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Puente-Hernandez M, Rivero-de-Aguilar A, Varela-Lema L. Cancer-associated spinal cord infarction: A systematic review and analysis of survival predictors. J Neurol Sci 2023; 446:120580. [PMID: 36764185 DOI: 10.1016/j.jns.2023.120580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 12/09/2022] [Accepted: 01/31/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE The association between spinal cord infarction (SCI) and cancer is an infrequent condition but requires an accurate diagnosis to establish the appropriate treatment. Clinical features and prognosis of cancer-associated SCI have never been assessed. The aim of this systematic review is to describe the characteristics and outcomes of patients with cancer-associated SCI. Illustratively, a case of ovarian cancer-related SCI is presented. MATERIAL AND METHODS Two authors independently analysed three different bibliographic databases looking for cancer-associated SCI case reports and case series. Data regarding age, sex, cardiovascular risk factors (CVRF), history of known cancer, infarction localization, spinal cord syndrome, Zalewski criteria classification, mechanism of ischemia, diagnostic tests, treatment and functional outcome were registered. A statistical analysis was carried out to identify factors related to mortality and survival time. RESULTS A total of 48 articles met the inclusion criteria and 52 patients were identified. The median age was 62 years. The most frequent neoplasm was intravascular large B-cell lymphoma. The median survival time was 17.4 weeks and the cumulative probability of survival at 12 months was 16.3%. In the group of deceased patients there was a higher proportion of malignant neoplasms than in those who survived (94.7% vs. 5.3%, p < 0.01). There were no statistically significant differences in terms of mortality or survival time depending on age, previously known cancer or CVRF. CONCLUSION Cancer-associated SCI entails a poor outcome. Mortality is increased in patients with malignant neoplasm. No other prognosis factors could be identified.
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Affiliation(s)
| | - Alejandro Rivero-de-Aguilar
- Department of Neurology, University Hospital of the Canary Islands, carretera Ofra S/N, La Laguna, Tenerife, Spain
| | - Leonor Varela-Lema
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Praza do Obradoiro, Santiago de Compostela, A Coruña, Spain; Consortium for Biomedical Research in Respiratory Diseases (CIBER de Enfermedades Respiratorias/CibeRes), Av. de Monforte de Lemos 3-5, Madrid, Spain
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2
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ÖZGÜROĞcarLU E, BÜYÜLBABANI N, ÖZGÖROĞcarLU M, BAYKAL C. Generalized telangiectasia as the major manifestation of angiotropic (intravascular) lymphoma. Br J Dermatol 2008. [DOI: 10.1046/j.1365-2133.1997.18621932.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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3
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Sukpanichnant S, Visuthisakchai S. Intravascular Lymphomatosis: A Study of 20 Cases in Thailand and a Review of the Literature. ACTA ACUST UNITED AC 2006; 6:319-28. [PMID: 16507210 DOI: 10.3816/clm.2006.n.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND According to the World Health Organization classification (2001), intravascular large B-cell lymphoma (IVLBCL) is characterized by the presence of lymphoma cells only in the lumina of small vessels. It has not been proven whether IVLBCL is a specific clinicopathologic entity. Intravascular large B-cell lymphoma and other intravascular lymphomatoses (IVLs), including IVL with B-cell phenotype and extravascular growth (B-IVL) and IVL with T-cell phenotype (T-IVL), were compared in a series of cases diagnosed at a single institution and in cases reported in the literature. PATIENTS AND METHODS Twenty cases of IVL diagnosed among 1826 consecutive cases of non-Hodgkin's lymphoma (NHL,1.1%) at Siriraj Hospital included 3 cases of IVLBCL, 14 cases of B-IVL, and 3 cases of T-IVL. In the literature, 102 cases of IVLBCL, 88 cases of B-IVL, and 18 cases of T-IVL were described in sufficient detail to be analyzed. RESULTS All 3 groups were quite similar in clinical manifestations and outcome. Contrary to the previous review of 79 cases of IVL in 1989, blood, marrow, and nodal involvement could be detected in approximately 30% of cases. Patients who received chemotherapy had better survival than patients without treatment (statistically significant in IVLBCL and B-IVL; P < 0.05). Cases with skin involvement had better survival than cases without skin involvement (statistically significantly in T-IVL; P < 0.05). CONCLUSION These results indicate that IVLBCL is not different from B-IVL or T-IVL in a biologic sense, and IVL seems to be better terminology than IVLBCL because it includes the T-cell phenotype that constitutes approximately 9% of cases. Early diagnosis is very important because chemotherapy significantly prolongs survival.
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Affiliation(s)
- Sanya Sukpanichnant
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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4
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Nixon BK, Kussick SJ, Carlon MJ, Rubin BP. Intravascular large B-cell lymphoma involving hemangiomas: an unusual presentation of a rare neoplasm. Mod Pathol 2005; 18:1121-6. [PMID: 15803190 DOI: 10.1038/modpathol.3800397] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report the clinicopathological features of two cases of intravascular large B-cell lymphoma involving cutaneous hemangiomas. The cases were identified from the consultation files of two of the authors. Both patients were women, 64 and 55 years of age, who presented with long-standing cutaneous hemangiomas of the posterior scalp and left shoulder, respectively. The lesions were brought to medical attention by an increase in size and change in color. Biopsies and immunohistochemical evaluation of the hemangiomas revealed extensive involvement by intravascular large B-cell lymphoma. The neoplastic cells were diffusely positive for CD20 in both cases and negative for CD3, pan-cytokeratin (AE1/AE3), epithelial membrane antigen, S-100, Factor VIII-related antigen, CD34 and CD31. Disease was limited to the hemangiomas in both patients. Treatment consisted of chemotherapy (both patients) and adjuvant radiation therapy (one patient). One patient had a recurrence of disease 33 months after initial diagnosis, leading to an autologous stem cell transplant. The other patient is without evidence of disease 27 months after initial diagnosis. Although this is a rare neoplasm, it is important to consider intravascular large B-cell lymphoma in the differential diagnosis of vascular lesions containing intravascular neoplastic cells.
