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Renal Involvement of CD20-Negative Intravascular Large B Cell Lymphoma with Neurological Manifestations. Case Rep Nephrol 2022; 2022:8613965. [PMID: 36124007 PMCID: PMC9482497 DOI: 10.1155/2022/8613965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022] Open
Abstract
The involvement of hematological tumors such as lymphoma in the kidneys is a well-recognized phenomenon. Some of the distinct reported pathological processes resulting in kidney dysfunction include minimal change disease, lymphocytic invasion of the parenchyma, immune complex disposition, immunotactoid glomerulopathy, membranous glomerulopathy, and acute tubular injury. We report a rare case of CD20-negative intravascular lymphoma found on a kidney biopsy in a male with primary angiitis of the central nervous system (CNS) who presented with acute kidney injury and proteinuria. After the initiation of rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone (R-CHOP), kidney function improved and proteinuria resolved.
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Seegobin K, Li Z, Alhaj Moustafa M, Majeed U, Wang J, Jiang L, Kuhlman J, Menke D, Li K, Kharfan-Dabaja MA, Ayala E, Iqbal M, Nowakowski GS, Habermann TM, Witzig TE, Johnston P, Thompson C, Ansell S, Tun HW. Clinical Characteristics, Prognostic Indicators, and Survival Outcomes in Intravascular Lymphoma: Mayo Clinic Experience (2003-2018). Am J Hematol 2022; 97:1150-1158. [PMID: 35713565 PMCID: PMC9541514 DOI: 10.1002/ajh.26635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022]
Abstract
Intravascular lymphoma (IVL) is a rare extranodal non‐Hodgkin lymphoma. We performed a retrospective analysis of 55 IVL patients who were treated at our institution 2003–2018. Median age at diagnosis was 68 years, and 64% were males. The most frequent presenting symptoms were skin rash 43% and weight loss 30%. MRI brain on IVL patients with CNS involvement (CNS‐IVL) showed multifocal involvement in 76% (13/17). 89% (17/19) of non‐CNS‐IVL patients with abnormal FDG‐PET had biopsy of an avid lesion resulting in definitive diagnosis. The top diagnostic biopsy site was the bone marrow (45%). 56% had multiorgan involvement. Based on CNS involvement, 36.5% (20/55) had CNS‐IVL and 63.5% (35/55) had non‐CNS‐IVL. CNS‐IVL group consists of clinically isolated CNS involvement (CNS‐only IVL) (22%;12/55) and mixed clinical CNS and peripheral site involvement (M‐IVL) (14.5%; 8/55). Non‐CNS‐IVL group consists of clinically isolated skin involvement (skin‐only IVL) (9%; 5/55) and peripheral IVL with or without skin involvement (P‐IVL); (54.5%; 30/55). Skin involvement was predominantly in the lower extremities. Pathologically, 89% (48/54) were B‐cell IVL. Rituximab + high‐dose methotrexate‐based regimen were used in 75% (12/16) of CNS‐IVL patients and RCHOP in 60% (17/28) of non‐CNS‐IVL patients. Estimated 5‐year progression free survival (PFS) and overall survival (OS) for the entire cohort were 38.6% and 52%, respectively. Skin‐only IVL was associated with excellent survival. Platelet count <150x109/L, age > 60Y, and treatment without Rituximab were poor prognostic factors. Further research is necessary to identify novel therapies.
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Affiliation(s)
- Karan Seegobin
- Department of Haematology and Medical Oncology, Mayo Clinic Jacksonville, Florida
| | - Zhuo Li
- Department of Biomedical Statistics and Informatics, Mayo Clinic Jacksonville, Florida
| | | | - Umair Majeed
- Department of Haematology and Medical Oncology, Mayo Clinic Jacksonville, Florida
| | - Jing Wang
- Department of Internal Medicine, Mayo Clinic Jacksonville, Florida
| | - Liuyan Jiang
- Department of Pathology, Mayo Clinic Jacksonville, Florida
| | - Justin Kuhlman
- Department of Internal Medicine, Mayo Clinic Jacksonville, Florida
| | - David Menke
- Department of Pathology, Mayo Clinic Jacksonville, Florida
| | - Ke Li
- Department of Pathology, Mayo Clinic Jacksonville, Florida
| | | | - Ernesto Ayala
- Department of Haematology and Medical Oncology, Mayo Clinic Jacksonville, Florida
| | - Madiha Iqbal
- Department of Haematology and Medical Oncology, Mayo Clinic Jacksonville, Florida
| | - Grzegorz S Nowakowski
- Department of Haematology and Medical Oncology, Mayo Clinic Rochester, Minnesota, United States
| | - Thomas M Habermann
- Department of Haematology and Medical Oncology, Mayo Clinic Rochester, Minnesota, United States
| | - Thomas E Witzig
- Department of Haematology and Medical Oncology, Mayo Clinic Rochester, Minnesota, United States
| | - Patrick Johnston
- Department of Haematology and Medical Oncology, Mayo Clinic Rochester, Minnesota, United States
| | - Carrie Thompson
- Department of Haematology and Medical Oncology, Mayo Clinic Rochester, Minnesota, United States
| | - Stephen Ansell
- Department of Haematology and Medical Oncology, Mayo Clinic Rochester, Minnesota, United States
| | - Han W Tun
- Department of Haematology and Medical Oncology, Mayo Clinic Jacksonville, Florida
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3
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Altintas A, Danyeli AE, Bozkurt SB, Uysal SP, Akpek S, Aygun MS, Akay OM, Kahyaoglu B, Peker S, Ure UB, Ferhanoglu B. A 52-Year-Old Man With Progressive Weakness and Incontinence. Neurohospitalist 2022; 12:307-311. [PMID: 35419156 PMCID: PMC8995596 DOI: 10.1177/19418744211039586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Here we report a challenging case of a 52-year-old man presenting with subacute constipation, urinary retention, impotence, absent Achilles reflexes, and hypoesthesia in S2-S5 dermatomes. We review the clinical decision-making as the symptoms evolved and diagnostic testing changed over time. Once the diagnosis is settled, we discuss the sign and symptoms, additional diagnostic tools, treatment options and prognosis.
