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Saka M, Fujimoto M, Mizoguchi K, Tsujimura M, Saeki M, Hirata M, Shibuya S, Odani K, Sakurai T, Yuba Y, Moriyoshi K, Nakajima N, Sumiyoshi S, Kono F, Ono K, Shirase T, Watanabe C, Yoshizawa A, Haga H. Insulin-like Growth Factor II mRNA-binding Protein 3 is a Highly Sensitive Marker for Intravascular Large B-cell Lymphoma: Immunohistochemical Analysis of 152 Pathology Specimens From 88 Patients. Am J Surg Pathol 2024; 48:671-680. [PMID: 38497417 DOI: 10.1097/pas.0000000000002214] [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: 03/19/2024]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare type of aggressive extranodal large B-cell lymphoma characterized by the selective growth of lymphoma cells within the lumina of blood vessels, particularly capillaries. IVLBCL lacks mass formation, and its diagnosis can be challenging. We analyzed the utility of insulin-like growth factor II mRNA-binding protein 3 (IMP3) immunohistochemistry for IVLBCL diagnosis in various organs. Double staining with paired box 5 (PAX5) was performed for validation. Overall, 152 pathological specimens (111 positive and 41 negative for IVLBCL) obtained from 88 patients with a diagnosis of IVLBCL were stained for IMP3 and IMP3/PAX5. As negative controls, 40 pathology specimens from 38 patients with no history of IVLBCL or other B-cell lymphomas were stained for IMP3, which comprised 31 benign pathological specimens from 29 patients in whom malignancy was suspected, 7 cases of appendicitis with intravascular and/or intralymphatic lymphoid proliferations, and 2 cases of intravascular natural killer/T-cell lymphoma. All mononuclear cells with cytoplasmic staining were considered positive for IMP3 expression, but expression restricted to germinal center B cells was excluded from evaluation. All 111 IVLBCL pathological specimens were positive for IMP3 and IMP3/PAX5. In addition, 11 of the 41 specimens originally diagnosed as IVLBCL-negative showed IMP3/PAX5 double-positive cells, raising the suspicion of IVLBCL. However, of the 40 negative control samples, IMP3-positive non-germinal center B cells were detected in only 2 samples ( P = 0.0131) and no intravascular IMP3-positive B cells suspicious for IVLBCL were identified. Altogether, IMP3 immunohistochemistry is a highly sensitive marker of IVLBCL and can be a helpful adjunct for IVLBCL diagnosis.
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Affiliation(s)
- Manduwa Saka
- Department of Diagnostic Pathology, Kyoto University Hospital
| | | | - Kai Mizoguchi
- Department of Diagnostic Pathology, Kyoto University Hospital
| | | | - Miho Saeki
- Department of Diagnostic Pathology, Kyoto University Hospital
| | - Masahiro Hirata
- Department of Diagnostic Pathology, Kyoto University Hospital
| | | | - Kentaro Odani
- Department of Diagnostic Pathology, Osaka Red Cross Hospital
| | - Takaki Sakurai
- Department of Diagnostic Pathology, Osaka Red Cross Hospital
| | - Yoshiaki Yuba
- Department of Pathology, Medical Research Institute, Kitano Hospital
| | - Koki Moriyoshi
- Department of Diagnostic Pathology, National Hospital Organization Kyoto Medical Center
| | - Naoki Nakajima
- Department of Diagnostic Pathology, Toyooka Hospital, Hyogo
| | | | - Fumihiko Kono
- Department of Diagnostic Pathology, Uji-Tokushukai Medical Center, Kyoto
| | - Kazuo Ono
- Department of Diagnostic Pathology, Japanese Red Cross Wakayama Medical Center, Wakayama
| | | | - Chihiro Watanabe
- Department of Diagnostic Pathology, Takatsuki Red Cross Hospital, Osaka
| | - Akihiko Yoshizawa
- Department of Diagnostic Pathology, Kyoto University Hospital
- Department of Diagnostic Pathology, Nara Medical University, Nara
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital
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Enzan N, Kitadate A, Kono M. Optimizing random skin biopsies: a review of techniques and indications for intravascular large B-cell lymphoma. Int J Hematol 2024; 119:619-625. [PMID: 38564093 PMCID: PMC11136846 DOI: 10.1007/s12185-024-03757-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/06/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024]
Abstract
