she developed a high fever. She tested negative for SARS-CoV-2. Neuropsychiatric SLE was suspected; therefore, glucocorticoid pulse therapy was initiated on day 1 and 8. She had thrombocytopenia, increased serum ferritin levels and hemophagocytosis. The patient was diagnosed with HLH and treated with etoposide, dexamethasone and cyclosporine. Despite treatment, the patient died on day 75; autopsy report findings suggested IVLBCL as the underlying cause of HLH. Differentiating comorbid conditions remains difficult; however, in the case of an atypical clinical presentation, other causes should be considered. Therefore, we speculate that the COVID-19 vaccination and her autoimmune condition may have expedited IVLBCL development.
Collapse
Affiliation(s)
- Yusuke Ueda
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Tomoyuki Sakai
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Kazunori Yamada
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
- Department of Medical Education, Kanazawa Medical University, Uchinada, Japan
| | - Kotaro Arita
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Yoko Ishige
- Department of Respiratory Medicine, Kanazawa Medical University, Uchinada, Japan
| | - Daisuke Hoshi
- Department of Oncologic Pathology, Kanazawa Medical University, Uchinada, Japan
| | - Hiroto Yanagisawa
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Haruka Iwao-Kawanami
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Takafumi Kawanami
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Shuichi Mizuta
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Toshihiro Fukushima
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Sohsuke Yamada
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Uchinada, Japan
| | - Akihiro Yachie
- Division of Medical Safety, Kanazawa University Hospital, Kanazawa, Japan
| | - Yasufumi Masaki
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| |
Collapse
|
3
|
Koizumi S, Togawa Y, Saeki Y, Shimizu R, Nakano M. A case of cutaneous variant of intravascular large B-cell lymphoma in which dermoscopy revealed telangiectasias associated with erythematous induration. Dermatol Reports 2024; 16:9731. [PMID: 38623370 PMCID: PMC11017709 DOI: 10.4081/dr.2023.9731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 04/26/2023] [Indexed: 04/17/2024] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare type of extranodal, diffuse, large B-cell lymphoma characterized by the selective growth of lymphoma cells within the lumen of small blood vessels, with no lymphadenopathy or masses. Herein, we report a cutaneous variant of IVLBCL that is rare in Asia. A healthy 73-year-old Japanese woman presented to our hospital with painful erythematous indurations and telangiectasia of the lower extremities, which was confirmed on dermoscopy. Physical examination revealed no systemic involvement, and laboratory parameters were within normal ranges. No abnormal fluorodeoxyglucose (FDG) uptake was detected on 18FDG positron emission tomography/computed tomography. Histopathological examination revealed proliferation and dilatation of blood vessels in the subcutis layer, occluded by CD20-positive atypical lymphoid cells. Thus, the patient was diagnosed with a cutaneous variant of IVLBCL without systemic symptoms. In conclusion, it is important to confirm telangiectasia using dermoscopy and perform skin biopsies in patients presenting with sudden-onset erythematous induration.
Collapse
Affiliation(s)
| | - Yaei Togawa
- Department of Dermatology, Chiba University Hospital, Chiba
| | - Yuka Saeki
- Department of Dermatology, Chiba University Hospital, Chiba
| | - Ryo Shimizu
- Division of Hematology, Asahi General Hospital, Asahi, Japan
| | | |
Collapse
|
4
|
Yamamoto R, Okagaki N, Sakamoto H, Tanaka Y, Takeda A, Maruguchi N, Nakamura S, Matsumura K, Ueyama M, Ikegami N, Kaji Y, Hashimoto S, Tanaka E, Taguchi Y, Maruyama W, Katsuragawa H, Sumiyoshi S, Hajiro T. Intravascular Large B-cell Lymphoma Presenting as Pulmonary Ground-glass Nodules That Progressed Slowly over Several Months with No Overt Symptoms. Intern Med 2024; 63:559-563. [PMID: 37407462 PMCID: PMC10937140 DOI: 10.2169/internalmedicine.2040-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/28/2023] [Indexed: 07/07/2023] Open
Abstract
A 74-year-old man with no overt symptoms was referred for a chest computed tomography (CT) that revealed multiple bilaterally pulmonary ground-glass nodules (GGNs) with subtle changes in size over eight months. Surgical lung biopsies were performed in the left upper lobe. A pathologic study confirmed the intravascular large B-cell lymphoma (IVLBCL). This lesion was a nodule-like cluster of atypical cells, meaning that it had been localized for several months. Pulmonary IVLBCL may form focal lesions presenting as GGN on chest CT and progress slowly without apparent symptoms.
Collapse
Affiliation(s)
- Ryo Yamamoto
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | | | | | - Yuuma Tanaka
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | - Atsushi Takeda
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | | | | | | | | | - Naoya Ikegami
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | - Yusuke Kaji
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | | | - Eisaku Tanaka
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | - Yoshio Taguchi
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | | | - Hiroyuki Katsuragawa
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Japan
- Department of Clinical Pathology, Tenri Hospital, Japan
| | | | - Takashi Hajiro
- Department of Respiratory Medicine, Tenri Hospital, Japan
| |
Collapse
|
5
|
Huang X, Wu X, Wang S, Mei C, Xu Y, Ren Y, Jin J, Tong H, Qian J. Effective management of a rare case of primary renal intravascular large B-cell lymphoma with modified R-CHOP regimen: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241232259. [PMID: 38362227 PMCID: PMC10868483 DOI: 10.1177/2050313x241232259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024] Open
Abstract
Intravascular large B-cell lymphoma, known for its diverse organ involvement, presents significant diagnostic challenges, particularly when it affects the kidneys. This report highlights a rare case of primary renal intravascular large B-cell lymphoma in a 60-year-old male patient, who presented with persistent fever and renal dysfunction. The case underscores the intricacy of diagnosis and the efficacy of personalized treatment. Following the identification of primary renal intravascular large B-cell lymphoma, a modified R-CHOP regimen was administered, resulting in notable amelioration of symptoms and renal function following the initial treatment cycle. The patient achieved sustained complete remission without any complications after completing five subsequent R-CHOP cycles and two additional cycles of rituximab monotherapy, as confirmed by recent assessments. He is currently under regular follow-up for ongoing monitoring and improvement. This case adds to the limited yet expanding pool of knowledge concerning intravascular large B-cell lymphoma, emphasizing the necessity for personalized therapeutic strategies in atypical presentations. It also highlights the importance of early detection and customized intervention in managing rare lymphoma subtypes with unique organ involvement.
Collapse
Affiliation(s)
- Xianbo Huang
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Xianhui Wu
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Shasha Wang
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Chen Mei
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Yu Xu
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Yanling Ren
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Jie Jin
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Hongyan Tong
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| | - Jiejing Qian
- Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Hematopoietic Malignancy, Zhejiang University, Hangzhou, China
| |
Collapse
|
6
|
Jin H, Liao W, Yang S, Peng L, Xing W. Clinical features and imaging manifestations for intravascular large B-cell lymphoma. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2023; 48:1920-1928. [PMID: 38448386 PMCID: PMC10930742 DOI: 10.11817/j.issn.1672-7347.2023.230305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Intravascular large B-cell lymphomas are a rare group of extranodal non-Hodgkin's lymphomas with no apparent specificity of symptoms and often a poor prognosis. This study aims to investigate the clinical features and imaging manifestations of intravascular large B-cell lymphoma, to improve the awareness of clinicians and imaging physicians and to reduce the underdiagnosis and misdiagnosis of this disease. METHODS Five patients with pathologically confirmed intravascular large B-cell lymphoma diagnosed between December 2011 and February 2022 at Xiangya Hospital of Central South University were retrospectively analyzed for clinical features and imaging manifestations. RESULTS The age range for the 5 patients in this paper was 44-72 years at an average of (55.4±11.2) years, 2 were male and 3 were female. There were 4 patients with fever, 3 patients with cough, 3 patients with fatigue, and 2 patients with neurological symptoms. The primary sites of lesions were bilateral adrenal glands (2 cases), liver (1 case), central nervous system (1 case), lung (1 case). Imaging of the corresponding site was performed in 5 cases. When the primary site is the adrenal gland, it appears as bilateral adrenal masses or bilateral adrenal thickening with clear contours. When the primary site is the liver, it appears as a hypodense lesion in the right lobe of the liver with "vascular floating sign". When the primary site is the central nervous system, it appears as multiple tumor-like lesions in the frontal-parietal-occipital lobe, right temporal lobe and bilateral cerebellar hemispheres with multiple hemorrhages within the lesions. When the primary site is the lung, it appears as multiple ground glass shadows and solid changes in both lungs with localized lobular septal thickening. The final pathological diagnosis was intravascular large B-cell lymphoma in all 5 patients, one of whom had a good prognosis after chemotherapy, 2 of whom died within 3 days of discharge, and two of whom were lost to follow-up. CONCLUSIONS Intravascular large B-cell lymphoma can involve multiple tissues and organs, and its prognosis is often poor, and its imaging manifestations possess certain specificity. When this disease is highly suspected, a biopsy of the corresponding organ should be performed as soon as possible to clarify the diagnosis.