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Affiliation(s)
- Ayse Altintas
- Department of Neurology and Koc University Research Center for Translational Medicine (KUTTAM), Koc University School of Medicine, Istanbul, Turkey
| | | | | | - Sanem Pinar Uysal
- Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Sergin Akpek
- Department of Radiology, American Hospital, Istanbul, Turkey
| | - Murat Serhat Aygun
- Department of Radiology, Koc University School of Medicine, Istanbul, Turkey
| | - Olga Meltem Akay
- Department of Hematology/Oncology, Koc University School of Medicine, Istanbul, Turkey
| | | | - Selcuk Peker
- Department of Neurosurgery, American Hospital, Istanbul, Turkey
| | - Umit Barbaros Ure
- Department of Hematology/Oncology, Koc University School of Medicine, Istanbul, Turkey
| | - Burhan Ferhanoglu
- Department of Hematology/Oncology, Koc University School of Medicine, Istanbul, Turkey
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4
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Roy AM, Pandey Y, Middleton D, Broadfoot B, Sasapu A, Veeraputhiran M. Intravascular Large B-Cell Lymphoma: A Diagnostic Dilemma. Cureus 2021; 13:e16459. [PMID: 34422488 PMCID: PMC8370572 DOI: 10.7759/cureus.16459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 11/05/2022] Open
Abstract
Intravascular large B-cell lymphoma is a rare malignancy characterized by the presence of lymphoma cells within the lumen of blood vessels. The annual incidence of cases is fewer than 0.5 cases per 1,000,000. It usually affects the elderly with an average age of diagnosis around 70 years. Due to the absence of lymphoma cells in the peripheral smear and lymphadenopathy, it is difficult to diagnose these cases. Although the central nervous system and skin are the commonly involved organs, they can involve any organ system. Prompt diagnosis and initiation of treatment are very crucial as it carries a high mortality. We describe two patients who presented with constitutional symptoms and fever of unknown origin, later diagnosed as intravascular large B- cell lymphoma. The diagnosis was difficult in both cases as the presenting symptoms were atypical. One of the patients was diagnosed at autopsy. The delay in diagnosis often leads to fatal outcomes as the disease is very aggressive. A high degree of clinical suspicion is the key to prompt diagnosis and improved outcomes.
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Affiliation(s)
- Arya Mariam Roy
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Yadav Pandey
- Department of Hematology and Oncology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Derek Middleton
- Department of Hematology and Oncology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Brannon Broadfoot
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Appalanaidu Sasapu
- Department of Hematology and Oncology, University of Arkansas for Medical Sciences, Little Rock, USA
| | - Muthu Veeraputhiran
- Department of Hematology and Medical Oncology, University of Arkansas for Medical Sciences, Little Rock, USA
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5
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Turin CG, Ting K, Bradshaw A, Dunham SR, Nunez-Wallace K, Patel SM, Dangayach P, Holdener S, Lin WC. Central nervous system intravascular lymphoma leading to rapidly progressive dementia. Proc (Bayl Univ Med Cent) 2021; 34:373-375. [PMID: 33953465 DOI: 10.1080/08998280.2020.1866943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Intravascular lymphoma is an uncommon subtype of B-cell lymphoma with neoplastic cells limited to the lumen of small blood vessels. We report a case of a 52-year-old man who presented with constitutional symptoms and rapidly progressive dementia. He was found to have diffuse leptomeningeal and faint parenchymal enhancement on magnetic resonance imaging and was subsequently diagnosed with intravascular lymphoma following a brain biopsy. He responded remarkably well to systemic and intrathecal chemotherapy. The diagnosis and treatment of intravascular lymphoma have been guided by a few case reports and are largely based on expert opinion.
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Affiliation(s)
- Christie G Turin
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Kevin Ting
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Anthony Bradshaw
- Department of Neurology, Baylor College of Medicine, Houston, Texas
| | - S Richard Dunham
- Department of Neurology, Baylor College of Medicine, Houston, Texas
| | | | - Shital M Patel
- Division of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Priti Dangayach
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Stephanie Holdener
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Weei-Chin Lin
- Department of Medicine, Baylor College of Medicine, Houston, Texas.,Division of Hematology-Oncology, Department of Medicine, Baylor College of Medicine, Houston, Texas
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6
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Spencer J, Dusing R, Yap W, Hill J, Walter C. Intravascular large B-cell lymphoma presenting with diffusely increased pulmonary fluorodeoxyglucose uptake without corresponding CT abnormality. Radiol Case Rep 2018; 14:260-264. [PMID: 30510608 PMCID: PMC6260434 DOI: 10.1016/j.radcr.2018.10.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/30/2018] [Accepted: 10/30/2018] [Indexed: 12/14/2022] Open
Abstract
A 60-year-old male presented with complaints of dyspnea, intermittent fever, and 40 pounds of weight loss over the previous 9 months and was admitted for acute hypoxemic respiratory failure. Labs demonstrated elevated inflammatory markers, mild anemia, and thrombocytopenia. Fluorodeoxyglucose-positron emission tomography scan demonstrated diffusely increased pulmonary fluorodeoxyglucose uptake without corresponding abnormality on CT images. Excisional lung biopsy demonstrated intravascular large B-cell lymphoma (IV-LBCL). Presentation, imaging findings, and diagnosis of IV-LBCL will be discussed, as well as differential considerations for pulmonary involvement by IV-LBCL.
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Affiliation(s)
- Jayden Spencer
- Department of Radiology, Kansas University Hospital, 3901 Rainbow Blvd, MS 4032, Kansas City, KS, USA
| | - Reginald Dusing
- Department of Radiology, Kansas University Hospital, 3901 Rainbow Blvd, MS 4032, Kansas City, KS, USA
| | - Wendell Yap
- Department of Radiology, Kansas University Hospital, 3901 Rainbow Blvd, MS 4032, Kansas City, KS, USA
| | - Jacqueline Hill
- Department of Radiology, Kansas University Hospital, 3901 Rainbow Blvd, MS 4032, Kansas City, KS, USA
| | - Carissa Walter
- Department of Radiology, Kansas University Hospital, 3901 Rainbow Blvd, MS 4032, Kansas City, KS, USA
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7
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Abstract
Primary cutaneous large B‑cell lymphomas (PCBLT), EBV-positive large B‑cell lymphomas, not otherwise specified (EBV+ DLBCL, NOS), and primary cutaneous intravascular large B‑cell lymphomas (PCIVLBL) are recognized as cutaneous lymphomas with intermediate to poor prognosis. Differentiation from indolent B‑cell lymphomas or other pathologies of the skin can be complex, both clinically and histologically, but vital for the outcome of the patient. The combination of immunotherapy and polychemotherapy regimens, such as R‑CHOP, has led to significant improvements in prognosis, especially in diffuse large B‑cell lymphomas. Therapeutic decisions need to be individually made for each patient, ideally within an interdisciplinary tumor conference. Immunosenescence may be an important factor in the pathogenesis of EBV+ DLBCL, NOS in elderly individuals. Their prognosis is less favorable than that of patients with EBV-negative PCBLT, whereby this has been observed particularly in elderly patients. One third of patients with PCIVLBL progress to systemic disease. The occurrence of nodal manifestation is rarely observed. Symptoms may vary depending on the organ system involved. Currently there are no evidence-based therapy recommendations due to the rarity of the disease. EBV-positive mucocutaneous ulcer is a new provisional category in the current WHO classification for lymphoid neoplasms. It has been segregated from EBV+ DLBCL, NOS due to its self-limiting course and good response to conservative therapy.