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MESH Headings
- Antigens, CD19/analysis
- Antigens, CD20/analysis
- CD5 Antigens/analysis
- DNA-Binding Proteins/analysis
- Diagnosis, Differential
- Female
- Hemangioma/metabolism
- Hemangioma/pathology
- Hemangioma/therapy
- Humans
- Immunohistochemistry
- Interferon Regulatory Factors
- Leukocyte Common Antigens/analysis
- Lymphoma, B-Cell/metabolism
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Middle Aged
- Neoplasm Recurrence, Local
- Proto-Oncogene Proteins/analysis
- Proto-Oncogene Proteins c-bcl-6
- Transcription Factors/analysis
- Vascular Neoplasms/metabolism
- Vascular Neoplasms/pathology
- Vascular Neoplasms/therapy
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Affiliation(s)
- Brigitte K Nixon
- Department of Anatomic Pathology, University of Washington Medical Center, Seattle, WA 98195, USA
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5
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Albrecht R, Krebs B, Reusche E, Nagel M, Lencer R, Kretzschmar HA. Signs of rapidly progressive dementia in a case of intravascular lymphomatosis. Eur Arch Psychiatry Clin Neurosci 2005; 255:232-5. [PMID: 15565300 DOI: 10.1007/s00406-004-0551-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2003] [Accepted: 09/16/2004] [Indexed: 10/26/2022]
Abstract
Intravascular lymphomatosis (IVL), a rare type of non-Hodgkin's lymphoma, is an uncommon cause of progressive dementia, usually followed by death within a few months of onset of clinical disease. Often this aggressive tumor is only diagnosed at autopsy, because of misleading clinical features mimicking a broad spectrum of syndromes and the absence of circulating lympoma cells in the blood, bone marrow or cerebrospinal fluid in many cases. Here we present IVL in a 78-year-old woman with findings leading to the clinical diagnosis of vascular dementia with sudden beginning and positive 14-3-3 protein in the CSF, commonly reported in Creutzfeldt-Jakob disease (CJD).
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Affiliation(s)
- R Albrecht
- Institute of Neuropathology, LMU Munich, 81377 Munich, Germany
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6
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Abstract
A 9-year-old German Shepherd cross was presented with a history of dyspnoea, decreased activity, episodic collapse and abdominal distention. Cytological examination of thoracic and abdominal fluid demonstrated neoplastic cells, either round or mesenchymal in nature. The dog was found to have a mass in the heart-base region. Exploratory thoracotomy was performed to identify the exact nature of the mass histologically, and to determine if it was the source of neoplastic cells seen in the effusions. Histological diagnosis of the mass was mesothelioma. Postoperatively the dog developed thrombocytopenia, probably immune-mediated, which was treated with prednisone therapy. The dog developed signs of respiratory distress shortly before discharge and, due to its deteriorating condition, was euthanased. A necropsy was performed and tissues were collected for histological examination. The histological diagnosis was angiotropic intravascular lymphosarcoma. Diagnosis of mesothelioma was not confirmed.
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Affiliation(s)
- L Ridge
- Washington State University, Department of Veterinary Clinical Sciences, PO Box 647060, Pullman, Washington 99164-7060, USA
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7
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Anghel G, Petrinato G, Severino A, Remotti D, Insabato L, De Renzo A, Rotoli B, Majolino I. Intravascular B-cell lymphoma: report of two cases with different clinical presentation but rapid central nervous system involvement. Leuk Lymphoma 2003; 44:1353-9. [PMID: 12952229 DOI: 10.1080/1042819031000097393] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Intravascular lymphomatosis (IVL) is a rare large-cell lymphoproliferative disorder characterized by a widespread lymphoma proliferation within the lumen of medium and small vessels, frequently presenting with skin and/or central nervous system (CNS) manifestations. The tumor is of B-cell origin in most cases. Prognosis is poor with a reported median survival of 5-7 months. We describe here two cases of IVL. The first was that of a 55-year-old woman with a large B-cell lymphoma of the leg, successfully treated with conventional chemotherapy (CHT) followed by autologous peripheral stem cell transplantation. At 3 months from the autograft she relapsed with a picture of hemophagocytic syndrome (HPS) and CNS symptoms. She died before any specific treatment, and post-mortem examination revealed the intravascular proliferation of lymphoma B-cells in the brain and bone marrow. The second case was that of a 60-year-old male with CNS involvement at diagnosis. He responded poorly to CHOP-like CHT, and died 2 months after diagnosis and 6 months after onset of symptoms. Failure of CHT at least in some IVL patients may be related to a delay in the initiation of therapy due to non-specific neurological symptoms. Therefore, early diagnosis based upon aggressive attempts immediately followed by adequate therapy may prove beneficial to these patients. In the present report, we performed an extended medline-based review of the published series of patients with IVL.
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Affiliation(s)
- G Anghel
- Hematology and Bone Marrow Transplantation Unit, San Camillo-Forlanini Hospital, Circonvalazione Gianicolense 87, Rome 00152, Italy
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8
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Asagoe K, Fujimoto W, Yoshino T, Mannami T, Liu Y, Kanzaki H, Arata J. Intravascular lymphomatosis of the skin as a manifestation of recurrent B-cell lymphoma. J Am Acad Dermatol 2003; 48:S1-4. [PMID: 12582370 DOI: 10.1067/mjd.2003.112] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Intravascular lymphomatosis (IVL) is a rare type of lymphoma with a poor prognosis. Its distinctive clinical and histopathologic features are generated by the proliferation of neoplastic mononuclear cells within blood vessels. We describe a patient with IVL of the skin as a manifestation of a recurrent diffuse large B-cell lymphoma of ureteral origin. Lymphoma cells were located both within the vessels and the parenchyma in an early cutaneous lesion. After recurrence in the skin, lymphoma cells gradually located only in the vascular lumina. This transition suggests that cells localized within the vessels were selected as a consequence of chemotherapy. Immunohistochemical examination revealed that the expression of surface adhesion molecules of lymphoma cells did not significantly change. The results of polymerase chain reaction revealed that the ureteral and cutaneous tumors were identical in clonality. Our findings suggest that conventional diffuse large B-cell lymphoma can change into IVL.
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Affiliation(s)
- Kenji Asagoe
- Department of Dermatology, Okayama University Medical School, Okayama, Japan.
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9
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10
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Dufau JP, Le Tourneau A, Molina T, Le Houcq M, Claessens YE, Rio B, Delmer A, Diebold J. Intravascular large B-cell lymphoma with bone marrow involvement at presentation and haemophagocytic syndrome: two Western cases in favour of a specific variant. Histopathology 2000; 37:509-12. [PMID: 11122432 DOI: 10.1046/j.1365-2559.2000.00980.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIMS To report two cases of an unusual form of intravascular lymphoma, characterized by bone marrow involvement at presentation with haemophagocytic syndrome. METHODS AND RESULTS We describe the clinicopathological features of two patients with intravascular lymphoma primarily involving bone marrow. Both patients complained only of fever with pancytopenia and reactive haemophagocytic syndrome. Diagnosis was made on bone marrow examination, which showed large tumour cells of B-cell lineage confined within the lumen of sinuses. CONCLUSION These two cases and five previous reports could represent a variant of intravascular lymphoma, characterized by early involvement of bone marrow without dissemination to other organs. This form of intravascular lymphoma, called IVL-HS, seems to be an 'Asian' variant with a high prevalence in Asian people and a very low prevalence in Western countries. At a practical level, bone marrow biopsy may be useful in the diagnosis of intravascular lymphoma when the clinical presentation is restricted to fever of unknown origin with a reactive haemophagocytic syndrome.
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Affiliation(s)
- J P Dufau
- Department of Pathology, Hôpital d'Instruction des Armées Percy, Clamart, France.