Collapse
Affiliation(s)
- Hong Jin
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha 410008, China.
| | - Weihua Liao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha 410008, China
| | - Shuai Yang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha 410008, China
| | - Lushan Peng
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha 410008, China
| | - Wu Xing
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha 410008, China.
| |
Collapse
|
7
|
Burningham KM, Patel RR, Gonzalez CD, Mauskar M, Vandergriff T, Goff HW. Western variant intravascular large B-cell lymphoma in an Indian man. JAAD Case Rep 2023; 40:8-10. [PMID: 37675066 PMCID: PMC10477727 DOI: 10.1016/j.jdcr.2021.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
| | - Ravi R. Patel
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Cristian D. Gonzalez
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Melissa Mauskar
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Travis Vandergriff
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Heather W. Goff
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas
| |
Collapse
|
8
|
Hirami Y, Nishimura MF, Urata T, Morimoto M, Maekawa Y, Yoshino T, Nishimura Y, Sato Y. Comparison of serum sIL-2R and LDH levels in patients with intravascular large B-cell lymphoma and patients with advanced stage diffuse large B-cell lymphoma. J Clin Exp Hematop 2023; 63:25-31. [PMID: 36843068 PMCID: PMC10158718 DOI: 10.3960/jslrt.22043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2023] Open
Abstract
Intravascular large B-cell lymphoma (IVL) is a rare type of lymphoma characterized by tumor growth selectively within the vessels. The 5th edition of the World Health Organization classification defines IVL as a large B-cell lymphoma, the same as diffuse large B-cell lymphoma, not otherwise specified (DLBCL, NOS). Since the clinical manifestations of IVL are nonspecific, the diagnosis is time-consuming, and the course is often fatal. Serum soluble interleukin-2 receptor (sIL-2R) and serum lactate dehydrogenase (LDH) levels are known to be elevated in a variety of lymphomas. However, the mechanism of sIL-2R elevation in B-cell lymphomas is not fully understood. In this study, we analyzed the serum level of laboratory findings, including sIL-2R and LDH, as well as the presence of B symptoms in 39 patients with IVL, and compared them with 56 patients with stage IV DLBCL. Both sIL-2R and LDH levels were significantly higher in IVL than in DLBCL (p = 0.035 and p = 0.002, respectively). In IVL, there were no significant differences in both sIL-2R and LDH levels between patients with and without B symptoms (p = 0.206 and p = 0.441, respectively). However, in DLBCL, both sIL-2R and LDH levels were significantly higher in the presence of B symptoms (p = 0.001 and p < 0.001, respectively). The high sIL-2R and LDH levels in IVL may be related to the peripheral blood microenvironment, but further studies are needed to verify this.
Collapse
Affiliation(s)
- Yuki Hirami
- Department of Nursing, Okayama University Graduate School of Health Sciences, Okayama, Japan
| | - Midori Filiz Nishimura
- Department of Molecular Hematopathology, Okayama University Graduate School of Health Sciences, Okayama, Japan
| | - Tomohiro Urata
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan.,Center for Comprehensive Genomic Medicine, Okayama University Hospital, Okayama, Japan
| | - Michiko Morimoto
- Department of Nursing, Okayama University Graduate School of Health Sciences, Okayama, Japan
| | - Yukina Maekawa
- Department of Molecular Hematopathology, Okayama University Graduate School of Health Sciences, Okayama, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshito Nishimura
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.,Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, USA
| | - Yasuharu Sato
- Department of Molecular Hematopathology, Okayama University Graduate School of Health Sciences, Okayama, Japan
| |
Collapse
|
9
|
Sánchez-Vicente JL, De Las Morenas-Iglesias J, Franco-Ruedas C, Rueda-Rueda T, Moruno-Rodríguez A, Lechón-Caballero B, Romero-Martínez A, Del Estad-Caballero A, González-Jauregui B, Cabrera-Pérez R, López-Herrero F. Ocular Involvement in a Patient with Intravascular Large B-Cell Lymphoma: A Diagnostic Challenge. Clinical Case Report and Literature Review. Ocul Immunol Inflamm 2023:1-8. [PMID: 36745689 DOI: 10.1080/09273948.2022.2103712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/30/2022] [Accepted: 07/14/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE To describe the ophthalmic findings and diagnosis of a case of intravascular large B-cell lymphoma. METHODS Clinical case observational report. CLINICAL CASE A Spanish 51-year-old man referred to our hospital with a diagnosis of panuveitis. The patient presented with blurred vision, photophobia, fever, and weight loss. Ocular examination revealed anterior uveitis, vitritis, and multiple round and oval creamy spots on the posterior pole. Fluorescein angiography, optical coherence tomography (OCT), and angio-OCT were used for the ocular examination. The diagnosis of lymphoma was formulated on the basis of a random normal skin biopsy, which showed significant CD20 cellularity within the vessels and extensive CD3 expression. CONCLUSIONS Intravascular lymphoma is a rare form of extranodal diffuse large B-cell lymphoma, often with delayed diagnosis because of the nonspecific symptoms. Hence, random skin biopsy could be useful in the diagnosis.
Collapse
Affiliation(s)
| | | | | | - Trinidad Rueda-Rueda
- Department of Ophthalmology, Virgen Del Rocío University Hospital, Seville, Spain
| | | | | | | | | | | | - Rocío Cabrera-Pérez
- Department of Anathomical Pathology, Virgen Del Rocío University Hospital, Seville, Spain
| | | |
Collapse
|
10
|
Cheng Q, Zhou X, Fan J, Jiang W. Fever of unknown origin characterized by acute kidney injury and nephrotic syndrome diagnosed as intravascular large B-cell lymphoma of kidney: case report and literature review. Int J Clin Exp Pathol 2023; 16:8-13. [PMID: 36815936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 01/04/2023] [Indexed: 02/24/2023]
Abstract
A 60-year-old Chinese female patient was admitted to the hospital with complaint of intermittent fever for more than seven months. The main clinical manifestations were acute kidney injury and nephrotic syndrome which developed into a hemophagocytic syndrome. The symptoms did not improve with antibiotics. Moreover, prednisone could only reduce the fever. Finally, a kidney biopsy showed many CD20-positive cells in the glomerulus and some in the peritubular capillaries. This led to a diagnosis of renal intravascular large B-cell lymphoma.
Collapse
|
11
|
Miyajima T, Ohigashi H, Yaguchi H, Teshima T. Neurolymphomatosis in Intravascular Large B-cell Lymphoma. Intern Med 2022; 62:1381-1382. [PMID: 36198588 DOI: 10.2169/internalmedicine.0021-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Affiliation(s)
- Toru Miyajima
- Department of Hematology, Hokkaido University Graduate School of Medicine, Japan
| | - Hiroyuki Ohigashi
- Department of Hematology, Hokkaido University Graduate School of Medicine, Japan
| | - Hiroaki Yaguchi
- Department of Neurology, Hokkaido University Graduate School of Medicine, Japan
| | - Takanori Teshima
- Department of Hematology, Hokkaido University Graduate School of Medicine, Japan
| |
Collapse
|
12
|
Tanigaki T, Kimizuka Y, Maki Y, Sato C, Yoshimatsu S, Ogata H, Nomura S, Nishimura M, Serizawa Y, Ito K, Igarashi S, Kurata Y, Ohno T, Miyata J, Fujikura Y, Sato K, Ogata S, Kawana A. Development of intravascular large B-cell lymphoma during prophylactic antibiotic treatment for anti-interferon-gamma autoantibody syndrome: A case report. J Infect Chemother 2022:S1341-321X(22)00211-2. [PMID: 35931413 DOI: 10.1016/j.jiac.2022.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/07/2022] [Accepted: 07/22/2022] [Indexed: 10/31/2022]
Abstract
Anti-interferon (IFN)-γ autoantibody-positive syndrome is one of the acquired non-HIV cellular immunodeficiencies, caused by abnormalities in the IFN-γ/interleukin (IL)-12 pathways. It is often diagnosed alongside the onset of disseminated mycobacterium infection, and requires continuous antimycobacterial chemotherapy; however, the detailed pathological mechanisms underlying this syndrome, including its prognosis, are not known. To the best of our knowledge, this is the first reported case of intravascular large B-cell lymphoma complicated by anti-IFN-γ autoantibody syndrome, presented in an 82-year-old woman. The patient had been diagnosed with anti-IFN-γ autoantibody immunodeficiency ten years ago. She had repeated subacute fever of undetermined origin for 13 months that made us suspect infections, such as disseminated mycobacterium disease and other viral and fungal infections, despite receiving prophylactic antimycobacterial chemotherapy with rifampicin and clarithromycin. However, all the screenings performed showed no evidence of infectious diseases; thus, she was finally diagnosed with intravascular large B-cell lymphoma via a random skin biopsy. Unfortunately, the patient debilitated rapidly and died. Evidence supporting a correlation between anti-IFN-γ autoantibody syndrome and carcinogenesis is still lacking, although it is known that patients with anti-IFN-γ autoantibody syndrome are at risk of persistent viral infection-related and T-cell lineage-related carcinogenesis. This case demonstrated that patients with anti-IFN-γ autoantibody syndrome are also at risk of developing B-cell lymphoma, such as intravascular lymphoma. This emphasizes that caution should be paid to increased risk of developing malignancy during the long-term management of anti-IFN-γ autoantibody syndrome with cellular immunodeficiency.