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Affiliation(s)
- C Lamos
- Hautklinik Ludwigshafen, Klinikum der Stadt Ludwigshafen am Rhein, Bremserstr. 79, 67063, Ludwigshafen, Deutschland.
| | - E Dippel
- Hautklinik Ludwigshafen, Klinikum der Stadt Ludwigshafen am Rhein, Bremserstr. 79, 67063, Ludwigshafen, Deutschland
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Weichert G, Martinka M, Rivers JK. Intravascular Lymphoma Presenting as Telangectasias: Response to Rituximab and Combination Chemotherapy. J Cutan Med Surg 2016. [DOI: 10.1177/120347540300700606] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Intravascular lymphoma is a rare and aggressive disease with abnormal lymphocytes confined within blood vessels. Cutaneous findings are common in the presentation of this disease. Objectives: The objectives of this article are (1) to describe a case of intravascular lymphoma treated with chemotherapy and rituximab and (2) to review the literature with respect to skin findings and outcomes of these patients after chemotherapy. Patient: Our patient had an unusual presentation of intravascular lymphoma characterized by tender, slightly indurated plaques composed of dense telangectatic vessels. Results: Our patient responded to combination chemotherapy with the addition of a partial course of rituximab (anti-CD20 monoclonal antibody). Conclusion: Intravascular lymphoma commonly presents with skin findings of tender indurated plaques and nodules. Although a number of clinical variations exist, telangectatic plaques are rarely described. Including our case, 50 patients have been reported after treatment with chemotherapy. Approximately 46% of treated patients exhibit either partial or complete response to chemotherapy. This is die first reported case of intravascular lymphoma treated successfully with the addition of rituximab. Overall, this malignancy remains an unusual and aggressive disease. Recognition of the cutaneous findings and early treatment with chemotherapy may alter the course of this disease. Rituximab may be an important addition to combination chemotherapy in treating intravascular lymphoma. Antécédents: Le lymphome intravasculaire est une maladie rare et agressive qui se caractérise par la présence dans les vaisseaux sanguins de lymphocytes anormaux. Les affections cutanées sont fréquentes. Objectifs: L'objectif de cette étude est 1) de décrire un cas de lymphome intravasculaire traité par chimiothérapie et rituximab et 2) de passer en revue la littérature médicale afin de recenser les troubles dermatologiques associés à la chimiothérapie. Méthode: Le patient présentait un cas inhabituel de lymphome intravasculaire se caractérisant par des plaques de veines télangiectasiques densesm, légèrement endurées et sensibles. Resultats: Le patient a réagi à une chimiothérapie en combinaison et au rituximab (anticorps monoclonal anti-CD20). Conclusion: Le lymphome intravasculaire s'associe souvent à des manifestations dermiques de plaques et de nodules indurés et sensibles. Bien qu'un nombre de variations cliniques existe, les plaques télangiectasiques sont rarement décrites. En tout, 50 patients, y compris notre cas, ont été signalés à la suite de traitements de chimiothérapie. Environ 46% des patients traités guérissent complètement ou partiellement. Il s'agit du premier cas signalé de traitement réussi du lymphome intravasculaire par ajout de rituximab. Il s'agit d'une maladie inhabituelle et agressive. Le diagnostic d'une affection dermique et la chimiothérapie précoce pourraient altérer le cours de la maladie. Le rituximab serait un important ajout à la chimiothérapie en combinaison dans le traitement du lymphome intravasculaire.
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Affiliation(s)
- Gabriele Weichert
- Division of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Magdalena Martinka
- Department of Pathology, Laboratory of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason K. Rivers
- Division of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Cancer Agency, Vancouver, British Columbia, Canada
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9
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Barrio Anta E, Cid Conde L, López Castro J, Rodríguez López J. Otro gran imitador…, con desenlace fatal. Rev Clin Esp 2015; 215:343-5. [DOI: 10.1016/j.rce.2015.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 12/11/2014] [Accepted: 02/01/2015] [Indexed: 11/16/2022]
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10
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Bailly P, Diraison P, Coustans M, Lamotte N, Breuilly C. [Intravascular large B-cell lymphoma revealed by a cerebral infarct and a mesenteric ischemia]. Presse Med 2014; 44:244-7. [PMID: 25542708 DOI: 10.1016/j.lpm.2014.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/28/2014] [Accepted: 09/22/2014] [Indexed: 11/19/2022] Open
Affiliation(s)
- Pierre Bailly
- Centre hospitalier de Cornouaille, service de neurologie, 29107 Quimper cedex, France.
| | - Philippe Diraison
- Centre hospitalier de Cornouaille, service de neurologie, 29107 Quimper cedex, France
| | - Marc Coustans
- Centre hospitalier de Cornouaille, service de neurologie, 29107 Quimper cedex, France
| | - Nadège Lamotte
- Centre hospitalier de Cornouaille, service de neurologie, 29107 Quimper cedex, France
| | - Christophe Breuilly
- Centre hospitalier de Cornouaille, service de neurologie, 29107 Quimper cedex, France
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11
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Abstract
Background:Intravascular large cell lymphoma (ILCL) is a diagnostic challenge, with neurological, cutaneous and constitutional symptoms. The natural history is usually an evolution to a comatose state. As invasive procedures are usually required for diagnosis, recognizing the typical clinical pattern is critical since an effective treatment is available.Method:After an extensive literature review of the subject, we report a case of ILCL, analyzing clinical, laboratory, radiological and pathological data. We will also give a special attention to the clinical picture of a conus medullaris (CM) lesion with subsequent encephalopathy in the same patient.Results:We report here a 61-year-old woman with a paraplegia caused by a CM lesion, evolving about one year latter to encephalopathy and eventual coma, with the diagnosis of ILCL confirmed by autopsy. The present case is similar to eight other cases in literature who had CM lesion associated with ILCL, knowing that 80-90% of these patients will eventually evolve to encephalopathy without treatment. Conclusions: ILCL is a recognized but rare cause of coma. Diagnosing it is tremendously important since it is fatal if left untreated. We propose that this specific picture (conus medullaris lesion, eventually evolving to encephalopathy) is quite characteristic and will directly result in better outcome if recognized.