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11
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Parrens M, Dubus P, Agape P, Rizcallah E, Marit G, de Mascarel A, Merlio JP. Intrasinusoidal bone marrow infiltration revealing intravascular lymphomatosis. Leuk Lymphoma 2000; 37:219-23. [PMID: 10721790 DOI: 10.3109/10428190009057649] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Intravascular lymphoma is a rare, often fatal disease characterized by a widespread intravascular proliferation of neoplastic lymphoid cells. Dermatological and bizarre neurological manifestations usually predominate. We report a case of intravascular lymphomatosis with an exceptional clinical presentation showing splenomegaly combined with early bone marrow involvement. The diagnosis was made on bone marrow biopsy examination using both immunohistochemistry and molecular biology analysis. We stress the histopathological features of bone marrow involvement by intravascular lymphoma which allow the prompt recognition of this disease. Early systemic chemotherapy, which represents the only chance of remission in such an aggressive disease, can then be initiated.
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Affiliation(s)
- M Parrens
- Laboratoire d'Anatomie et Cytologie Pathologiques, Hôpital du Haut-Lévèque, CHU de Bordeaux, Pessac, France.
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12
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Calamia KT, Miller A, Shuster EA, Perniciaro C, Menke DM. Intravascular Lymphomatosis. RHEUMADERM 1999. [DOI: 10.1007/978-1-4615-4857-7_37] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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13
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Requena L, Sangueza OP. Cutaneous vascular proliferations. Part III. Malignant neoplasms, other cutaneous neoplasms with significant vascular component, and disorders erroneously considered as vascular neoplasms. J Am Acad Dermatol 1998; 38:143-75; quiz 176-8. [PMID: 9486670 DOI: 10.1016/s0190-9622(98)70237-3] [Citation(s) in RCA: 142] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In this third and last part of our review of cutaneous vascular proliferations we include malignant vascular neoplasms and a group of heterogeneous cutaneous neoplasms characterized by a significant vascular component. We also review some disorders that, in our opinion, have been erroneously considered as vascular neoplasms. We review the epidemiologic, histogenetic, clinical, and histopathologic aspects of Kaposi's sarcoma in its four distinctive variants (classic, African-endemic, immunosuppressive drug-associated, and AIDS-associated Kaposi's sarcoma). There is still controversy about whether Kaposi's sarcoma represents a reactive vascular proliferation or a true neoplastic proliferation. In any event, most authors believe that Kaposi's sarcoma does not produce metastatic disease, but rather develops in multifocal fashion. However, Kaposi's sarcoma may cause death, especially in immunosuppressed patients. Epithelioid hemangioendothelioma, Dabska's tumor, and retiform hemangioendothelioma are examples of low-grade angiosarcoma. In contrast, cutaneous angiosarcomas, including the clinical variants of angiosarcoma of face and scalp in elderly patients, angiosarcoma associated with lymphedema, and radiation-induced angiosarcoma are highly aggressive neoplasms with poor prognosis and most patients die within a short period after presentation. A group of benign and relatively frequent cutaneous neoplasms, including multinucleate cell angiohistiocytoma, angiofibroma, angioleiomyoma, angiolipoma, cutaneous angiolipoleiomyoma, and cutaneous angiomyxoma are here covered because of their significant vascular component. Finally, we review briefly a series of cutaneous disorders that have been erroneously considered as vascular neoplasms. Kimura's disease is an inflammatory reactive condition of unknown origin, "benign" angioendotheliomatosis is a reactive intravascular proliferation of endothelial cells that occurs in the skin as a response to a variety of stimuli, "malignant" angioendotheliomatosis is an intravascular lymphoma, and acral pseudolymphomatous angiokeratoma of children (APACHE) is better interpreted as a pseudolymphoma.
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Affiliation(s)
- L Requena
- Department of Dermatology, Fundación Jiménez-Díaz, Universidad Autónoma, Madrid, Spain
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14
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ÖZGÜROĞcar;LU E, BÜYÜLBABANI N, ÖZGÖROĞcar;LU M, BAYKAL C. Generalized telangiectasia as the major manifestation of angiotropic (intravascular) lymphoma. Br J Dermatol 1997. [DOI: 10.1111/j.1365-2133.1997.tb03751.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Rubin MA, Cossman J, Freter CE, Azumi N. Intravascular large cell lymphoma coexisting within hemangiomas of the skin. Am J Surg Pathol 1997; 21:860-4. [PMID: 9236844 DOI: 10.1097/00000478-199707000-00016] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Intravascular lymphomatosis is a rare and peculiar subtype of large cell lymphoma. The authors present the pathologic, clinical, and radiologic findings of a patient with intravascular large cell lymphoma coexisting within hemangiomas of the skin. Initially the lymphoma was clinically confined to the hemangiomas and the patient was closely observed for disease progression. Within 10 months the patient developed disseminated lymphoma involving both adrenals. A clinical remission was achieved, but the patient soon relapsed, and despite further chemotherapy he died with disseminated disease 23 months after the initial diagnosis. This report presents the only known case of an intravascular large cell lymphoma coexisting within a vascular lesion and highlights the potential aggressive nature of intravascular lymphomas.
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Affiliation(s)
- M A Rubin
- Department of Pathology, Georgetown University School of Medicine, Washington, DC 20007, USA
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16
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Abstract
Angiotropic large cell lymphoma is reported in two patients who developed severe metabolic acidosis and unexplained hypotension before death. In addition to the usual multiorgan involvement of the disease, the adrenal glands of both patients were symmetrically enlarged. Histologically, the cortical vessels were engorged and filled with neoplastic lymphoid cells of B-cell lineage, whereas the parenchymal cells were compressed and atrophic. Angiotrophic large cell lymphoma seems to be a distinct and unrecognized cause of primary adrenal insufficiency, and should be included in the differential diagnosis of adrenal hormone deficiency.
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Affiliation(s)
- P Chu
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06520-8070, USA
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17
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Prayson RA. Angiotropic large cell lymphoma: simultaneous peripheral nerve and skeletal muscle involvement. Pathology 1996; 28:25-7. [PMID: 8714265 DOI: 10.1080/00313029600169453] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Angiotropic large cell lymphoma is a rarely encountered disorder characterized by a proliferation of malignant lymphoid cells within vascular lumina. Sites usually affected include the skin and central nervous system, although involvement of multiple other organ symptoms have been described including peripheral nerve and skeletal muscle. Simultaneous involvement of both skeletal muscle and peripheral nerve has rarely been reported. In most of those cases the diagnosis was made only at the time of autopsy. A case of an elderly male with angiotropic large cell lymphoma and in whom the diagnosis was made antemortem on a peripheral nerve and skeletal muscle biopsy is reported.