Collapse
|
13
|
Yokota K, Umeda M, Hongo S, Tsuchida T, Umemori Y, Fujita N. [A case of intravascular large B-cell lymphoma manifested as lacunar infarction]. Rinsho Shinkeigaku 2022; 62:492-495. [PMID: 35644581 DOI: 10.5692/clinicalneurol.cn-001704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A 79-year-old man was admitted to our hospital because of sudden onset of left ataxic hemiparesis. Brain MRI diffusion weighted images showed typical lacunar infarction on the right internal capsule. He had no risk factors of cerebrovascular disorder such as hypertension, diabetes mellitus, hyperlipidemia and arrhythmia. On admission, he had a slight fever and his laboratory data showed anemia, thrombocytopenia and elevation of CRP and LDH. Intravascular large B-cell lymphoma (IVLBCL) was suspected because the serum level of soluble IL-2 receptor was also elevated. Pathological diagnosis of IVLBCL was underwent by the skin biopsy from his senile hemangiomas. Although IVLBCL was known to demonstrate various CNS lesions, it is extremely rare to be manifested as a single lacunar infarction, and this case must be important for the differential diagnosis.
Collapse
Affiliation(s)
| | - Maiko Umeda
- Department of Neurology, Nagaoka Red Cross Hospital
| | - Shoko Hongo
- Department of Neurology, Nagaoka Red Cross Hospital
| | | | - Yukie Umemori
- Department of Dermatology, Nagaoka Red Cross Hospital
| | | |
Collapse
|
14
|
Wang D, Marous CL, Ozay F, Timashpolsky A, Gulati RD, Gottesman SRS, Boruk M, Shinder R, Hodgson NM. Intravascular Large B-cell Lymphoma Diagnosed by Nasal Biopsy in a Patient Presenting with Bilateral Ptosis and Ophthalmoplegia. Orbit 2022:1-5. [PMID: 35226576 DOI: 10.1080/01676830.2022.2034170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare type of lymphoma, involving the lumen of predominantly small blood vessels, especially capillaries. The orbit is an uncommon site of involvement for IVLBCL, and diagnosis before autopsy is even more rare as most cases are established post-mortem. Herein, the authors describe a 73-year-old male who presented with 3 weeks of progressive bilateral ptosis and ophthalmoplegia. Computed tomography (CT) and subsequent magnetic resonance imaging (MRI) revealed diffuse abnormal thickening and enhancement of bilateral orbital apices, superior orbital fissures, and cavernous sinus, along with persistent focal opacification of the left frontal and ethmoid sinuses. Infectious and inflammatory workup of serum and cerebrospinal fluid was negative. Ethmoidal sinus and middle turbinate biopsy confirmed intravascular large B-cell lymphoma and the patient was started on R-CHOP chemotherapy regimen.
Collapse
Affiliation(s)
- Diane Wang
- Department of Ophthalmology, Suny Downstate Medical Center. Brooklyn, New York, USA
| | - Charlotte L Marous
- Department of Ophthalmology, Suny Downstate Medical Center. Brooklyn, New York, USA
| | - Fatih Ozay
- Department of Pathology, Suny Downstate Medical Center, Brooklyn, New York, USA
| | - Alisa Timashpolsky
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Rahul D Gulati
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Susan R S Gottesman
- Department of Pathology, Suny Downstate Medical Center, Brooklyn, New York, USA.,Department of Cell Biology, Suny Downstate Medical Center, Brooklyn, New York, USA
| | - Marina Boruk
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Roman Shinder
- Department of Ophthalmology, Suny Downstate Medical Center. Brooklyn, New York, USA.,Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Nickisa M Hodgson
- Department of Ophthalmology, Suny Downstate Medical Center. Brooklyn, New York, USA
| |
Collapse
|
15
|
Odani K, Fujimoto M, Hirata M, Nishikori M, Usui S, Yamada Y, Saeki M, Ono K, Iwasa Y, Haga H. Immunohistochemistry of the oncofetal protein IMP3 is helpful in the diagnosis of intravascular large B-cell lymphoma using skin biopsy. J Cutan Pathol 2022; 49:438-441. [PMID: 34981542 DOI: 10.1111/cup.14196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/20/2021] [Accepted: 12/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The oncofetal protein insulin-like growth factor 2 mRNA binding protein-3 (IMP3) is expressed in various cancers. In this study, we examined the diagnostic utility of IMP3 immunohistochemistry in the context of intravascular large B-cell lymphoma (IVL). METHODS We obtained 25 skin biopsy (SB) specimens diagnosed as IVL and nine IVL-negative SB specimens from 27 IVL patients. Additionally, 27 negative SB specimens from 26 non-IVL patients were obtained from our pathology archives. We performed IMP3 immunohistochemistry on these 61 SB specimens, considering IMP3 expression in any mononuclear cell as positive. In selected cases, triple immunostaining for IMP3, PAX5, and CD34 was performed to analyze the origin and location of IMP3-positive cells. RESULTS IMP3 was expressed in most intravascular lymphoma cells in all the 25 SB specimens diagnosed as IVL. Furthermore, our evaluation revealed the presence of intravascular IMP3-positive B-cells in five of the nine negative SB specimens from IVL patients; however, this was not observed in the 27 SB specimens from non-IVL patients. CONCLUSION IMP3 was expressed in most IVL cells, and IMP3 immunohistochemistry could serve as a sensitive diagnostic aid for detecting IVL cells in SB.
Collapse
Affiliation(s)
- Kentaro Odani
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Masakazu Fujimoto
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Masahiro Hirata
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Momoko Nishikori
- Department of Hematology, Kyoto University Hospital, Kyoto, Japan
| | - Shunya Usui
- Department of Dermatology, Kyoto University Hospital, Kyoto, Japan
| | - Yosuke Yamada
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Miho Saeki
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Kazuo Ono
- Department of Diagnostic Pathology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yoko Iwasa
- Department of Diagnostic Pathology, Shiga General Hospital, Moriyama, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| |
Collapse
|
16
|
Porzionato A, Pelletti G, Barzon L, Contran M, Emmi A, Arminio A, Macchi V, De Caro R. Intravascular large B-cell lymphoma affecting multiple cranial nerves: A histopathological study. Neuropathology 2021; 41:396-405. [PMID: 34541718 PMCID: PMC9293035 DOI: 10.1111/neup.12767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/23/2021] [Accepted: 05/31/2021] [Indexed: 12/16/2022]
Abstract
Intravascular large B‐cell lymphoma (IVLBCL) is a rare form of lymphomas with poor prognosis, characterized by atypical lymphocytes selectively growing within the lumen of small or medium‐sized vessels. Here, we report a case of intracerebral IVLBCL in a 54‐year‐old man who died three months after symptom onset. The diagnosis was made by postmortem pathological examination, based on the identification of multiple ischemic lesions, with small or medium‐sized vessels filled with malignant B‐cells, in the cerebral hemispheres, cerebellum, midbrain, and medulla oblongata, including the external cuneate nucleus and trigeminal spinal tract nucleus. Apart from necrotic lesions, specific histopathological search for occluded vessels in the other brain stem structures permitted identification of significant involvement of the cuneate nucleus, solitary tract nucleus, hypoglossal nucleus, and inferior olivary complex. Small vessels affected by IVLBCL were also found in the trunks of the oculomotor, trigeminal, glossopharyngeal, vagal, and hypoglossal nerves. These histopathological findings were consistent with some cranial nerve symptoms/signs ascertained during hospitalization, such as diplopia, dysphonia, and asymmetry/hypomotility of the palatal veil. The case study presented here reports novel insights on radiological, anatomical, and clinical correlations of the IVLBCL, including the possible involvement of nuclei and trunks of multiple cranial nerves. The reported findings may help clinicians in the early identification of this rapidly progressive disease that can be easily misdiagnosed, through integrated neuroradiological, neurological and neuropathological approaches.
Collapse
Affiliation(s)
- Andrea Porzionato
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Guido Pelletti
- Section of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Luisa Barzon
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Martina Contran
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Aron Emmi
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Angelo Arminio
- Section of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Veronica Macchi
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Raffaele De Caro
- Section of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| |
Collapse
|
17
|
Minish JM, Kelkar AH, Mehta AR, Gaffar M, Dang NH. Intravascular Large B-Cell Lymphoma Presenting as Acute Axonal Polyneuropathy: A Case Report and Literature Review. J Investig Med High Impact Case Rep 2021; 8:2324709620959997. [PMID: 32935589 PMCID: PMC7498961 DOI: 10.1177/2324709620959997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Intravascular large B-cell lymphoma (ILBL) is a rare and difficult to diagnose
subtype of large B-cell lymphoma. The most common locations of presentation are
in the central nervous system and the skin, but there are reports of other organ
involvement. Due to the indolence, nonspecific symptoms, and rarity of the
disease, this form of lymphoma is most often diagnosed postmortem. In this
article, we describe a case of ILBL that presented as a rapidly progressive
acute axonal polyneuropathy. Acute axonal polyneuropathy is a common disease
process with a wide differential diagnosis, but there is limited literature on
its prevalence as the presenting symptom of ILBL. This patient was treated with
R-EPOCH and intrathecal methotrexate with significant improvement in his
polyneuropathy after 1 cycle, and complete remission after 6 cycles. Data on
chemotherapy regimens and their success rates for this disease are lacking.