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12
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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] [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.
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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
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13
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Abstract
BACKGROUND Intravascular lymphoma (IVL) is a rare subtype of large-cell non-Hodgkin lymphoma, characterized by proliferation of lymphoma cells within the lumina of small vessels. There are no previously reported cases of IVL involving the pituitary gland presenting with neuro-ophthalmic findings. METHODS A 68-year-old female presented with headache, right third nerve palsy, and Horner syndrome. MRI showed a 1.4-cm sellar mass consistent with a pituitary macroadenoma. Two weeks later, despite treatment with dexamethasone, the patient developed complete bilateral ophthalmoplegia and ptosis. Repeat MRI showed invasion of the clivus and cavernous sinuses, and a transsphenoidal pituitary biopsy was undertaken. RESULTS The preliminary histopathology was consistent with bland pituitary apoplexy, but subsequent examination of an incidentally biopsied nasal polyp revealed endovascular malignant lymphoid cells that, on further scrutiny, were also present in the pituitary tissue. The diagnosis of IVL was confirmed, and the patient had an excellent clinical and radiological response to cyclophosphamide, doxorubicin, vincristine, prednisolone, and rituximab (CHOP-R) chemotherapy. CONCLUSION IVL may involve the pituitary gland, causing sellar mass effect, cavernous sinus infiltration, and pituitary ischemia, mimicking pituitary apoplexy with neuro-ophthalmic features. It can be effectively treated with CHOP-R chemotherapy.
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14
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Hiraga A, Ozaki D, Kamitsukasa I, Araki N, Arai K. Status epilepticus as the initial presentation of intravascular lymphoma. Case Rep Neurol 2012; 4:107-12. [PMID: 22807906 PMCID: PMC3398095 DOI: 10.1159/000339815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Intravascular lymphoma (IVL) is a rare disease form of malignant lymphoma, and it is characterised by the selective growth of lymphoma cells within the lumina of vessels. Identification of this disease at an early stage is difficult because of non-specific clinical symptoms and neuroradiological findings. Most reported IVL cases are diagnosed at post-mortem following autopsy. We report the case of a patient who presented with status epilepticus (SE) as the initial manifestation of IVL. Despite the administration of anti-convulsant agents and general care the patient's condition deteriorated rapidly after admission, culminating in death due to respiratory failure and heart failure 21 days after the onset of symptoms. Post-mortem examination revealed IVL in the brain and multiple organs. Epileptic seizures often appear during the clinical course of IVL; however, they occur most frequently at advanced stages. Diagnosis of IVL that first presents with SE is of clinical importance because the treatment and prognosis of acute SE arising from IVL are different from those of SE originating from other causes.
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Affiliation(s)
- Akiyuki Hiraga
- Departments of Neurology, Chiba Rosai Hospital, Ichihara, Chiba, Japan
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15
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Yamashita H, Suzuki A, Takahashi Y, Kubota K, Kano T, Mimori A. Intravascular large B-cell lymphoma with diffuse FDG uptake in the lung by 18FDG-PET/CT without chest CT findings. Ann Nucl Med 2012; 26:515-21. [PMID: 22539250 PMCID: PMC7102326 DOI: 10.1007/s12149-012-0600-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 04/03/2012] [Indexed: 12/14/2022]
Abstract
We report a rare case of intravascular large B-cell lymphoma (IVLBCL) with diffuse fluorodeoxyglucose (FDG) uptake in the lung by 18FDG-positron emission tomography/computed tomography (PET/CT). CT showed nodular shadow, whereas diffuse FDG uptake in PET/CT suggested IVLBCL in the lung. A random skin biopsy provided histological evidence of IVLBCL. The patient responded well to combination chemotherapy. Only two cases of IVLBCL in which diffuse pulmonary FDG uptake was demonstrated have been reported previously. FDG-PET/CT plus random skin biopsy may be useful for the early diagnosis of IVLBCL with pulmonary involvement even without convincing radiological findings in the lung.
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Affiliation(s)
- Hiroyuki Yamashita
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan.
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Niida T, Isoda K, Miyazaki K, Kanoh S, Kobayashi H, Kobayashi A, Kimura F, Hayashi K, Kusuhara M, Ohsuzu F. Pulmonary intravascular lymphoma diagnosed by 18-fluorodeoxyglucose positron emission tomography-guided transbronchial lung biopsy in a man with long-term survival: a case report. J Med Case Rep 2011; 5:295. [PMID: 21736708 PMCID: PMC3152526 DOI: 10.1186/1752-1947-5-295] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 07/07/2011] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION 18-Fluorodeoxyglucose positron emission tomography can detect the pulmonary involvement of intravascular lymphoma that presents no abnormality in a computed tomography scan. CASE PRESENTATION We report the case of a 61-year-old Japanese man who had pulmonary intravascular lymphoma and no computed tomography abnormality. We were able to make an antemortem diagnosis of pulmonary intravascular lymphoma by transbronchial lung biopsy according to 18-fluorodeoxyglucose positron emission tomography findings. He is free of recurrent disease 24 months after chemotherapy. CONCLUSIONS To the best of our knowledge, this is the first reported case of a long-term survivor of pulmonary intravascular lymphoma diagnosed by transbronchial lung biopsy under the guide of 18-fluorodeoxyglucose positron emission tomography.
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Affiliation(s)
- Tomiharu Niida
- Division of Cardiovascular Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan.