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Affiliation(s)
- R A Prayson
- Department of Anatomic Pathology, Cleveland Clinic Foundation, Ohio, USA
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18
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Abstract
Intravascular lymphomatosis is a rare fatal neoplasm characterized by malignant cells of lymphocytic lineage producing vascular occlusions. The cerebral vasculature is particularly affected. Two patients seen at our institution presented with progressive neurologic deficits including dementia, hemiparesis and myelopathy. Review of an additional 64 reported cases with neurologic involvement indicates that patients developed intermittent fevers, an encephalopathy ranging from acute disorientation to rapidly progressive dementia, and focal signs such as hemiparesis and myelopathy. Common laboratory abnormalities include elevated cerebrospinal fluid protein and a lymphocytic pleocytosis, elevated blood erythrocyte sedimentation rate and serum lactate dehydrogenase. Malignant cells are rarely seen in cerebrospinal fluid, blood or bone marrow. Neuroimaging is usually abnormal with parenchymal lesions seen on cerebral tomography and magnetic resonance imaging along with an occasional meningeal pattern of contrast enhancement. Treatment with corticosteroids, chemotherapy, radiation therapy, or plasmapheresis provided limited benefit. Intravascular lymphomatosis should be considered in the differential diagnosis of unexplained progressive encephalopathy with superimposed focal deficits.
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Affiliation(s)
- J E Chapin
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, USA
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19
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al-Chalabi A, Sivakumaran M, Holton J, West KP, Wood JK, Abbott RJ. A case of intravascular malignant lymphomatosis (angiotropic lymphoma) with raised perinuclear antineutrophil cytoplasmic antibody titres--a hitherto unreported association. CLINICAL AND LABORATORY HAEMATOLOGY 1994; 16:363-9. [PMID: 7736714 DOI: 10.1111/j.1365-2257.1994.tb00436.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- A al-Chalabi
- Department of Neurology, Leicester Royal Infirmary, UK
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20
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Abstract
BACKGROUND Intravascular lymphoma (IVL) is an uncommon malignancy defined pathologically by neoplastic proliferation of lymphoid cells within the lumens of capillaries, small veins, and arteries, with little or no adjacent parenchymal involvement. The nature of IVL has been the subject of considerable controversy. Recent immunohistochemical studies have demonstrated clearly that the tumors bear the immunophenotype of neoplastic lymphoid cells of either B-cell or T-cell lineage. IVL commonly affects the central nervous system, resulting in progressive dementia and multiple neurologic deficits; skin is the second most common site of involvement, in the form of cutaneous plaques and nodules. METHODS In a retrospective review of all cases of non-Hodgkin's lymphoma seen at our institution, four cases of IVL were identified. Case 1 was fixed in methacarin, and Cases 2-4 were fixed in 10% formalin. Standard fixation, tissue processing, sectioning, and hematoxylin and eosin staining were used. Immunophenotypic studies were performed using a modified avidin-biotin complex technique. The specimen in Case 1 was stained by Giemsa stain using standard techniques. RESULTS Four cases of IVL are presented. One patient experienced hypoxemia and fevers of unknown origin; the second, dementia and a vasculitislike illness; the third rapidly progressive dementia, nonlocalizing neurologic deficits, and panhypopituitarism; the fourth Kaposi-like skin lesions. Case 1 relapsed shortly after completing chemotherapy. Salvage chemotherapy has yielded good initial response. Autopsy findings in cases 2, 3 and 4 confirmed IVL in many vessels, including the brain, lung, liver, heart, gastrointestinal tract, glomerulus, central nervous system, and skin. Malignant lymphoid cells marked as B-cells in all cases. CONCLUSIONS Unusual and interesting clinical presentations may occur in patients with IVL. The medical literature indicates that few cases are diagnosed ante mortem. Although isolated patients may respond favorably to chemotherapy, most will deteriorate rapidly and the diagnosis of IVL not contemplated until necropsy.
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Affiliation(s)
- T Demirer
- Division of Oncology, Virginia Mason Medical Center, Seattle, WA 98111
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21
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Liszka U, Drlicek M, Hitzenberger P, Machacek E, Mayer H, Stockhammer G, Grisold W. Intravascular lymphomatosis: a clinicopathological study of three cases. J Cancer Res Clin Oncol 1994; 120:164-8. [PMID: 8263013 DOI: 10.1007/bf01202196] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In patients with intravascular lymphomatosis (IL) a broad spectrum of neuro-psychiatric disorders including dementia, focal neurological signs and seizures has been reported. Clinical diagnosis is difficult since neuroimaging findings are nonspecific. The clinical histories, biopsy and autopsy findings of three patients with IL, one with brain biopsy, are described. Two of them presented with rapidly progressive, fluctuating dementia. The third patient suffered from seizures followed by aphasia. Histology revealed large-cell lymphoma of the B cell type. The prognosis of IL, in general, is poor.
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Affiliation(s)
- U Liszka
- Department of Pathology and Bacteriology, Psychiatric Hospital Baumgartner Hoehe, Vienna, Austria
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22
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Abstract
BACKGROUND Intravascular lymphomatosis (IL) is a systemic neoplasm that often involves the nervous system, inducing progressive neurologic deficits in the setting of undiagnosed or quiescent extranodal non-Hodgkin lymphoma. METHODS The clinical and pathologic files of the Massachusetts General Hospital and New York University Medical Center and the English language literature were reviewed to identify all reports of intravascular lymphomatosis (angioendotheliomatosis) or other examples of a diffuse proliferation of neoplastic cells filling capillaries, arterioles, and venules. RESULTS The authors report seven patients with IL and note 114 patients reported in the literature. Almost two-thirds (63%) of patients had neurologic manifestations, without abnormalities on bone marrow biopsy, chest and abdominal tomographic examinations for adenopathy, and cerebrospinal fluid (CSF) analysis. All patients had one or more of four syndromes, each reflecting a vascular occlusive process: progressive, multifocal cerebrovascular events; paraparesis, pain, and incontinence; a subacute encephalopathy; and peripheral or cranial neuropathies. CONCLUSIONS The unexplained presence of any one or more of these neurologic syndromes should alert the physician to the possible presence of this disease.
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Affiliation(s)
- J Glass
- Department of Neurology, Temple University Health Sciences Center, Philadelphia, Pennsylvania 19140
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23
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Miyata T, Fujimoto Y, Fukushima M, Torisu M, Tanaka M. Spontaneous rupture of splenic angiosarcoma: a case report of chemotherapeutic approach and review of the literature. Surg Today 1993; 23:370-4. [PMID: 8318793 DOI: 10.1007/bf00309058] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Angiosarcoma of the spleen is a rare disease, and the prognosis of this disease is extremely unfavorable. We herein review the case of a 45-year-old Japanese woman, who received a combined chemotherapy with cyclophosphamide, Adriamycin, vincristine, and prednisone after splenectomy and experienced a good response. The various types of chemotherapy for this disease are also discussed with references to the above case because no effective chemotherapeutic protocol for angiosarcomas has yet to be established.