Collapse
Affiliation(s)
- Jordan M Minish
- University of Florida, University of Florida Health Shands Hospital, Gainesville, FL, USA
| | - Amar H Kelkar
- University of Florida, University of Florida Health Shands Hospital, Gainesville, FL, USA
| | - Amol R Mehta
- University of Florida, University of Florida Health Shands Hospital, Gainesville, FL, USA
| | - Maira Gaffar
- University of Florida, University of Florida Health Shands Hospital, Gainesville, FL, USA
| | - Nam H Dang
- University of Florida, University of Florida Health Shands Hospital, Gainesville, FL, USA
| |
Collapse
|
18
|
Shimada K, Kiyoi H. Current progress and future perspectives of research on intravascular large B-cell lymphoma. Cancer Sci 2021; 112:3953-3961. [PMID: 34327781 PMCID: PMC8486207 DOI: 10.1111/cas.15091] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/12/2021] [Accepted: 07/25/2021] [Indexed: 12/30/2022] Open
Abstract
Intravascular large B‐cell lymphoma is a rare disease of the large B cells characterized by selective growth in the lumina of small vessels in systemic organs. Since first reported in 1959, the difficulty of obtaining sufficient tumor cells from biopsy specimens has hampered the elucidation of its underlying biology. Recent progress using xenograft models and plasma cell‐free DNA has uncovered genetic features that are similar to those of activated B‐cell type diffuse large B‐cell lymphoma, including MYD88 and CD79B mutations and frequent alterations in immune check point‐related genes such as PD‐L1 and PD‐L2. Given the improvement in clinical outcomes and a higher risk of secondary central nervous system (CNS) involvement in the rituximab era, a phase 2 trial of R‐CHOP combined with high‐dose methotrexate and intrathecal chemotherapy as a CNS‐oriented therapy has been conducted. This trial, the PRIMEUR‐IVL study, has displayed good progression‐free survival and a low cumulative incidence of secondary CNS involvement. Long‐term follow‐up within this trial is still ongoing. Further understanding of the pathophysiology of the disease and improvements in clinical outcomes are still needed.
Collapse
Affiliation(s)
- Kazuyuki Shimada
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hitoshi Kiyoi
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
19
|
Sanguedolce F, Zanelli M, Zizzo M, Bisagni A, Soriano A, Cocco G, Palicelli A, Santandrea G, Caprera C, Corsi M, Cerrone G, Sciaccotta R, Martino G, Ricci L, Sollitto F, Loizzi D, Ascani S. Primary Pulmonary B-Cell Lymphoma: A Review and Update. Cancers (Basel) 2021; 13:cancers13030415. [PMID: 33499258 PMCID: PMC7865219 DOI: 10.3390/cancers13030415] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/10/2021] [Accepted: 01/19/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The group of B-cell lymphomas primarily involving the lung encompasses different histological entities with distinct biological aspects, while sharing some clinical and radiological features related to their common anatomic site of occurrence. Recent molecular advances in the molecular genetics of these lesions have substantially improved of our understanding of the mechanisms of lymphomagenesis, adding novel information to histology in order to better characterize and manage these diseases. This review summarizes the available clinical, radiological, pathological, and molecular data on primary pulmonary B-cell lymphomas, discusses the mechanisms of lymphomagenesis, and highlights the role of a multi-disciplinary management in overcoming the diagnostic and therapeutic challenges in this setting. Abstract Primary pulmonary B-cell lymphomas (PP-BCLs) comprise a group of extranodal non-Hodgkin lymphomas of B-cell origin, which primarily affect the lung without evidence of extrapulmonary disease at the time of diagnosis and up to 3 months afterwards. Primary lymphoid proliferations of the lung are most often of B-cell lineage, and include three major entities with different clinical, morphological, and molecular features: primary pulmonary marginal zone lymphoma of mucosa-associated lymphoid tissue (PP-MZL, or MALT lymphoma), primary pulmonary diffuse large B cell lymphoma (PP-DLBCL), and lymphomatoid granulomatosis (LYG). Less common entities include primary effusion B-cell lymphoma (PEL) and intravascular large B cell lymphoma (IVLBCL). A proper workup requires a multidisciplinary approach, including radiologists, pneumologists, thoracic surgeons, pathologists, hemato-oncologists, and radiation oncologists, in order to achieve a correct diagnosis and risk assessment. Aim of this review is to analyze and outline the clinical and pathological features of the most frequent PP-BCLs, and to critically analyze the major issues in their diagnosis and management.
Collapse
Affiliation(s)
- Francesca Sanguedolce
- Pathology Unit, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Foggia, 71122 Foggia, Italy
- Correspondence: ; Tel.: +39-0881-736315
| | - Magda Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.Z.); (A.B.); (A.P.); (G.S.)
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Alessandra Bisagni
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.Z.); (A.B.); (A.P.); (G.S.)
| | - Alessandra Soriano
- Gastroenterology, Division and Inflammatory Bowel Disease Center, Department of Internal Medicine, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Giorgia Cocco
- Radiotherapy Unit, Azienda Ospedaliero-Universitaria, Ospedali Riuniti di Foggia, 71122 Foggia, Italy;
| | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.Z.); (A.B.); (A.P.); (G.S.)
| | - Giacomo Santandrea
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (M.Z.); (A.B.); (A.P.); (G.S.)
| | - Cecilia Caprera
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (M.C.); (G.C.); (R.S.); (G.M.); (L.R.); (S.A.)
| | - Matteo Corsi
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (M.C.); (G.C.); (R.S.); (G.M.); (L.R.); (S.A.)
| | - Giulia Cerrone
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (M.C.); (G.C.); (R.S.); (G.M.); (L.R.); (S.A.)
| | - Raffaele Sciaccotta
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (M.C.); (G.C.); (R.S.); (G.M.); (L.R.); (S.A.)
| | - Giovanni Martino
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (M.C.); (G.C.); (R.S.); (G.M.); (L.R.); (S.A.)
| | - Linda Ricci
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (M.C.); (G.C.); (R.S.); (G.M.); (L.R.); (S.A.)
| | - Francesco Sollitto
- Institute of Thoracic Surgery, University of Foggia, 71122 Foggia, Italy; (F.S.); (D.L.)
| | - Domenico Loizzi
- Institute of Thoracic Surgery, University of Foggia, 71122 Foggia, Italy; (F.S.); (D.L.)
| | - Stefano Ascani
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, 05100 Terni, Italy; (C.C.); (M.C.); (G.C.); (R.S.); (G.M.); (L.R.); (S.A.)
| |
Collapse
|
20
|
Lauw MIS, Lucas CHG, Ohgami RS, Wen KW. Primary Central Nervous System Lymphomas: A Diagnostic Overview of Key Histomorphologic, Immunophenotypic, and Genetic Features. Diagnostics (Basel) 2020; 10:diagnostics10121076. [PMID: 33322508 PMCID: PMC7764608 DOI: 10.3390/diagnostics10121076] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 02/07/2023] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare form of extranodal non-Hodgkin lymphoma that primarily arises in the brain, spinal cord, leptomeninges, and vitreoretinal compartment of the eye. The term is sometimes used interchangeably with primary central nervous system diffuse large B-cell lymphoma (PCNS DLBCL) because DLBCL comprises a great majority (90–95%) of PCNSL. Although rare, other types of lymphomas can be seen in the central nervous system (CNS), and familiarity with these entities will help their recognition and further workup in order to establish the diagnosis. The latter is especially important in the case of PCNSL where procurement of diagnostic specimen is often challenging and yields scant tissue. In this review, we will discuss the most common types of primary lymphomas that can be seen in the CNS with emphasis on the diagnostic histomorphologic, immunophenotypic, and molecular genetic features. The differential diagnostic approach to these cases and potential pitfalls will also be discussed.
Collapse
Affiliation(s)
- Marietya I. S. Lauw
- Department of Pathology, University of California, San Francisco, CA 94143, USA; (C.-H.G.L.); (R.S.O.); (K.W.W.)
- Correspondence:
| | - Calixto-Hope G. Lucas
- Department of Pathology, University of California, San Francisco, CA 94143, USA; (C.-H.G.L.); (R.S.O.); (K.W.W.)
| | - Robert S. Ohgami
- Department of Pathology, University of California, San Francisco, CA 94143, USA; (C.-H.G.L.); (R.S.O.); (K.W.W.)
- Department of Pathology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA 94158, USA
| | - Kwun Wah Wen
- Department of Pathology, University of California, San Francisco, CA 94143, USA; (C.-H.G.L.); (R.S.O.); (K.W.W.)
- Department of Pathology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA 94158, USA
| |
Collapse
|
21
|
Shiroshita K, Kikuchi T, Okayama M, Kasahara H, Kamiya T, Shimizu T, Kurose N, Masaki Y, Okamoto S. Interleukin-6-producing Intravascular Large B-cell Lymphoma with Lymphadenopathy Mimicking the Histology of Multicentric Castleman Disease. Intern Med 2020; 59:3061-3065. [PMID: 32759587 PMCID: PMC7759707 DOI: 10.2169/internalmedicine.5046-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
An inguinal lymph node biopsy of a woman with a one-month history of a progressive fever, fatigue, dyspnea, skin rash, and lymphadenopathy revealed a well-preserved basic structure, hyperplastic germinal centers, and an interfollicular region containing polyclonal plasma cell sheets, suggesting plasma cell-type multicentric Castleman disease (MCD). We initiated prednisolone and anti-interleukin (IL)-6 antibody (tocilizumab), without success. A biopsy specimen re-evaluation detected CD20-positive atypical large B cells infiltrating the small vessels within and around the lymph node and its capsule. We diagnosed her with intravascular large B-cell lymphoma (IVLBCL). Lymphoma cells were weakly positive for IL-6 by immunohistochemical staining. IL-6 from lymphoma cells may have caused the MCD-like presentation as a paraneoplastic etiology. Malignant lymphoma should be excluded before diagnosing MCD.