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Intravascular lymphoma presenting as a longitudinally-extensive myelitis: Diagnostic challenges and etiologic clues. J Neurol Sci 2011; 303:146-9. [DOI: 10.1016/j.jns.2010.12.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 12/17/2010] [Indexed: 11/17/2022]
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Lee BS, Frankfort BJ, Eberhart CG, Weinberg RS. Diagnosis of intravascular lymphoma by a novel biopsy site. Ophthalmology 2010; 118:586-90. [PMID: 21035865 DOI: 10.1016/j.ophtha.2010.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 07/31/2010] [Accepted: 08/02/2010] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To report the first known case of intravascular lymphoma (IVL), a rare disease, diagnosed via lacrimal gland biopsy. DESIGN Interventional case report. PARTICIPANTS Single patient case report. INTERVENTION Bedside lacrimal gland biopsy. MAIN OUTCOME MEASURES Clinicopathologic diagnosis of IVL, a neoplasm with only a few prior reports of ophthalmic manifestations, via a novel biopsy site. RESULTS A 70-year-old Chinese man with 6 months of progressive paraplegia complained of blurred vision in both eyes. He had unremarkable cerebrospinal fluid studies and magnetic resonance imaging that showed abnormal thoracic cord signal and periventricular brain white matter changes with a normal pituitary gland and stalk. Dilated fundus examination showed multifocal areas of intra- and subretinal hemorrhage with serous retinal detachment. The workup included serologies and 2 normal bone marrow biopsies but did not reveal the underlying etiology. Because of the continued high suspicion for a malignant process, we performed bedside transconjunctival biopsy of the lacrimal gland. This demonstrated large, atypical CD20-positive B cells confined to the vessel lumina, consistent with IVL, an unusual form of large B-cell lymphoma. CONCLUSIONS This case represents the first time that IVL has been detected via lacrimal gland biopsy, which may be a useful way to investigate cryptogenic neurologic processes. Furthermore, it is one of the only reported cases of ophthalmic IVL diagnosed before autopsy. IVL is a rare disease but has protean manifestations involving the central nervous system, skin, bone marrow, liver, and spleen. The eye should also be considered an end organ for involvement.
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Affiliation(s)
- Bryan S Lee
- Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, Maryland 21287, USA.
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Kotake T, Kosugi S, Takimoto T, Nakata S, Shiga J, Nagate Y, Nakagawa T, Take H, Katagiri S. Intravascular large B-cell lymphoma presenting pulmonary arterial hypertension as an initial manifestation. Intern Med 2010; 49:51-4. [PMID: 20046001 DOI: 10.2169/internalmedicine.49.2774] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a 39-year-old man with intravascular large B-cell lymphoma (IVLBCL) who had been treated as a case with pulmonary arterial hypertension (PAH) for one year. After he became worse, diffuse pulmonary (18)F-fluorodeoxyglucose (FDG) uptake in positron emission tomography (PET) suggested the existence of IVLBCL in the lung showing normal CT images. The diagnosis was confirmed with random transbronchial lung biopsy, and he was then successfully treated. Since IVLBCL presenting PAH has been rare and is difficult to diagnose, early application of FDG-PET may provide early recognition of the disorder, leading to a better outcome.
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Affiliation(s)
- Takeshi Kotake
- Department of Internal Medicine, Toyonaka Municipal Hospital, Toyonaka, Japan.
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Affiliation(s)
- John Anastasi
- Department of Pathology, University of Chicago, Chicago, IL 60637, USA.
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Narimatsu H, Morishita Y, Saito S, Shimada K, Ozeki K, Kohno A, Kato Y, Nagasaka T. Usefulness of Bone Marrow Aspiration for Definite Diagnosis of Asian Variant of Intravascular Lymphoma: Four Autopsied Cases. Leuk Lymphoma 2009; 45:1611-6. [PMID: 15370213 DOI: 10.1080/10428190410001683769] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The Asian variant of intravascular lymphoma (AIVL) is characterized by hemophagocytic syndrome, pancytopenia and hepatosplenomegaly but usually lacks any neurological abnormality and skin lesions, which are typical features of classical intravascular lymphoma (IVL). An ante-mortem diagnosis of AIVL is difficult due to the absence of visible lymphoma lesions and unspecific clinical manifestations. A definite diagnosis relies on the presence of neoplastic B cells in the lumina of small vessels. Paraffin block samples of aspirated bone marrow clots were obtained from 4 patients with clinically suspected IVL and subjected to immunohistopathological analysis. All samples exhibited CD 20+ or CD 79a+ lymphoma cells proliferating intravascularly as well as erythrocytic hemophagocytosis. The distribution of neoplastic cells in the structure of the bone marrow allowed IVL to be distinguished from bone marrow invasions due to other types of lymphoma. We demonstrated the successful establishment of a definite ante-mortem diagnosis of AIVL in 3 of 4 patients by the rapid and simple method of using aspirated bone marrow samples.
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Affiliation(s)
- Hiroto Narimatsu
- Department of Hematology and Oncology, JA Aichi Showa Hospital, Konan, Japan.
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22
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Abstract
INTRODUCTION Comorbidity between epilepsy and cancer is elevated. As a life-time condition, it is not impossible for a patient with epilepsy to have a cancer at some point. Besides, at least 30% of patients with primary brain tumors have epileptic seizures, but also in patients with metastatic infiltrating lesions of the central nervous system and with extracerebral tumors, epilepsy can be related. Seizures may also appear associated with paraneoplastic syndromes, such as limbic encephalitis and metabolic and infectious complications of chemotherapy and radiotherapy. RESULTS The precise mechanisms by which brain tumors and the other conditions mentioned above produce seizures are not fully understood, but are reviewed in this article, as well as the many different therapeutic options that may be used in the treatment of epileptic seizures. Pharmacological treatment poses various controversies, such as the utility of prophylactic treatment, interactions between antiepileptic drugs (AEDs) and chemotherapeutic drugs and the complications derived from the adverse effects of AEDs in this population. Finally, other treatments are proposed such as chemotherapy, radiotherapy and surgery, the rational application of which allows for an improvement in the patients' quality of life. CONCLUSION In order to arrive at a diagnosis, the different causes that could condition the appearance of epileptic seizures in cancer patients must be known. After this, the most adequate treatment should be chosen, thus ensuring the comprehensive treatment of cancer and epilepsy.
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Intravascular Lymphoma Masquerading as Multiembolic Stroke Developing After Coronary Artery By-Pass Surgery. Neurologist 2009; 15:98-101. [DOI: 10.1097/nrl.0b013e31817833ad] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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24
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Kitanaka A, Kubota Y, Imataki O, Ohnishi H, Fukumoto T, Kurokohchi K, Tanaka T. Intravascular large B-cell lymphoma with FDG accumulation in the lung lacking CT/67gallium scintigraphy abnormality. Hematol Oncol 2009; 27:46-9. [DOI: 10.1002/hon.876] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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25
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Intravascular lymphomatosis of the nervous system. J Neurol 2008; 255:1590-2. [PMID: 18670799 DOI: 10.1007/s00415-008-0966-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 03/17/2008] [Accepted: 04/11/2008] [Indexed: 10/21/2022]
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26
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Szots M, Bors L, Kálmán E, Szapáry L, Illés Z. [Intravascular lymphomatosis: diagnostic problems of a rare disease]. Orv Hetil 2007; 148:749-52. [PMID: 17437952 DOI: 10.1556/oh.2007.27974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intravascular lymphomatosis is a rare systemic disease characterized by proliferation of malignant B or rarely T lymphocytes. Skin and the brain are predominantly affected. We describe a patient presenting with focal neurological signs and progressive dementia. Cerebral neuroimaging findings were nonspecific. Postmortem examination revealed intravascular proliferation of atypical mononuclear cells in the lumens of small vessels in all organs. The authors conclude that diagnosis requires a high index of suspicion and pathological examination of the affected organs, but is rarely made ante mortem.