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Affiliation(s)
- T Miyata
- Itoda Hospital, Itoda, Fukuoka, Japan
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24
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Setoyama M, Mizoguchi S, Orikawa T, Tashiro M. A case of intravascular malignant lymphomatosis (angiotropic large-cell lymphoma) presenting memory T cell phenotype and its expression of adhesion molecules. J Dermatol 1992; 19:263-9. [PMID: 1644950 DOI: 10.1111/j.1346-8138.1992.tb03223.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A case of intravascular malignant lymphomatosis (angiotropic large cell lymphoma), T cell type was reported. The patient, a 59-year-old woman, had reddish or violaceous indurated macules scattered over the entire body surface. Neither lymphadenopathy nor hepatosplenomegaly was recognized. A chest Roentgenogram, whole body CT scan, and 67Ga-citrate scintigraphy yielded normal findings. Serum anti-HTLV-1 antibody was negative. Histopathologically, lesions showed intravascular large mononuclear cell proliferation associated with occasional fibrin thrombi formation in the dermis to subcutis. Immunohistochemically, the large mononuclear cell immuno-phenotype had a memory T cell character. Also, both lymphocyte function-associated antigen-1s, CD11a and CD18, and intercellular adhesion molecule-1 were demonstrated on the tumor cells and vascular walls in the lesions. To our knowledge, the present case is the fourth case of intravascular malignant lymphomatosis in the T cell lineage.
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Affiliation(s)
- M Setoyama
- Department of Dermatology, Faculty of Medicine, Kagoshima University, Japan
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25
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Usuda H, Homma K, Nemoto K, Ohnishi Y. Non-Hodgkin's lymphoma with histological features of neoplastic angioendotheliosis. ACTA PATHOLOGICA JAPONICA 1992; 42:272-8. [PMID: 1609614 DOI: 10.1111/j.1440-1827.1992.tb02541.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Three cases of non-Hodgkin's lymphoma, B-cell type, identical histologically to so-called neoplastic angioendotheliosis (NAE), are reported. All showed a rapidly progressive clinical course and were not properly diagnosed before death. The lymphoma cells were distributed in many vessels of systemic organs with a tendency to form aggregates. The primary sites in the three cases were probably the adrenal gland, lymph node, and spleen, respectively. In particular, in one case it was suggested that the lymphoma cells had spread from the adrenal tumor to other organs, showing the histological features of NAE. In the literature, the primary sites of NAE have been scarcely mentioned. However, gross tumors were present in some cases. In such cases, it is possible that the tumors could be the primary sites of NAE. We conclude that some non-Hodgkin's lymphomas can exhibit the features of NAE during their course, particularly in the terminal stages.
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Affiliation(s)
- H Usuda
- Second Department of Pathology, Niigata University School of Medicine, Japan
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26
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López-Gil F, Roura M, Umbert I, Umbert P. Malignant proliferative angioendotheliomatosis or angiotropic lymphoma associated with a soft-tissue lymphoma. J Am Acad Dermatol 1992; 26:101-4. [PMID: 1732314 DOI: 10.1016/0190-9622(92)70015-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We report a 63-year-old man with violaceous nummular patches on the trunk. Histopathologic studies were consistent with a diagnosis of malignant angioendotheliomatosis or angiotropic lymphoma. Immunohistochemical study of skin was positive for UCHL-1 antigen and leukocyte common antigen and negative for L-26, Ulex europaeus lectin I, vimentin, cytokeratin, and epithelial membrane antigen. Ultrastructural study ruled out an endothelial origin of the neoplastic cells. These data confirmed the diagnosis of malignant proliferative angioendotheliomatosis. Five years before, a soft tissue lymphoma had been excised. This is an unusual case of malignant angioendotheliomatosis for the following two reasons: (1) a previous association with a soft tissue lymphoma and (2) the rarely described T immunophenotype of neoplastic lymphoid cells.
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Affiliation(s)
- F López-Gil
- Dermatology Department, Hospital Sagrado Corazón-Q.S.A., Barcelona, Spain
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27
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28
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Abstract
Disseminated intravascular coagulopathy (DIC) occurred in a patient with hemolytic anemia and anasarca. Skin and muscle biopsy showed intravascular lymphomatosis (malignant angioendotheliomatosis). Combination chemotherapy resulted in resolution of the DIC and anasarca. After an unmaintained 8-month clinical remission, the patient had central nervous system relapse and died. Malignant angioendotheliomatosis is a rare disorder that should be considered among the occult causes of DIC.
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Affiliation(s)
- R L Stahl
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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29
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Drlicek M, Grisold W, Liszka U, Hitzenberger P, Machacek E. Angiotropic lymphoma (malignant angioendotheliomatosis) presenting with rapidly progressive dementia. Acta Neuropathol 1991; 82:533-5. [PMID: 1785263 DOI: 10.1007/bf00293391] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
An 87-year-old male presented with rapidly progressive dementia, disorder of consciousness and myoclonus, suggesting Creutzfeldt-Jakob disease, but with nonspecific EEG and negative CT findings. Autopsy revealed a malignant angiotropic lymphoma with accumulation of tumor cells within small vessels of the brain and visceral organs. Immunohistochemistry disclosed a large cell lymphoma of B cell type.
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Affiliation(s)
- M Drlicek
- Pathologisch-bakteriologisches Institut, Psychiatrisches Krankenhaus, Wien, Austria
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30
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Smadja D, Mas JL, Fallet-Bianco C, Meyniard O, Sicard D, de Recondo J, Rondot P. Intravascular lymphomatosis (neoplastic angioendotheliosis) of the central nervous system: case report and literature review. J Neurooncol 1991; 11:171-80. [PMID: 1744685 DOI: 10.1007/bf02390177] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
A 63-year-old woman developed gradual slowness, recurrent multifocal deficits, severe constitutional symptoms and hypopituitarism which progressed to death over 2.5 months. Elevation in lactico dehydrogenases was the main biological abnormality. Necropsy showed an intravascular malignant proliferation which proved to be a lymphoma of B-lineage. In order to better define diagnostic criteria, we reviewed previously reported cases of intravascular lymphomatosis of the central nervous system. A strategy for establishing the diagnosis is proposed.
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Affiliation(s)
- D Smadja
- Service de Neurologie, CHS Sainte-Anne, Centre Raymond Garcin, Paris, France
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31
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Tateyama H, Eimoto T, Tada T, Kamiya M, Fujiyoshi Y, Kajiura S. Congenital angiotropic lymphoma (intravascular lymphomatosis) of the T-cell type. Cancer 1991; 67:2131-6. [PMID: 2004333 DOI: 10.1002/1097-0142(19910415)67:8<2131::aid-cncr2820670821>3.0.co;2-i] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The autopsy of a stillborn infant showed an extensive intravascular proliferation of atypical cells throughout the body. There was no infiltration by these cells of the parenchyma of the bone marrow, lymph nodes, or thymus. By histochemistry, these cells were negative for naphthol-ASD-chloroacetate esterase, a marker of granulocytes. By immunohistochemistry, they were reactive with MT-1 and anti-Leu-22, but unreactive with MB-1, L26, anti-Leu-M1, Tü-9, and antihemoglobin antibodies. A few cells reacted with antileukocyte common antigen and UCHL-1. Based on these findings, the lesion was diagnosed as angiotropic lymphoma (intravascular lymphomatosis) of the T-cell type, which occurred congenitally. Most angiotropic lymphomas in the literature are of the B-cell type, and no leukemia virus type I antibody was negative in the mother.