Collapse
Affiliation(s)
- Kohei Shiroshita
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Taku Kikuchi
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Mikio Okayama
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Hidenori Kasahara
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Takahiro Kamiya
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Takayuki Shimizu
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| | - Nozomu Kurose
- Department of Pathology and Laboratory Medicine, Kanazawa Medical University, Japan
| | - Yasufumi Masaki
- Department of Hematology and Immunology, Kanazawa Medical University, Japan
| | - Shinichiro Okamoto
- Division of Hematology, Department of Medicine, Keio University School of Medicine, Japan
| |
Collapse
|
22
|
Weingarten M, Weingarten M, Sidhu H, Sidhu JS. A poisoned cherry: Migratory cutaneous intravascular large B-cell lymphoma with subsequent systemic nodal lymphoma. JAAD Case Rep 2020; 6:1336-8. [PMID: 33299917 DOI: 10.1016/j.jdcr.2020.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
23
|
Zamò A, Johnston P, Attygalle AD, Laurent C, Arber DA, Fend F. Aggressive B-cell lymphomas with a primary bone marrow presentation. Histopathology 2020; 77:369-379. [PMID: 32324290 DOI: 10.1111/his.14124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/28/2020] [Accepted: 04/21/2020] [Indexed: 12/11/2022]
Abstract
Aggressive B-cell lymphomas present as a heterogeneous spectrum of disease. A primary diagnosis in the bone marrow (BM) may be challenging in terms of diagnostic classification and clinical handling, owing to limited architectural information. Aggressive B-cell lymphomas can be subdivided into entities that typically present primarily in the BM, and cases with BM involvement in which the bulk of disease is present in other organs. One main topic at the 2018 BM workshop of the European Association of Haematopathology/Society of Hematopathology was therefore aggressive B-cell lymphomas with a primary BM presentation. The spectrum of cases submitted to this topic gave a good overview of commonly encountered problems, as well as unusual manifestations, and highlighted areas of imprecise disease definitions and diagnostic grey zones. The categories submitted to the workshop included cases of Burkitt lymphoma (BL) with unusual features, high-grade B-cell lymphomas (HG-BCLs) with and without so-called double/triple-hit, and diffuse large B-cell lymphomas (DLBCLs) with a primary BM presentation. Areas of difficulties included the morphological boundaries of HG-BCL not otherwise specified, cases with MYC and bcl-2 or bcl-6 translocations and terminal deoxynucleotidyl transferase (TdT) expression, which were categorised as B-cell lymphoblastic leukaemia/lymphoma if most cells showed TdT positivity, and the clinicopathological overlap between intravascular large B-cell lymphoma, CD5-positive DLBCL, and DLBCL with primary presentations in the BM, spleen, and liver. This review summarises our understanding of the main aggressive B-cell lymphoma categories with a common primary BM presentation and potential problem areas, and makes suggestions for the immunophenotypic and genetic work-up, illustrated by the interesting and challenging cases submitted to the workshop.
Collapse
Affiliation(s)
- Alberto Zamò
- Department of Oncology, University of Turin, Turin, Italy.,Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Peter Johnston
- Department of Pathology, NHS Grampian, University of Aberdeen, NHS Education for Scotland, Aberdeen, Scotland
| | | | - Camille Laurent
- Pathology and Cytology Department, Centre Hospitalo-Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Centre de Recherche en Cancerologie de Toulouse, Inserm, UMR1037 laboratoire d'excellence TOUCAN, Paul Sabatier University Toulouse III, Toulouse, France
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Falko Fend
- Institute of Pathology and Comprehensive Cancer Centre, Tübingen University Hospital, Tübingen, Germany
| |
Collapse
|
24
|
Suzuki Y, Kohno K, Matsue K, Sakakibara A, Ishikawa E, Shimada S, Shimada K, Mabuchi S, Takahara T, Kato S, Nakamura S, Satou A. PD-L1 (SP142) expression in neoplastic cells predicts a poor prognosis for patients with intravascular large B-cell lymphoma treated with rituximab-based multi-agent chemotherapy. Cancer Med 2020; 9:4768-4776. [PMID: 32367674 PMCID: PMC7333862 DOI: 10.1002/cam4.3104] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/03/2020] [Accepted: 04/17/2020] [Indexed: 12/11/2022] Open
Abstract
Background Intravascular large B‐cell lymphoma (IVLBCL) is a rare form of diffuse large B‐cell lymphoma (DLBCL) arising in extranodal sites. PD‐L1 expression of tumor cells has been reported in IVLBCL cells, but its clinicopathological relevance remains to be elucidated. Aims This study was aimed to reveal the characteristics of PD‐L1+ IVLBCL. Methods and results Neoplastic PD‐L1 expression was examined in 34 cases of IVLBCL and clinicopathological characteristics between patients with PD‐L1+ and PD‐L1− IVLBCL were compared. We assessed PD‐L1 expression with SP142 antibody. Twelve (35%) of 34 cases showed positivity for PD‐L1. The PD‐L1+ group had significantly lower survival rates compared to the PD‐L1− group. The PD‐L1+ IVLBCL group also had a significantly lower age distribution and a lower frequency of patients older than 60 years compared to the PD‐L1− group. Very recently, we speculate that there is possible link between PD‐L1+ IVLBCL and PD‐L1+ extranodal DLBCL‐NOS (eDLBCL) because features of the two groups showed overlapping. Therefore, we compared the clinicopathological characteristics of the PD‐L1+ IVLBCL and PD‐L1+ eDLBCL. There were no significant differences in clinicopathological parameters and prognosis. Conclusion The worse prognosis of the PD‐L1+ group might be caused by immune evasion mechanisms, which are linked to PD‐L1 expression. Therefore, PD‐L1+ IVLBCL cases might be regarded as good candidates for targeted immunotherapy. We also highlighted the overlapping features of PD‐L1+ IVLBCL and PD‐L1+ eDLBCL. This result suggests that they should be regarded as one entity, immune evasion‐related extranodal large B‐cell lymphoma.
Collapse
Affiliation(s)
- Yuka Suzuki
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Kei Kohno
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Kosei Matsue
- Division of Haematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, Kamogawa, Japan
| | - Ayako Sakakibara
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Eri Ishikawa
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan.,Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoko Shimada
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Kazuyuki Shimada
- Department of Haematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Seiyo Mabuchi
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Taishi Takahara
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan
| | - Seiichi Kato
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Centre Hospital, Nagoya, Japan
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Akira Satou
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan
| |
Collapse
|
25
|
Goyal A, Totoraitis K, Toama W, He F, Bohjanen K, Williams S, Miller DD. Concurrent mycosis fungoides and intravascular large B-cell lymphoma in a single patient. J Cutan Pathol 2020; 47:643-648. [PMID: 32087036 DOI: 10.1111/cup.13669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 12/07/2019] [Accepted: 12/14/2019] [Indexed: 12/12/2022]
Abstract
Mycosis fungoides (MF) is an indolent, uncommon, non-Hodgkin T-cell lymphoma of the skin. It classically presents with patches, plaques, and tumors and may rarely show spread to internal organs or bone marrow. Up to 7.5% of MF patients may be diagnosed with a second malignancy. Intravascular large B-cell lymphoma (IVLBCL) is an exceedingly rare non-Hodgkin B-cell lymphoma characterized by predominant growth of large neoplastic cells in the lumina of blood vessels. This case presents with an unusual confluence of two rare diagnoses, MF and IVLBCL, made more remarkable by the presence of both diagnoses on a single skin biopsy sample.
Collapse
Affiliation(s)
- Amrita Goyal
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kristin Totoraitis
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Wael Toama
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Fiona He
- Department of Medicine, Division of Hematology, Oncology, and Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
| | - Kimberly Bohjanen
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sarah Williams
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel D Miller
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota, USA
| |
Collapse
|
26
|
Abstract
We herein report the case of a 67-year-old man who presented with the acute onset of limb weakness. Brain magnetic resonance imaging revealed multiple abnormal-signal-intensity lesions. Steroids were administered, and the patient initially responded. Nerve conduction testing findings were consistent with demyelinating polyneuropathy. A sural nerve biopsy specimen revealed fascicles with extensive onion-bulb formation. Although skin and sural nerve biopsies showed no atypical cellular infiltration, the histopathological diagnosis of intravascular large B-cell lymphoma was obtained by a brain biopsy. The neuropathy in this patient may be attributed to a demyelinating process independent of ischemic damage by lymphoma.