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Affiliation(s)
- Mónika Szots
- Pécsi Tudományegyetem, Altalános Orvostudományi Kar, Neurológiai Klinika, Pécs.
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27
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Affiliation(s)
- Katsuya Shiraki
- Department of Gastroenterology, Mie University School of Medicine, Tsu.
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Ponzoni M, Ferreri AJM. Intravascular lymphoma: a neoplasm of 'homeless' lymphocytes? Hematol Oncol 2006; 24:105-12. [PMID: 16721900 DOI: 10.1002/hon.776] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Intravascular lymphoma (IVL) is an extremely rare form of non-Hodgkin lymphoma characterized by almost exclusive growth of neoplastic lymphocytes within blood vessel lumen. IVL is morphologically characterized in most instances by large cells with B-cell lineage. IVL is an aggressive and usually disseminated disease that predominantly affects elderly patients, resulting in poor PS, B-symptoms, anemia, and high lactate dehydrogenase serum level. The brain and skin are the most commonly involved sites; nodal disease is rare. Survival after conventional chemotherapy is disappointing, with a relevant impact of diagnostic delay and lethal complications. Notwithstanding these results, IVL limited to the skin (cutaneous variant) is a favorable presentation with distinctive clinical characteristics. Moreover, differences in clinical presentation with Eastern Countries IVL cases, mostly associated with hemophagocytic syndrome, do exist. Intensive combinations containing drugs with higher central nervous system bioavailability are needed in cases with brain involvement; the role of high-dose chemotherapy with autologous stem cell transplantation should be investigated in younger patients with unfavorable features. The present review will discuss the most recent acquisitions related either to diagnosis and immunophenotypic/biologic characteristics as well as clinical/therapeutic issues of IVL.
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Affiliation(s)
- Maurilio Ponzoni
- Pathology Unit, San Raffaele H Scientific Institute, Milan, Italy.
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29
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Gaul C, Hanisch F, Neureiter D, Behrmann C, Neundörfer B, Winterholler M. Intravascular lymphomatosis mimicking disseminated encephalomyelitis and encephalomyelopathy. Clin Neurol Neurosurg 2006; 108:486-9. [PMID: 16720222 DOI: 10.1016/j.clineuro.2005.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2004] [Revised: 12/30/2004] [Accepted: 01/24/2005] [Indexed: 11/17/2022]
Abstract
Intravascular lymphomatosis is characterized by the presence of large lymphoma cells predominantly within small vessels. This report presents two patients with diagnostically misleading neurological manifestation of this disease. Case 1, a 63-year-old man, developed a sensorimotor transverse spinal cord syndrome and encephalopathy. Lumbar puncture revealed albuminocytological dissociation. Magnetic resonance imaging (MRI) showed progression of multifocal infarct-like lesions in the brain, the thoracic cord and the medullary cone. Autoimmune inflammation was suspected, and the patient received immunosuppressive therapy with immunoglobulins, steroids and azathioprine. He died 18 months after the onset of symptoms. Case 2, a 68-year-old man, showed fluctuating aphasia, disorientation, and fever for several months. Brain MRI-scan, electroencephalography (EEG) and cerebrospinal fluid (CSF) cytology were inconclusive. Premortal biopsy of lesions in liver and right suprarenal gland showed no further characterized malignancy. He died 6 months after the first occurrence of symptoms. Autopsy of both cases revealed an intravascular lymphomatosis. Tumour cells were seen disseminated in extranodal sites including heart, lung, adrenal gland, spleen, thyroid gland and brain. An intravascular lymphomatosis should be considered when a meningoencephalitic symptomatology is unclear. A biopsy of different organs including the brain and leptomeninges should not be delayed to ensure ante mortem diagnosis and to initiate chemotherapy.
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Affiliation(s)
- Charly Gaul
- Neurologische Klinik, Friedrich-Alexander Universität, Erlangen-Nürnberg, Germany; Neurologische Klinik, Martin-Luther-Universität, Halle-Wittenberg, Germany.
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30
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Raidal S, Clark P, Raidal S. Angiotrophic T-Cell Lymphoma as a Cause of Regenerative Anemia in a Horse. J Vet Intern Med 2006. [DOI: 10.1111/j.1939-1676.2006.tb01820.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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31
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Imamura K, Awaki E, Aoyama Y, Kondo S, Horie Y, Ohama E, Nakashima K. Intravascular large B-cell lymphoma following a relapsing stroke with temporary fever: a brain biopsy case. Intern Med 2006; 45:693-5. [PMID: 16778343 DOI: 10.2169/internalmedicine.45.1621] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Keiko Imamura
- Department of Neurology, Institute of Neurological Sciences, Faculty of Medicine, Tottori University, Nishicho, Yonago
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32
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Wong P, Moonie A, Dennett X, Anpalahan M. A case of intravascular lymphomatosis (IVL) presenting as polyneuropathy. Eur J Intern Med 2006; 17:59-60. [PMID: 16378890 DOI: 10.1016/j.ejim.2005.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Revised: 06/02/2005] [Accepted: 06/02/2005] [Indexed: 11/28/2022]
Abstract
Intravascular lymphomatosis (IVL) is a rare, yet important, cause of a variety of unexplained neurological syndromes. In this clinical context, the only clue to the diagnosis may be a significantly raised plasma lactate dehydrogenase (LDH) on a background of clinical features of a systemic illness.
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Affiliation(s)
- Phillip Wong
- General Internal Medicine, Western Hospital, Melbourne, Australia
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33
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Hsu YH, Tseng BY, Shyu WC, Yen PS. Intravascular Lymphomatosis Mimicking Acute Disseminated Encephalomyelitis: A Case Report. Kaohsiung J Med Sci 2005; 21:93-7. [PMID: 15825696 DOI: 10.1016/s1607-551x(09)70284-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We describe the clinical, radiologic, and postmortem findings in a 49-year-old woman with intravascular lymphomatosis. The patient presented with progressive limb weakness followed by progressive disseminated cerebral neurologic symptoms. Disseminated encephalomyelitis was suspected due to the clinical and radiologic findings. Steroid pulse therapy and intravenous immunoglobulin were given but did not help. The patient died of multiple organ failure 3 months after the onset of symptoms. A diagnosis of disseminated intravascular large B-cell lymphomatosis was established based on findings from histopathology and immunohistochemistry studies on autopsy specimens of the brain and other visceral organs collected postmortem.