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Affiliation(s)
- H Tateyama
- Department of Pathology, Nagoya City University School of Medicine, Japan
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32
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Fredericks RK, Walker FO, Elster A, Challa V. Angiotropic intravascular large-cell lymphoma (malignant angioendotheliomatosis): report of a case and review of the literature. SURGICAL NEUROLOGY 1991; 35:218-23. [PMID: 1996451 DOI: 10.1016/0090-3019(91)90074-j] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We present a case of angiotropic large-cell lymphoma and review the literature in order to define the neurologic features of this rare disorder. This is the first report of gadolinium-DTPA imaging in angiotropic large-cell lymphoma that demonstrates infarcts of multiple ages, as well as striking meningeal enhancement. Angiotropic large-cell lymphoma should be suspected in patients with clinical evidence of small and large cerebral vessel disease and diagnosis requires skin, liver, renal, meningeal, or brain biopsy. Single modality treatment, using either radiation therapy or steroids, has been ineffective, and new findings of a lymphomatous origin of this neoplasm suggest that combination chemotherapy may be indicated.
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Affiliation(s)
- R K Fredericks
- Department of Neurology, Wake Forest University, Bowman Gray School of Medicine, Winston-Salem, North Carolina 27103
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33
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Stroup RM, Sheibani K, Moncada A, Purdy LJ, Battifora H. Angiotropic (intravascular) large cell lymphoma. A clinicopathologic study of seven cases with unique clinical presentations. Cancer 1990; 66:1781-8. [PMID: 1698530 DOI: 10.1002/1097-0142(19901015)66:8<1781::aid-cncr2820660824>3.0.co;2-5] [Citation(s) in RCA: 126] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The authors recently reported the antigenic phenotypes of three cases of so-called "malignant angioendotheliomatosis" and suggested that angiotropic large cell lymphoma (ALCL) is a more appropriate designation for this disease. The authors now report an additional seven cases of ALCL with unique clinical presentations. One patient presented with prostate enlargement, the second with lytic bone lesions and thickened nasal sinus mucosa, the third had diffuse myalgia, the fourth had dyspnea and pulmonary infiltrates, the fifth had gangrene of the lower extremities, total-body skin involvement, and pancytopenia, the sixth had a lesion of the foreskin mimicking squamous cell carcinoma, and the seventh had a mediastinal mass. In all cases histologic features were characteristic of ALCL with, in two cases, extravascular spread into soft tissue. Immunohistologic studies showed a B-cell phenotype in five cases and a T-cell phenotype in one case. Two patients received combination chemotherapy using established treatment protocol for large cell lymphoma, and remain in complete clinical remission and two patients are responding clinically to combination chemotherapy. Two patients died shortly after receiving combination chemotherapy. One patient has only recently been diagnosed as having ALCL and no long-term follow-up is available. These data indicate that, although ALCL affects predominantly the central nervous system and skin, unusual clinical presentations may occur, and patients with ALCL may respond to combination chemotherapy for large cell lymphoma.
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Affiliation(s)
- R M Stroup
- James Irvine Center for the Study of Leukemia and Lymphoma, City of Hope National Medical Center, Duarte, California
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34
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Sepp N, Schuler G, Romani N, Geissler D, Gattringer C, Burg G, Bartram CR, Fritsch P. "Intravascular lymphomatosis" (angioendotheliomatosis): evidence for a T-cell origin in two cases. Hum Pathol 1990; 21:1051-8. [PMID: 2210728 DOI: 10.1016/0046-8177(90)90255-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Intravascular lymphomatosis (IL) is a rare and potentially fatal multifocal intravascular proliferative disorder, most often involving the skin and the central nervous system. Originally considered an endothelial disorder, IL has recently been reclassified as an angiotropic lymphoma, most often of B-cell origin. We report immunocytochemical and ultrastructural findings in two patients with IL, both representing angiotropic T-cell lymphomas. In one patient, lesional tissue was examined by Southern blot analysis and monoclonal T-cell receptor rearrangement was found. As an additional feature in one patient, a myelosuppressive serum factor was demonstrated in peripheral blood progenitor cell cultures as the cause of underlying chronic anemia and leukopenia; this factor is thought to be a cytokine product of the lymphoma cells.
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MESH Headings
- Aged
- Aged, 80 and over
- Antigens, CD/immunology
- Blotting, Southern
- Cell Transformation, Neoplastic/immunology
- Cell Transformation, Neoplastic/pathology
- Cell Transformation, Neoplastic/ultrastructure
- Endothelium, Vascular/pathology
- Female
- Gene Rearrangement, T-Lymphocyte/immunology
- Hemangioendothelioma/immunology
- Hemangioendothelioma/pathology
- Hemangioendothelioma/ultrastructure
- Humans
- Immunohistochemistry
- Microscopy, Electron
- Neoplasms, Vascular Tissue/immunology
- Neoplasms, Vascular Tissue/metabolism
- Neoplasms, Vascular Tissue/pathology
- Stem Cells/immunology
- Stem Cells/pathology
- Stem Cells/ultrastructure
- T-Lymphocytes/immunology
- T-Lymphocytes/pathology
- T-Lymphocytes/ultrastructure
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Affiliation(s)
- N Sepp
- Department of Dermatology, University of Innsbruck, Austria
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35
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Molina A, Lombard C, Donlon T, Bangs CD, Dorfman RF. Immunohistochemical and cytogenetic studies indicate that malignant angioendotheliomatosis is a primary intravascular (angiotropic) lymphoma. Cancer 1990; 66:474-9. [PMID: 2364360 DOI: 10.1002/1097-0142(19900801)66:3<474::aid-cncr2820660313>3.0.co;2-p] [Citation(s) in RCA: 66] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The authors performed immunohistochemical and cytogenetic studies in a 73-year old man with malignant angioendotheliomatosis. The patient was referred for evaluation of fever of unknown origin, hepatic failure, and neurologic deterioration. Examination of a muscle biopsy revealed numerous, noncohesive atypical mononuclear cells within small vessels. These cells stained positively with a pan-leukocyte marker CD45(PD7/26/16) and with a B-cell marker L26 but negatively with Factor VIII-related antigen, an endothelial cell marker. Peripheral blood obtained before chemotherapy was cultured and analyzed by the G-band method. A new translocation and numerous chromosomal aberrations were identified. The major cell line karyotype was 53,XY, +X, +5q?,-6, +i(6p), +7, -10, +11, -12, +12p-, +12p-, +18, +mar1, +mar2, t(1;3)(p22;p21),3q+,8p+. This is the first cytogenetic study performed in a case of malignant angioendotheliomatosis. Our findings demonstrate that the neoplastic cells in this disorder circulate in the peripheral blood and provide further evidence that malignant angioendotheliomatosis is a diffuse intravascular neoplasm of lymphoid origin. Furthermore, the authors conclude that this malignant lymphoproliferative disorder should be reclassified as a primary intravascular (angiotropic) lymphoma.