Collapse
Affiliation(s)
- Yuki Fukami
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Haruki Koike
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Masahiro Iijima
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
- Center for Advanced Medicine and Clinical Research, Department of Advanced Medicine, Nagoya University Hospital, Japan
| | - Junichirou Hagita
- Department of Internal Medicine, Kariya Toyota General Hospital, Japan
| | - Hisayoshi Niwa
- Department of Neurology, Kariya Toyota General Hospital, Japan
| | - Ryoji Nishi
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Yuichi Kawagashira
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| | - Masahisa Katsuno
- Department of Neurology, Nagoya University Graduate School of Medicine, Japan
| |
Collapse
|
27
|
Vitiello P, Sica A, Ronchi A, Caccavale S, Franco R, Argenziano G. Primary Cutaneous B-Cell Lymphomas: An Update. Front Oncol 2020; 10:651. [PMID: 32528871 PMCID: PMC7266949 DOI: 10.3389/fonc.2020.00651] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/07/2020] [Indexed: 12/13/2022] Open
Abstract
Primary cutaneous B-cell lymphomas (PCBCLs) comprise a group of extranodal B-cell non-Hodgkin lymphomas B-cell derived, which primarily involve the skin without evidence of extracutaneous disease at the time of diagnosis. They include ~25% of all cutaneous lymphomas and are classified in three major subgroups (World Health Organization (WHO) 2017): primary cutaneous marginal zone lymphoma (PCMZL), primary cutaneous follicle-center cell lymphoma (PCFCL), and diffuse large B-cell lymphoma, leg type (PCDLBCL, LT). This classification also includes some less common entities such as intravascular large B-cell lymphoma. Recently, WHO-EORTC added Epstein-Barr virus positive (EBV+) mucocutaneous ulcer, as a new provisional distinct entity, to cutaneous B-cell lymphomas. PCBCLs are classically characterized by patches, plaques, or nodules showing great variability for color, shape, and location. Diagnosis requires histological examination with immunohistochemical staining. In general, therapeutic options depend on the exact histological and immunohistochemical classification, disease presentation, and risk assessment. PCMZL and PCFCL are considered indolent lymphomas with a good prognosis and are associated with 5-year disease-specific survival ≥ 95%. In contrast, PCDLBCL, LT is considered an aggressive lymphoma with a survival rate in 5 years of lower than 60%. Patients with a solitary lesion or limited lesions in a single anatomical site require different treatments as compared to patients with generalized lesions or refractory disease or extracutaneous involvement. Therapeutic choice includes observation, local, or systemic therapy based on histology and disease extension. Patient management is multidisciplinary, including dermatologists, pathologists, hemato-oncologists, and radiation oncologists.
Collapse
Affiliation(s)
- Paola Vitiello
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Antonello Sica
- Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
- *Correspondence: Antonello Sica
| | - Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Stefano Caccavale
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | | |
Collapse
|
28
|
Matsue K, Abe Y, Narita K, Kobayashi H, Kitadate A, Takeuchi M, Miura D, Takeuchi K. Diagnosis of intravascular large B cell lymphoma: novel insights into clinicopathological features from 42 patients at a single institution over 20 years. Br J Haematol 2019; 187:328-336. [PMID: 31267524 PMCID: PMC6900202 DOI: 10.1111/bjh.16081] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 05/13/2019] [Indexed: 01/06/2023]
Abstract
This study aimed to clarify the comprehensive clinical, laboratory, pathological and imaging features of intravascular large B‐cell lymphoma (IVLBCL) using data on 42 IVLBCL patients diagnosed at our hospital over the past 20 years. The majority of patients were diagnosed via random skin biopsy (29/42, 69·0%) followed by bone marrow biopsy alone (8/42, 19·0%). Characteristic features included persistent fever (41/42, 97·6%), decreased performance status (≥2) (100%), hypoxaemia (32/40, 80·0%), impaired consciousness (19/42, 45·2%), hypoalbuminemia (42/42, 100%) and extreme elevation of lactate dehydrogenase and soluble interleukin 2 receptor levels. Brain magnetic resonance imaging showed abnormal findings in 32/37 patients (86·4%). Hyperintense lesion in the pons was a peculiar finding that was unrelated to the neurological deficits. Positron emission tomography‐computed tomography revealed a high incidence of bone marrow (26/34, 76·5%), spleen (19/34, 55·9%) and adrenal gland (9/34, 26·5%) involvement. Neurolymphomatosis was noted in 6 patients during the course of the disease. About 60% of IVLBCL patients in whom in vivo diagnosis was possible survived more than 5 years with combination chemotherapy. Our observations provide additional insight into the diagnosis of IVLBCL and indicate that early disease recognition via random skin biopsy combined with imaging, enables in vivo diagnosis of the disease and improved survival for many patients.
Collapse
Affiliation(s)
- Kosei Matsue
- Division of Haematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, Chiba, Japan
| | - Yoshiaki Abe
- Division of Haematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, Chiba, Japan
| | - Kentaro Narita
- Division of Haematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, Chiba, Japan
| | - Hiroki Kobayashi
- Division of Haematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, Chiba, Japan
| | - Akihiro Kitadate
- Division of Haematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, Chiba, Japan
| | - Masami Takeuchi
- Division of Haematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, Chiba, Japan
| | - Daisuke Miura
- Division of Haematology/Oncology, Department of Internal Medicine, Kameda Medical Centre, Chiba, Japan
| | - Kengo Takeuchi
- Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| |
Collapse
|
29
|
Suzuki Y, Sakakibara A, Shimada K, Shimada S, Ishikawa E, Nakamura S, Kato S, Takahara T, Asano N, Satou A, Kohno K. Immune evasion-related extranodal large B-cell lymphoma: A report of six patients with neoplastic PD-L1-positive extranodal diffuse large B-cell lymphoma. Pathol Int 2019; 69:13-20. [PMID: 30601579 DOI: 10.1111/pin.12742] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/22/2018] [Indexed: 01/12/2023]
Abstract
We identified six patients with Epstein-Barr virus (EBV)-negative extranodal diffuse large B-cell lymphoma (DLBCL) and immunohistochemical expression of PD-L1 on their tumor cells by examining 283 DLBCL cases with the PD-L1 SP142 clone between 2015 and 2017. They consisted of two men and four women with a median age of 71 years, and were examined in an autopsy (n = 1) and biopsies from the adrenal gland (n = 2), skin (n = 1), pelvic cavity (n = 1), and kidney (n = 1). All showed a monomorphic population of large transformed B-cells leading to diagnoses of DLBCL with two intravascular large B-cell lymphoma (IVLBCL) and one de novo CD5+ type and were featured by an invariable immunephenotype: CD3-, CD20+, BCL-2+, and MUM1+. In addition, CD5 and CD10 were each detected in one case. All cases expressed PD-L1 on >10% to >90% of tumor cells, which was confirmed with two other PD-L1 antibodies (E1J2J and 28-8). Three untreated patients had a rapid, lethal clinical course within 7 months after diagnosis; while, the remaining three achieved complete remission after treatment and were alive at the last follow-up. We suggest immune evasion-related extranodal large B-cell lymphoma should be recognized beyond the currently identified entities of IVLBCL and de novo CD5+ DLBCL.
Collapse
Affiliation(s)
- Yuka Suzuki
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Ayako Sakakibara
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Kazuyuki Shimada
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoko Shimada
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Eri Ishikawa
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan.,Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Seiichi Kato
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Taishi Takahara
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan
| | - Naoko Asano
- Department of Clinical Laboratory, Nagano Prefectural Shinshu Medical Center, Suzaka, Japan
| | - Akira Satou
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan
| | - Kei Kohno
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| |
Collapse
|
30
|
Kusunoki R, Fujishiro H, Yoshimura M, Sawada K, Suemitsu S, Kataoka M, Fujiwara A, Tsukano K, Kotani S, Yamanouchi S, Tanaka M, Miyaoka Y, Miyake T, Kohge N, Imaoka T, Ohnuma H, Ishihara S, Kinoshita Y. Intravascular Large B-cell Lymphoma Mimicking Hepatobiliary Infection: A Case Report and Literature Review. Intern Med 2019; 58:1885-1889. [PMID: 31257276 PMCID: PMC6663525 DOI: 10.2169/internalmedicine.1995-18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) frequently involves the hepatobiliary system, but its clinical course and pathophysiology are still not fully known. We herein describe a case of IVLBCL mimicking acute hepatobiliary infection. An 85-year-old woman was admitted because of fever and epigastric pain, and she was diagnosed to have acute acalculous cholecystitis based on gallbladder wall thickening with fluid collection. The gallbladder swelling regressed within several days, and areas of intrahepatic hypoperfusion appeared. Inflammation continued despite treatment with antibiotics, and she died within 21 days. An autopsy examination revealed IVLBCL. IVLBCL can present as acute cholecystitis with an improvement in the imaging findings and the presence of a subsequent liver mass.
Collapse
Affiliation(s)
- Ryusaku Kusunoki
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Hirofumi Fujishiro
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Misaki Yoshimura
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Kiyoka Sawada
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Shinsuke Suemitsu
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Masatoshi Kataoka
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Aya Fujiwara
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Kousuke Tsukano
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Satoshi Kotani
- Department of Endoscopy, Shimane Prefectural Central Hospital, Japan
| | - Satoshi Yamanouchi
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Masaki Tanaka
- Department of Endoscopy, Shimane Prefectural Central Hospital, Japan
| | - Youichi Miyaoka
- Department of Endoscopy, Shimane Prefectural Central Hospital, Japan
| | - Tatsuya Miyake
- Department of Hepatology, Shimane Prefectural Central Hospital, Japan
| | - Naruaki Kohge
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Tomonori Imaoka
- Department of Gastroenterology, Shimane Prefectural Central Hospital, Japan
| | - Hideyuki Ohnuma
- Department of Pathology, Shimane Prefectural Central Hospital, Japan
| | - Shunji Ishihara
- Department of Internal Medicine 2, Shimane University School of Medicine, Japan
| | - Yoshikazu Kinoshita
- Department of Internal Medicine 2, Shimane University School of Medicine, Japan
| |
Collapse
|
31
|
Abstract
We herein report a rare case of methotrexate (MTX)-associated intravascular large B-cell lymphoma (IVLBCL) in a man with rheumatoid arthritis. Two episodes of a fever of unknown origin accompanied by elevated levels of serum lactate dehydrogenase and the soluble interleukin-2 receptor occurred within a year, so the patient was suspected of having an MTX-associated lymphoproliferative disorder. His clinical symptoms resolved after the cessation of MTX. However, after treatment with iguratimod, another disease-modified anti-rheumatic drug, markedly similar symptoms recurred, and random skin biopsies resulted in a diagnosis of IVLBCL. The patient received a rituximab-containing chemotherapy and achieved complete remission.