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Affiliation(s)
- Yung-Hsiang Hsu
- Department of Pathology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
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34
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Ferreri AJM, Campo E, Seymour JF, Willemze R, Ilariucci F, Ambrosetti A, Zucca E, Rossi G, López-Guillermo A, Pavlovsky MA, Geerts ML, Candoni A, Lestani M, Asioli S, Milani M, Piris MA, Pileri S, Facchetti F, Cavalli F, Ponzoni M. Intravascular lymphoma: clinical presentation, natural history, management and prognostic factors in a series of 38 cases, with special emphasis on the ‘cutaneous variant’1. Br J Haematol 2004; 127:173-83. [PMID: 15461623 DOI: 10.1111/j.1365-2141.2004.05177.x] [Citation(s) in RCA: 385] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite its recognition as a distinct, extremely rare entity, no large studies of intravascular lymphoma (IVL) have been reported. The clinico-pathological characteristics of 38 human immunodeficiency virus-negative patients with IVL diagnosed in Western countries were reviewed to better delineate clinical presentation, clinical variants, natural history and optimal therapy. The IVL is an aggressive and usually disseminated disease (Ann Arbor stage IV in 68% of cases) that predominantly affects elderly patients (median age 70 years, range: 34-90; male:female ratio 0.9), resulting in poor Eastern Cooperative Oncology Group Performance Status (ECOG-PS >1 in 61%), B symptoms (55%), anaemia (63%) and high serum lactate dehydrogenase level (86%). The brain and skin are the most common sites of disease. In contrast to previous reports, hepatosplenic involvement (26%) and bone marrow infiltration (32%) were found to be common features in IVL, while nodal disease was confirmed as rare (11% of cases). Patients with disease limited to the skin ('cutaneous variant'; 26% of cases) were invariably females with a normal platelet count, and exhibited a significantly better outcome than the remaining patients, which deserves further investigation. Overall survival was usually poor; however, the early use of intensive therapies could improve outcome in young patients with unfavourable features. ECOG-PS >1, 'cutaneous variant', stage I and chemotherapy use were independently associated with improved survival.
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Affiliation(s)
- Andrés J M Ferreri
- Department of Radiochemotherapy, San Raffaele H Scientific Institute, Milan, Italy
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35
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Ferreri AJM, Campo E, Ambrosetti A, Ilariucci F, Seymour JF, Willemze R, Arrigoni G, Rossi G, López-Guillermo A, Berti E, Eriksson M, Federico M, Cortelazzo S, Govi S, Frungillo N, Dell'Oro S, Lestani M, Asioli S, Pedrinis E, Ungari M, Motta T, Rossi R, Artusi T, Iuzzolino P, Zucca E, Cavalli F, Ponzoni M. Anthracycline-based chemotherapy as primary treatment for intravascular lymphoma. Ann Oncol 2004; 15:1215-21. [PMID: 15277261 DOI: 10.1093/annonc/mdh274] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Optimal therapeutic management of intravascular lymphoma (IVL) lacks precise guidelines. PATIENTS AND METHODS The clinico-pathological features of 38 HIV-negative patients with IVL were reviewed to define efficacy of chemotherapy in these malignancies. Clinical characteristics of 22 patients treated with chemotherapy and of 16 untreated patients were compared in order to understand better the impact and causes of potential patient selection. RESULTS Median age was 70 years (range 34-90), with a male/female ratio of 0.9; 23 (61%) patients had Eastern Cooperative Oncology Group performance status (ECOG-PS) > 1; 21 (55%) had systemic symptoms. Cutaneous lesions and anemia were significantly more common among patients treated with chemotherapy; central nervous system (CNS) and renal involvement were significantly more common among untreated patients. Chemotherapy was associated with a response rate of 59% and a 3-year overall survival of 33 +/- 11%. Five of six patients with CNS involvement received chemotherapy: four of them died early; only one patient, treated with adriamycin, cyclophosphamide, vincristine, methotrexate, bleomycin and prednisolone (MACOP-B) followed by high-dose chemotherapy and autologous stem cell transplantation (ASCT), was alive at 19 months. High-dose chemotherapy supported by ASCT was indicated at diagnosis in another patient (43 years of age, stage I), who was alive at 71 months, and at relapse after cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) in two patients who died early after transplantation. PS < or = 1, disease limited to the skin, stage I, and use of chemotherapy were independently associated with better outcome. CONCLUSIONS Anthracycline-based chemotherapy is the standard treatment for IVL. However, survival is disappointing, with a relevant impact of diagnostic delay and lethal complications. More intensive combinations, containing drugs with higher CNS bioavailability, are needed in cases with brain involvement, and the role of high-dose chemotherapy supported by ASCT should be further investigated in younger patients with unfavorable features.
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Affiliation(s)
- A J M Ferreri
- Department of Radiochemotherapy, San Raffaele H Scientific Institute, Milan, Italy.
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36
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Hoshino A, Kawada E, Ukita T, Itoh K, Sakamoto H, Fujita K, Mantani N, Kogure T, Tamura J. Usefulness of FDG-PET to diagnose intravascular lymphomatosis presenting as fever of unknown origin. Am J Hematol 2004; 76:236-9. [PMID: 15224358 DOI: 10.1002/ajh.20099] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Intravascular lymphomatosis (IVL) is a rare systemic disease characterized by proliferation of lymphoid cells within the lumina of small arteries, veins, and capillaries. Diagnosis requires skin, liver, lung, bone marrow, renal, meningeal, or brain vessel biopsy but is often made only when the illness has progressed or post mortem because early involvement of organs was not evident. We report a case of IVL presenting as fever of unknown origin (FUO). In this case, gallium scintigraphy and computed tomography (CT) showed no evidence of malignancy, whereas (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) showed increased FDG uptake in the sternum, left and right vertebra, humerus, femur, and especially ilium. The diagnosis was made on iliac bone marrow biopsy examination. FDG-PET was useful for the detection of spread of disease in a patient with IVL suffering from FUO.
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Affiliation(s)
- A Hoshino
- Department of General Medicine, Gunma University Hospital, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan.