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Affiliation(s)
- A Molina
- Department of Medicine (Oncology), Stanford University Medical Center, California 94305
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36
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37
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Abstract
We report four patients who had intravascular lymphomatosis (IVL) that presented as interstitial lung disease. All four patients had progressive shortness of breath, weight loss, fever, and diffuse interstitial infiltrates on chest radiographs. Open lung biopsy samples showed an interstitial pneumonia except for the intravascular proliferation of large lymphoid cells associated with irregular congestion, fibrin microthrombi, and intimal proliferation in vessels. This appearance corresponded to an intravascular large cell lymphoma (malignant angioendotheliomatosis [MAE], angiotropic lymphoma). The differential diagnosis of IVL with other pulmonary lymphoproliferations and intravascular malignancies is reported.
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Affiliation(s)
- S A Yousem
- Department of Pathology, Presbyterian University Hospital University of Pittsburgh School of Medicine, Pennsylvania 15213
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38
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Jalkanen S, Aho R, Kallajoki M, Ekfors T, Nortamo P, Gahmberg C, Duijvestijn A, Kalimo H. Lymphocyte homing receptors and adhesion molecules in intravascular malignant lymphomatosis. Int J Cancer 1989; 44:777-82. [PMID: 2573578 DOI: 10.1002/ijc.2910440505] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Intravascular malignant lymphomatosis (IML) is a highly malignant, recently recognized form of lymphoma. It is characterized by multifocal proliferation of malignant lymphocytes within small blood vessels, primarily in the central nervous system and skin, frequently resulting in circulatory disturbances. The cause of the impaired capability of the malignant lymphocytes to extravasate has remained unclear. We analyzed the presence of immunoreactivity for certain homing receptor and adhesion molecules associated with lymphocyte extravasation in 3 patients with this disease. Compared with non-neoplastic leukocytes, large malignant lymphocytes appeared either negative or only weakly positive for the leukocyte surface glycoprotein, CD18 that is the beta chain of the CDIIa/CD18 complex (lymphocyte-function associated antigen-I, LFA-I), which mediates cell-to-cell adhesion of lymphocytes. On the other hand, antibody to one of the proposed ligands for this complex, intercellular adhesion molecule-I, gave positive reactivity both on lymphocytes and on endothelial cells. Further, the malignant lymphoid cells stained positively with Hermes-3 antibody, which recognizes a common structure of CD44 class of molecules involved in lymphocyte homing. It was also shown that HECA-452 antigen, a marker of high endothelial venules (HEV) supporting lymphocyte extravasation, can be synthesized by an IML patient even at the site of inflammation but it is not prerequisite for extravasation of inflammatory lymphocytes. Our results suggest that the deficiency or absence of the adhesion molecule CDIIa/CD18 may contribute to the inability of the malignant lymphoid cells to extravasate in IML, and perhaps also to the high malignancy of this form of lymphoma.
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Affiliation(s)
- S Jalkanen
- Department of Medical Microbiology, University of Turku, Finland
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39
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Petroff N, Koger OW, Fleming MG, Fishleder A, Bergfeld WF, Tuthill R, Tubbs R. Malignant angioendotheliomatosis: an angiotropic lymphoma. J Am Acad Dermatol 1989; 21:727-33. [PMID: 2808788 DOI: 10.1016/s0190-9622(89)70245-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Malignant angioendotheliomatosis is a rare, systemic, usually fatal disease characterized by massive proliferation of large, neoplastic, mononuclear cells within the lumen of small blood vessels. Recent studies suggested that the tumor cells are of lymphoid origin. We studied two cases of malignant angioendotheliomatosis by Southern blot hybridization analysis that showed rearrangements of the immunoglobulin heavy chain and kappa light chain (case 2), indicating the presence of a monoclonal B cell lymphoma. Our results provide further evidence that malignant angioendotheliomatosis is an angiotropic lymphoma.
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Affiliation(s)
- N Petroff
- Cleveland Clinic Foundation, OH 44106
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40
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Domizio P, Hall PA, Cotter F, Amiel S, Tucker J, Besser GM, Levison DA. Angiotropic large cell lymphoma (ALCL): morphological, immunohistochemical and genotypic studies with analysis of previous reports. Hematol Oncol 1989; 7:195-206. [PMID: 2651272 DOI: 10.1002/hon.2900070303] [Citation(s) in RCA: 110] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The entity 'angioendotheliomatosis proliferans systemisata' was first described 28 years ago as a cutaneous small vessel neoplasm of presumed endothelial origin. Since then, 101 similar cases have been reported under a variety of different names, most with systemic as well as cutaneous lesions, and a lymphoid histogenesis of the tumour cell is now favoured. Review of these cases has shown a characteristic clinical presentation with predominant neurological and dermatological features, although the diagnosis was made at autopsy in 53 per cent of patients. Most therapeutic regimens have proved ineffective with a median survival of 5 months from date of clinical presentation. Aggressive combination chemotherapy can produce complete and lasting remission and a partial response to steroids is sometimes seen. We have examined a case of this condition showing unusual clinical features. Immunohistochemical studies confirm the lymphoid origin of the tumour cells with B cell phenotype. Antigen receptor gene rearrangement studies indicate the presence of the same clonal population of B cells in multiple sites. We suggest that the term 'angioendotheliomatosis proliferans systemisata' should be dropped and support the use of 'angiotropic large cell lymphoma' to describe this unusual condition.
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Affiliation(s)
- P Domizio
- Department of Histopathology, St Bartholomew's Hospital, London, U.K
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41
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Erlandson RA, Filippa DA. Unusual non-Hodgkin's lymphomas and true histiocytic lymphomas. Ultrastruct Pathol 1989; 13:249-73. [PMID: 2660369 DOI: 10.3109/01913128909057444] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
MESH Headings
- Acquired Immunodeficiency Syndrome/complications
- Adolescent
- Adult
- Aged
- Female
- Humans
- Immunohistochemistry
- Lymphoma, Large B-Cell, Diffuse/classification
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/ultrastructure
- Lymphoma, Non-Hodgkin/classification
- Lymphoma, Non-Hodgkin/metabolism
- Lymphoma, Non-Hodgkin/ultrastructure
- Male
- Microscopy, Electron
- Middle Aged
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Affiliation(s)
- R A Erlandson
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021
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42
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Letter to the Case. Pathol Res Pract 1988. [DOI: 10.1016/s0344-0338(88)80069-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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43
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Abe J, Kaneko H, Takagi A, Umezu H. Primary adrenal lymphoma. Report of an autopsy case. ACTA PATHOLOGICA JAPONICA 1988; 38:929-39. [PMID: 3188907 DOI: 10.1111/j.1440-1827.1988.tb02364.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A rare case of malignant lymphoma of the adrenal gland in a 68-year-old male is reported. Autopsy revealed bilateral and symmetrical adrenal tumors (lt: 54 g, rt: 39 g) and almost complete effacement of both adrenal glands, while no tumors were present in other organs or systemic lymph nodes. Both adrenal tumors histologically presented a picture of diffuse malignant lymphoma of mixed cell type. Microscopic involvement in both lungs, spleen, liver, lymph node, bone marrow and both kidneys was found. Immunohistochemically, the positive reactions shown by the lymphoma cells were of B cell type, i.e., observed using antibodies to the leukocyte common antigens, MB-1, LN-1, LN-2 and LN-3, but not by anti-factor VIII-related antigen or MT-1. Examination of peripheral blood obtained just before the patient died showed the presence of 18% atypical cells. This lymphoma was considered to have transformed to a leukemic phase, at least at the end stage. To the author's knowledge, this is the second case of primary adrenal lymphoma to be reported in Japan, and the first case showing formation of bilateral and symmetrical tumors.