Collapse
Affiliation(s)
| | - Toru Mese
- Department of Hematology, Eiju General Hospital, Japan
| | - Shin Ohara
- Department of Hematology, Eiju General Hospital, Japan
| | - Jian Hua
- Department of Hematology, Eiju General Hospital, Japan
| | - Shiro Ide
- Department of Hematology, Eiju General Hospital, Japan
| | | |
Collapse
|
32
|
Sakakibara A, Inagaki Y, Imaoka E, Ishikawa E, Shimada S, Shimada K, Suzuki Y, Nakamura S, Satou A, Kohno K. Autopsy case report of intravascular large B-cell lymphoma with neoplastic PD-L1 expression. J Clin Exp Hematop 2018; 58:32-35. [PMID: 29415979 DOI: 10.3960/jslrt.17037] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare and clinically distinctive entity characterized by the almost exclusive growth of large cells within the lumen of blood vessels in particular capillaries. Reports of this peculiar disease, do not commonly address the PD-L1 expression on IVLBCL tumor cells. Here, we describe a 51-year-old Japanese woman who presented with rapidly progressive cognitive decline and higher brain dysfunction. CT scan and MRI revealed multiple ischemic foci in the cerebral hemispheres, ground-glass opacity in the lungs, and splenomegaly. Random skin biopsy for IVLBCL diagnosis yielded negative results. The patient experienced a rapidly deteriorating clinical course with no treatment, and died from the disease after 3 months of hospitalization. Post-mortem examination revealed systemic intravascular plugging of lymphoma cells, without mass lesions in the central nervous system or in visceral organs such as the lungs, liver, pituitary gland, ovaries, and uterus. The tumor cells were positive for CD10, CD20, BCL2, BCL6, and MUM1, but not other lineage-specific markers. Notably, the tumor cells showed strong PD-L1 expression. Our case was diagnosed as IVLBCL with neoplastic PD-L1 expression. These findings suggest that PD-L1 is associated with immune evasion of IVLBCL and may play a role in the pathogenesis and peculiar biological behavior of this unique disease. Additionally, PD-L1 may represent a possible therapeutic target for immune check-point inhibitors.
Collapse
Affiliation(s)
- Ayako Sakakibara
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital
| | | | - Eiki Imaoka
- Department of Neurosurgery, Anjo Kosei Hospital
| | - Eri Ishikawa
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital
| | - Satoko Shimada
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital
| | - Kazuyuki Shimada
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine
| | - Yuka Suzuki
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital
| | - Akira Satou
- Department of Surgical Pathology, Aichi Medical University Hospital
| | - Kei Kohno
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital
| |
Collapse
|
33
|
Banjongjit A, Chiratikarnwong K, Saelue P, Sangmala S, Auepemkiate S, Kayasut K. Random skin biopsy for diagnosis of intravascular large B-cell lymphoma in a patient with hypoxemia and normal lung imaging. JAAD Case Rep 2018; 4:149-151. [PMID: 29387769 PMCID: PMC5789758 DOI: 10.1016/j.jdcr.2017.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Athiphat Banjongjit
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Kanokphorn Chiratikarnwong
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Pirun Saelue
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Siripan Sangmala
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Sauvarat Auepemkiate
- Department of Pathology, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Kanita Kayasut
- Department of Pathology, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| |
Collapse
|
34
|
Yamasaki M, Itagaki M, Taniwaki M, Asaoku H. Intravascular Large B-cell Lymphoma with a Pulmonary [18F]-Fluorodeoxyglucose Uptake. Intern Med 2018; 57:2593-2594. [PMID: 30175729 PMCID: PMC6172540 DOI: 10.2169/internalmedicine.0776-18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Masahiro Yamasaki
- Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Japan
| | - Mitsuhiro Itagaki
- Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Japan
| | - Masaya Taniwaki
- Department of Respiratory Disease, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Japan
| | - Hideki Asaoku
- Department of Hematology, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Japan
| |
Collapse
|
35
|
Kubisova K, Martanovic P, Sisovsky V, Tomleinova Z, Steno A, Janega P, Rychly B, Babal P. Dominant neurologic symptomatology in intravascular large B-cell lymphoma. ACTA ACUST UNITED AC 2017; 117:308-11. [PMID: 27546361 DOI: 10.4149/bll_2016_061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare variant of extranodal large B-cell lymphoma and it is characterized by selective intravascular proliferation of malignant cells. Typical features of the disease include aggressive behavior, rapid and frequently fatal course. Clinical picture is non-specific and heterogeneous, depending on the affected organ. It is not uncommon that this unique type of lymphoma is diagnosed post mortem. Herein, we report two cases of IVLBCL with neurologic symptomatology. In our clinical study patient 1 was an 80-year-old male with mixed paraparesis of lower extremities and difficulties with sphincter control. Patient 2 (56-year-old male) had vision malfunction, mental status changes and defect in phatic and motor functions. In both cases definite diagnosis was established by histological examination of necroptic material. We propose to include IVLBCL in differential diagnostic considerations in patients presenting with gradually impairing neurological status and spinal cord damage of unknown etiology (Fig. 2, Ref. 9).
Collapse
|
36
|
Takeshige T, Harada N, Sekimoto Y, Kanemaru R, Tsutsumi T, Matsuno K, Shiota S, Masuda A, Gotoh A, Asahina M, Uekusa T, Takahashi K. Pulmonary Intravascular Large B-cell Lymphoma (IVLBCL) Disguised as an Asthma Exacerbation in a Patient with Asthma. Intern Med 2017; 56:1885-1891. [PMID: 28717087 PMCID: PMC5548684 DOI: 10.2169/internalmedicine.56.7613] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A 62-year-old man with asthma presented with a 1-month history of wheezing and exertional dyspnea. Although the wheezing symptoms disappeared after systemic corticosteroid therapy, the exertional dyspnea and hypoxemia did not improve. A diagnosis of intravascular large B-cell lymphoma (IVLBCL) with pulmonary involvement was suspected because of the increased serum lactic dehydrogenase (LDH) and soluble interleukin-2 receptor (sIL-2R) level, increased alveolar-arterial oxygen difference (AaDO2), decreased pulmonary diffusing capacity for carbon monoxide (DLCO) and scintigraphic, computed tomography (CT) and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)-CT findings. The patient was diagnosed as having IVLBCL with pulmonary involvement based on a pathological analysis of a random skin biopsy and a transbronchial lung biopsy. IVLBCL should be considered in patients with symptoms of asthma that are refractory to corticosteroid treatment.
Collapse
Affiliation(s)
- Tomohito Takeshige
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Norihiro Harada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Yasuhito Sekimoto
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Ryota Kanemaru
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Takeo Tsutsumi
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Kei Matsuno
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Satomi Shiota
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Azuchi Masuda
- Department of Hematology, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Akihiko Gotoh
- Department of Hematology, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Miki Asahina
- Department of Human Pathology, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Toshimasa Uekusa
- Department of Pathology, Labour Health and Welfare Organization Kanto Rosai Hospital, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| |
Collapse
|
37
|
Nishii-Ito S, Izumi H, Touge H, Takeda K, Hosoda Y, Yamasaki A, Kuwamoto S, Shimizu E, Motokura T. Pulmonary intravascular large B-cell lymphoma successfully treated with rituximab, cyclophosphamide, vincristine, doxorubicin and prednisolone immunochemotherapy: Report of a patient surviving for over 1 year. Mol Clin Oncol 2016; 5:689-692. [PMID: 28105347 PMCID: PMC5228415 DOI: 10.3892/mco.2016.1063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 09/05/2016] [Indexed: 12/01/2022] Open
Abstract
A 73-year-old man with a history of lethargy, fever and dyspnea was admitted to Tottori University Hospital. A computed tomography (CT) scan revealed splenomegaly and diffusely spreading ground-glass opacities (GGOs) in both lungs. A video-assisted thoracoscopic surgery (VATS)-guided lung biopsy revealed intravascular proliferation of large atypical lymphoid cells in the arteries, veins and alveolar walls. The patient was diagnosed with intravascular large B-cell lymphoma (IVLBCL); he received 6 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP) immunochemotherapy and has remained in complete remission for >1 year. Although IVLBCL is a rare disease, it should be considered in the differential diagnosis of pulmonary diffuse lesions that present with GGOs on CT scans.