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37
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Manckoundia P, Rigaud-Royer I, Berthier S, Popitean L, Bonnotte B, Justrabo E, Pfitzenmeyer P, Lorcerie B. Intravascular malignant lymphomatosis diagnosed on a muscular biopsy: a case report. Eur J Intern Med 2004; 15:190-192. [PMID: 15245725 DOI: 10.1016/j.ejim.2004.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2003] [Accepted: 12/18/2003] [Indexed: 11/29/2022]
Abstract
Intravascular malignant lymphomatosis (IML) is characterized by proliferation of malignant lymphoid B cells within the lumens of small vessels. Common symptoms include general weakness and central neurological and cutaneous signs. Only histopathological analysis can confirm the diagnosis. We report on a 69-year-old man hospitalized for general weakness, inflammatory syndrome, and hemophagocytic syndrome (HS). Our observation shows that histopathological signs may be observed on a muscular biopsy without clinical or biological signs of muscular involvement.
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Affiliation(s)
- Patrick Manckoundia
- Service de Médecine Interne Gériatrique Hôpital de Champmaillot CHU, BP 87 909 2 rue Jules Violle, 21079 Dijon Cedex, France
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38
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Baehring JM, Longtine J, Hochberg FH. A new approach to the diagnosis and treatment of intravascular lymphoma. J Neurooncol 2003; 61:237-48. [PMID: 12675317 DOI: 10.1023/a:1022588812415] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In intravascular lymphoma (IVL) tumor cells are initially restricted to vascular lumina. Neurological syndromes predominate and are caused by ischemia as well as tumor infiltration into the nervous system. Ante mortem diagnosis is challenging and frequently impossible. Chemotherapy is effective if started prior to ischemic damage. Over a three year period, we have diagnosed IVL in seven patients. Tissue diagnosis could be accomplished in only three cases. Forthose in whom tissue diagnosis failed we based our diagnosis on clinical presentation, typical magnetic resonance imaging findings, spinal fluid cytopathology, and molecular analyses. Six patients were treated with methotrexate chemotherapy alone or in combination with CHOP. Three patients are in complete remission 9-20 months after initial diagnosis. Another patient achieved a partial response. Two patients died due to progressive disease shortly after initiation of treatment. Grade III toxicity was observed in only 4 of 61 cycles. Based on a small retrospective series of patients, we conclude that methotrexate is a well tolerated and effective agent for the treatment of IVL.
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Affiliation(s)
- Joachim M Baehring
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
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Bush WW, Throop JL, McManus PM, Kapatkin AS, Vite CH, Van Winkle TJ. Intravascular lymphoma involving the central and peripheral nervous systems in a dog. J Am Anim Hosp Assoc 2003; 39:90-6. [PMID: 12549621 DOI: 10.5326/0390090] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 5-year-old, castrated male mixed-breed dog was presented for paraparesis, ataxia, hyperesthesia, and thrombocytopenia of 5 months' duration and recurrent seizures during the preceding 2 weeks. Multifocal neurological, ophthalmological, pulmonary, and cardiac diseases were identified. Magnetic resonance imaging and cerebrospinal fluid analysis supported a tentative diagnosis of neoplastic or inflammatory disease. A computed tomography-guided biopsy provided both cytopathological and histopathological evidence of intravascular lymphoma. The disease progressed despite chemotherapy with prednisone, L-asparginase, and vincristine. Postmortem histopathological examinations suggested intravascular lymphoma in the central and peripheral nervous systems as well as in multiple other organ systems. This is the first description of an antemortem diagnosis and treatment of intravascular lymphoma involving the central nervous system of a dog.
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Affiliation(s)
- William W Bush
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey Street, Philadelphia, Pennsylvania 19104, USA
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Lopez-Yunez A, Vakili S, Witt T, Biller J. Diagnostic conundrum: A young woman with multifocal recurrent cerebral infarctions. J Stroke Cerebrovasc Dis 2002; 11:290-4. [PMID: 17903888 DOI: 10.1053/jscd.2002.129619] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Alfredo Lopez-Yunez
- Department of Neurology, Section of Neuropathology, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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Abstract
Intravascular lymphomatosis, also known as endovascular lymphoma or angiotropic large cell lymphoma, is a rare malignancy typically diagnosed at autopsy. We describe a case in which the diagnosis was made at an early stage. Specific electrodiagnostic findings suggested concomitant polyneuropathy and myopathy. Suspicion of a paraneoplastic syndrome during electrodiagnostic testing prompted muscle biopsy, which revealed myopathy due to the direct infiltration of neoplastic cells. Resultant treatment with a standard chemotherapy regimen not only increased the patient's survival, but also improved neurological function.
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Affiliation(s)
- Melina E Oei
- Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - George H Kraft
- Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Harvey B Sarnat
- Departments of Pathology (Neuropathology) and Pediatrics (Neurology), Cedars-Sinai Medical Center, Los Angeles, California, USA
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Rulli F, Neri A, Bigotti G, Tartaglione R, Cefaro GA, Farinon AM. Primary malignant lymphoma of the saphenous vein. J Vasc Surg 2002; 35:168-71. [PMID: 11802150 DOI: 10.1067/mva.2002.119753] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We herein present a case of primary malignant lymphoma of the saphenous vein. A 72-year-old man suffered from tumor and pain of the anteromedial aspect of the left upper thigh. Local thigh ultrasound scanning and computed tomography revealed a mass within the superior third of the internal saphenous vein. The patient underwent surgical exploration and removal of the saphenous vein between the groin and the upper third of the leg. The resected vessel was surrounded and infiltrated by a whitish, rubbery tissue all along its course. The histologic findings were consistent with high-grade, diffuse, large-cell lymphoma of peripheral B lymphocyte origin, primarily arising in the saphenous vein. Antiactin monoclonal antibodies depicted the venous vascular wall infiltrated by tumor cells, confirming the lymphomatous localization within the saphenous vein. The patient is now alive and free of tumor 10 months after the operation.
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Affiliation(s)
- Francesco Rulli
- Department of Surgery, Tor Vergata University of Rome, c/o Complesso Integrato Columbus, via Muscati 1, 00168 Rome, Italy.
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Al-Shahi R, Warlow CP, Jansen GH, Frijns CJ, van Gijn J. A 59 year old man with progressive spinal cord and peripheral nerve dysfunction culminating in encephalopathy: Edinburgh advanced clinical neurology course, 1999. J Neurol Neurosurg Psychiatry 2001; 71:696-703. [PMID: 11606689 PMCID: PMC1737602 DOI: 10.1136/jnnp.71.5.696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- R Al-Shahi
- Department of Clinical Neurosciences, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK
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