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Affiliation(s)
- J Abe
- Department of Pathology, Nagaoka Red Cross Hospital, Japan
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44
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Abstract
Primary lymphoma of the central nervous system (CNS), including reticulum cell sarcoma, microglioma, and histiocytic lymphoma, represents less than 1% of all primary brain tumors. In the last 10 years, this tumor has tripled in frequency in the nonimmunosuppressed population. By 1991, the tumor will be the most common neurological neoplasm by virtue of the increase in sporadic occurrence and in the acquired immunodeficiency syndrome (AIDS) population. Three percent of AIDS patients will develop this tumor either prior to AIDS diagnosis or during their subsequent course. In addition to acquired immunosuppression, patients with inherited disorders (such as Wiskott-Aldrich syndrome, severe combined immunodeficiency, and X-linked immunodeficiency) and other acquired disorders of the immune system are predisposed to the development of CNS lymphoma. Immunological studies have suggested a role for Epstein-Barr virus in the production of this tumor. Although subtypes exist, non-Hodgkin's lymphoma of the CNS most commonly consists of histiocytic cells or large immunoblastic cells bearing B cell surface markers in close proximity to the lateral and third ventricles. Sixty percent of these deposits are multiple, and subarachnoid invasion is seen in one-quarter of patients. Vitreous involvement of the eye occurring prior to and during the course of CNS lymphoma has been noted in up to 25% of patients. The involvement of multiple areas of the neuraxis, the eye, and multiple intracranial sites often occurs in the absence of obvious systemic lymphoma. Therapeutic trials of brain radiation therapy are associated with median survivals of less than 1 year. Uniform complete responses of intracranial deposits are recorded following chemotherapy with high-dose intravenous methotrexate, CHOP (cyclophosphamide, hydroxydaunomycin/doxorubicin, Oncovin (vincristine), and prednisone), high-dose cytosine arabinoside, and intra-arterial methotrexate with barrier modification.
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Affiliation(s)
- F H Hochberg
- Department of Neurology, Massachusetts General Hospital, Boston
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45
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Nakamura T, Watanabe M, Hotchi M, Fujimori N, Mizuno M. Neoplastic angioendotheliomatosis. Report of two autopsy cases with special reference to the origin of atypical cells. ACTA PATHOLOGICA JAPONICA 1987; 37:1337-46. [PMID: 3314333 DOI: 10.1111/j.1440-1827.1987.tb00466.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Two autopsy cases of neoplastic angioendotheliomatosis (NAE) were presented. Both patients were elderly woman, characterized by an ascending progression of transverse myelopathy and abnormal brain shadows similar to metastatic tumor in computer tomographic examination in Case 1, and by typical clinical features of cerebral infarction in Case 2. Postmortem examinations of both cases revealed an exclusive intravascular distribution of large atypical cells in generalized organs, especially in the central nervous system, and associated multiple cerebral infarcts and, in Case 1, widespread demyelination of the spinal cord. There were no distinct lesions suggestive of a primary focus. In both cases only a few atypical cells were immunohistochemically positive for factor VIII-related antigen, likely due to non-specific absorption of serum factor VIII into the cells. On the other hand, almost all of the atypical cells were immunoreactive for LN-1, LN-2, and leukocyte common antigen, suggestive of lymphocytic (B cell) origin.
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Affiliation(s)
- T Nakamura
- Department of Pathology, Shinshu University School of Medicine, Matsumoto, Japan
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46
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Llombart-Bosch A. Letters to the editor. Pathol Res Pract 1987. [DOI: 10.1016/s0344-0338(87)80118-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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47
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Müller KM. Letters to the Case. Pathol Res Pract 1987. [DOI: 10.1016/s0344-0338(87)80117-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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Abstract
Systemic angioendotheliomatosis is a very rare malignant disease characterized by intravascular neoplastic proliferation of reticuloendothelial cells. According to the clinical features three different types of prognostic value can be distinguished: Exclusive skin involvement; Progressive skin lesions disseminating to internal organs; Aggressive and lethal type affecting primarily internal organs. Until now about 60 cases of systemic angioendotheliomatosis have been reported in the literature. Here we describe the first well-documented case with almost isolated lung involvement. The presentation of morphologic and clinical signs and differential-diagnostic considerations are followed by a critical review of the literature.
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49
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Willemze R, Kruyswijk MR, De Bruin CD, Meijer CJ, Van Berkel W. Angiotropic (intravascular) large cell lymphoma of the skin previously classified as malignant angioendotheliomatosis. Br J Dermatol 1987; 116:393-9. [PMID: 2952157 DOI: 10.1111/j.1365-2133.1987.tb05854.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
A 63-year-old female with the classical clinical and histological features of malignant angioendotheliomatosis with disease limited to the skin is reported. Immunohistochemical studies revealed the presence of an intravascular large cell lymphoma of B cell origin. The recent literature regarding the histogenesis and nomenclature of this disease is reviewed.
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50
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Kitagawa M, Tanaka I, Takemura T, Matsubara O, Kasuga T. Angiosarcoma of the scalp: report of two cases with fatal pulmonary complications and a review of Japanese autopsy registry data. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOPATHOLOGY 1987; 412:83-7. [PMID: 3120405 DOI: 10.1007/bf00750735] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Two cases of angiosarcoma of the scalp were reported. The patients were elderly men and died from pulmonary complications, including pneumothorax, pulmonary haemorrhage and pneumonia, associated with metastatic tumours in the lungs. The data recorded from 95 autopsies of patients with angiosarcoma in Japan during 1980-1984 were analyzed. According to the anatomical distribution of the primary tumour, the patients could be subdivided into a scalp group and non-scalp group. In both groups, the most common metastatic site was the lung. The patients of the scalp group had more frequent pulmonary complications such as pneumonia, haemothorax, atelectasis and pneumothorax, when compared with the patients of the non-scalp group. In particular, pneumothorax was observed only in the patients of angiosarcoma of the scalp. The results indicate that angiosarcoma of the scalp tends to metastasize to the lung, especially to the subpleural or surface pleural area and these metastatic tumours are prone to necrosis, causing characteristic pulmonary complications.
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Affiliation(s)
- M Kitagawa
- Second Department of Pathology, Faculty of Medicine, Tokyo Medical and Dental University, Japan
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