Collapse
Affiliation(s)
- Shizuka Nishii-Ito
- Department of Hematology, Tottori University Hospital, Yonago, Tottori 683-8504, Japan; Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori 683-8503, Japan
| | - Hiroki Izumi
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori 683-8503, Japan
| | - Hirokazu Touge
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori 683-8503, Japan
| | - Kenichi Takeda
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori 683-8503, Japan
| | - Yuzuru Hosoda
- Department of Hematology, Tottori University Hospital, Yonago, Tottori 683-8504, Japan; Division of Clinical Laboratory Medicine, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Tottori 683-8503, Japan
| | - Akira Yamasaki
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori 683-8503, Japan
| | - Satoshi Kuwamoto
- Division of Molecular Pathology, Department of Pathology, Faculty of Medicine, Tottori University, Yonago, Tottori 683-8503, Japan
| | - Eiji Shimizu
- Division of Medical Oncology and Molecular Respirology, Department of Multidisciplinary Internal Medicine, Faculty of Medicine, Tottori University, Yonago, Tottori 683-8503, Japan
| | - Toru Motokura
- Department of Hematology, Tottori University Hospital, Yonago, Tottori 683-8504, Japan; Division of Clinical Laboratory Medicine, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Tottori 683-8503, Japan
| |
Collapse
|
38
|
Wang J, Ding W, Gao L, Yao W, Chen M, Zhao S, Liu W, Zhang W. High Frequency of Bone Marrow Involvement in Intravascular Large B-Cell Lymphoma. Int J Surg Pathol 2016; 25:118-126. [PMID: 27553679 DOI: 10.1177/1066896916665203] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of diffuse large B-cell lymphoma. Thirteen cases of IVLBCL with a median age of 56 years were analyzed retrospectively. Nonspecific symptoms such as fever and hepatosplenomegaly were the most common manifestations, and the bone marrow was usually involved in 8/13 (61.5%) cases. All tumors expressed CD20, and 12/13 (92.3%) of the tumors exhibited a nongerminal center phenotype by Hans algorithm. CD5 was expressed in 3/12 (25%) of the tumors. MYC was negative in all cases, and BCL2 was positive in 10/12 (83.3%) cases. Cytogenetic analysis revealed 5 cases that did not have rearrangements in either the MYC or the BCL2 gene. No association with Epstein-Barr virus was found. Seven of 11 patients received chemotherapy. The median survival time was 6 months. Patients with hemophagocytic syndrome had poor prognoses. Our study demonstrates that IVLBCL has a poor clinical outcome with a high frequency of bone marrow involvement and that the MYC gene may not play an important role in the poor prognosis of IVLBCL.
Collapse
Affiliation(s)
- Jianchao Wang
- 1 West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wenshuang Ding
- 1 West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Limin Gao
- 1 West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wenqing Yao
- 1 West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Min Chen
- 1 West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Sha Zhao
- 1 West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Weiping Liu
- 1 West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wenyan Zhang
- 1 West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
39
|
Sawada T, Omuro Y, Kobayashi T, Hishima T, Koizumi F, Kanemasa Y, Shimoyama T, Sasaki E, Maeda Y. Long-term complete remission in a patient with intravascular large B-cell lymphoma with central nervous system involvement. Onco Targets Ther 2014; 7:2133-6. [PMID: 25429230 PMCID: PMC4242899 DOI: 10.2147/ott.s72596] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This report describes a patient with intravascular large B-cell lymphoma (IVLBCL) with central nervous system involvement at the time of diagnosis who achieved complete remission for over 5 years in response to therapy. The patient, a 71 year-old woman, was previously healthy with the exception of taking verapamil for paroxysmal supraventricular tachycardia. She had presented with pyrexia and gradually progressive anemia. Brain magnetic resonance imaging revealed an infarct-like lesion in the pons, although no paralysis was observed. She was diagnosed with IVLBCL on the basis of random skin biopsy. After eight cycles of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone therapy, abnormal laboratory data had normalized, and no pontine lesion was evident on magnetic resonance imaging without receiving any intrathecal chemotherapy. IVLBCL is associated with poor prognosis, particularly in patients with central nervous system involvement. Early initiation of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone therapy and drug interactions between anticancer agents and verapamil as a p-glycoprotein inhibitor were considered the possible reasons for favorable outcome in the present case.
Collapse
Affiliation(s)
- Takeshi Sawada
- Department of Chemotherapy, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yasushi Omuro
- Department of Chemotherapy, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Takeshi Kobayashi
- Department of Hematology, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Tunekazu Hishima
- Department of Pathology, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Fumiaki Koizumi
- Department of Laboratory Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yusuke Kanemasa
- Department of Chemotherapy, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Tatsu Shimoyama
- Department of Chemotherapy, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Eisaku Sasaki
- Department of Chemotherapy, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| | - Yoshiharu Maeda
- Department of Chemotherapy, Komagome Hospital, Bunkyo-ku, Tokyo, Japan
| |
Collapse
|
40
|
Xiao D, Fu C, Long X, Liu W, Chen C, Zhou J, Fan S. Lung intravascular large B-cell lymphoma with ground glass opacities on chest computed tomography: a case report. Int J Clin Exp Pathol 2014; 7:5285-5290. [PMID: 25197411 PMCID: PMC4152101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/01/2014] [Indexed: 06/03/2023]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare type of extranodal large B-cell lymphoma characterized by the selective growth of lymphoma cells within the lumina of vessels, particularly within capillaries, with exception of larger arteries and veins. The authors reported a case of a 45-year-old woman who was admitted in hospital with refractory fever, cough and progressive dyspnea despite of receiving broad-spectrum antibiotics. Computed tomography (CT) of the lung showed bilateral patchy ground-glass opacities with some pleural effusion in the left lung. A CT-guided percutaneous lung biopsy was performed and primary pulmonary intravascular large B-cell lymphoma was diagnosed by histopathology, immunophenotype and fluorescence in situ hybridization. The patient's general status was improved after chemotherapy with R-CHOP. CT-guided percutaneous biopsy of lung is a safe and accurate diagnostic procedure in IVLBCL.
Collapse
Affiliation(s)
- Desheng Xiao
- Department of Pathology, Xiangya School of Medicine, Central South UniversityHunan, China
| | - Chunyan Fu
- Department of Pathology, Xiangya School of Medicine, Central South UniversityHunan, China
| | - Xueying Long
- Department of Radiology, Xiangya Hospital, Central South UniversityHunan, China
| | - Wei Liu
- Department of Oncology, Xiangya Hospital, Central South UniversityHunan, China
| | - Chen Chen
- Department of Pathology, Xiangya School of Medicine, Central South UniversityHunan, China
| | - Jianhua Zhou
- Department of Pathology, Xiangya School of Medicine, Central South UniversityHunan, China
| | - Songqing Fan
- Department of Pathology, The Second Xiangya Hospital, Central South UniversityChangsha, Hunan, China
| |
Collapse
|
41
|
Adachi Y, Kosami K, Mizuta N, Ito M, Matsuoka Y, Kanata M, Akiyama H, Murao T, Li M, Ieki R, Ikehara S. Benefits of skin biopsy of senile hemangioma in intravascular large B-cell lymphoma: A case report and review of the literature. Oncol Lett 2014; 7:2003-2006. [PMID: 24932279 PMCID: PMC4049734 DOI: 10.3892/ol.2014.2017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 01/27/2014] [Indexed: 12/18/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of B-cell lymphoma characterized by selective growth of clonal B-cells in the lumen of the small vessels of various organs including the liver, spleen, lungs, skin, brain, and kidney. An 86-year-old male presented with weight loss, fever and night sweats (known as B symptoms). Blood examination revealed pancytopenia, high lactate dehydrogenase and high soluble interleukin-2 receptor, suggesting hematopoietic malignancy. However, there were no abnormal hematopoietic cells in the peripheral blood. No lymph node swelling was identified on examination by whole-body computed tomography scan. Therefore, IVLBCL was suspected, and random skin biopsies and a skin biopsy from a senile hemangioma were carried out. A small number of large atypical lymphoid cells resided in the small blood vessels in the deep dermis and subcutaneous tissue of the random skin biopsies, and numerous atypical lymphoid cells were identified in the small vessels of the senile hemangioma. These results suggest the usefulness of skin biopsy from senile hemangiomas in the diagnosis of IVLBCL.
Collapse
Affiliation(s)
- Yasushi Adachi
- Division of Surgical Pathology, Toyooka Hospital, Toyooka City, Hyogo 668-8501, Japan ; Department of Stem Cell Disorders, Kansai Medical University, Hirakata City, Osaka 573-1010, Japan
| | - Koki Kosami
- Department of Internal General Medicine, Toyooka Hospital, Toyooka City, Hyogo 668-8501, Japan
| | - Noritoshi Mizuta
- Department of Internal General Medicine, Toyooka Hospital, Toyooka City, Hyogo 668-8501, Japan
| | - Mitsuhiro Ito
- Division of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe City, Hyogo 650-0017, Japan
| | - Yuki Matsuoka
- Department of Internal Medicine, Public Muraoka Hospital, Kami-Cho, Hyogo 667-1311, Japan
| | - Mami Kanata
- Department of Dermatology, Toyooka Hospital, Toyooka City, Hyogo 668-8501, Japan
| | - Hajime Akiyama
- Department of Dermatology, Toyooka Hospital, Toyooka City, Hyogo 668-8501, Japan
| | - Tomoko Murao
- Department of Clinical Laboratory, Toyooka Hospital, Toyooka City, Hyogo 668-8501, Japan
| | - Ming Li
- Department of Stem Cell Disorders, Kansai Medical University, Hirakata City, Osaka 573-1010, Japan
| | - Ryuji Ieki
- Department of Internal General Medicine, Toyooka Hospital, Toyooka City, Hyogo 668-8501, Japan
| | - Susumu Ikehara
- Department of Stem Cell Disorders, Kansai Medical University, Hirakata City, Osaka 573-1010, Japan
| |
Collapse
|