Intravascular large B-cell lymphoma (IVLBCL), a rare subtype of malignant lymphoma, is diagnosed by observation of intravascular proliferation of tumor cells in samples taken from affected organs. However, diagnosis of IVLBCL is usually difficult due to the lack of mass formation. IVLBCL may be fatal when the diagnosis is delayed, so an accurate early diagnosis is the key to successful treatment. Random skin biopsy (RSB), in which specimens are sampled from normal-appearing skin, has been reported as useful. However, the specific method of RSB remains controversial, with individual institutions using either the punch method or the incisional method. Research has shown that the incisional method has higher sensitivity than the punch method. We discuss whether this difference might owe to the collection of punch specimens from an insufficient depth and whether the punch method might result in false negatives. For RSB, we recommend taking specimens not only from normal-appearing skin, but also from any lesional skin, because lesions may reflect micro IVLBCL lesions. To ensure accurate diagnosis, both dermatologists and hematologists should know the proper method of RSB. This review summarizes the appropriate biopsy method and sites for RSB.
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Affiliation(s)
- Naoko Enzan
- Department of Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - Akihiro Kitadate
- Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine, Akita, Japan
| | - Michihiro Kono
- Department of Dermatology and Plastic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
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Pan C, Ma X, Yao Y, Wang C. EBV-Positive Intravascular Large B-Cell Lymphoma of the Small Intestine: A Case Report and Literature Review. Int J Surg Pathol 2024; 32:586-593. [PMID: 37431259 DOI: 10.1177/10668969231183637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare lymphoma that affects the brain, skin, and bone marrow. We describe the case of a 75-year-old man who was admitted to the hospital after 4 h of stomach aches. A thorough physical examination indicated stomach discomfort and skin discoloration. Laboratory tests revealed thrombocytopenia and elevated lactate dehydrogenase levels. A computed tomography scan of the abdomen revealed that the small intestine wall was thickened, edematous, and necrotic. The necrotic small bowel was surgically removed, revealing many little round, homogenous, and unusual cells in the mesenteric vein. In-situ hybridization revealed that these cells were positive for PAX5, CD20, CD79a, CD10, and BCL2, as well as Epstein-Barr virus-encoded small RNA. After 1 week of hospitalization without treatment, the patient was diagnosed with IVLBCL and died of multiple organ dysfunction syndrome. IVLBCL is a rare illness that affects the small intestine and possibly the gastrointestinal system. It has an insidious start, a fast development, and a dismal prognosis. Knowing its clinicopathologic traits helps in understanding the illness, making an early diagnosis, and preventing rapid worsening.
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Affiliation(s)
- Chenglong Pan
- Department of Pathology, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Xiaoling Ma
- Department of Pathology, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Yanfei Yao
- Department of Pathology, Kunming Medical University First Affiliated Hospital, Kunming, China
| | - Chunyan Wang
- Department of Pathology, Kunming Medical University First Affiliated Hospital, Kunming, China
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Roditi E, Panicker S, Fung AT. Intravascular large B-cell lymphoma of the eye: Literature review and new findings. Asia Pac J Ophthalmol (Phila) 2024; 13:100053. [PMID: 38556129 DOI: 10.1016/j.apjo.2024.100053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/03/2024] [Accepted: 01/21/2024] [Indexed: 04/02/2024] Open
Abstract
PURPOSE Intravascular large B-cell lymphoma (IVLBCL) is an extremely rare, aggressive, multi-system disease that can affect the eye. We describe the ophthalmic presentation, multimodal imaging and treatment response of uveal IVLBCL. METHODS Review and case report. RESULTS Twenty-five published cases of IVLBCL involving the eye including our own were identified. Of these, 15 patients (60%) had clinically-detectable intraocular involvement, 6 (24%) had extraocular ophthalmic involvement only and 4 (16%) had subclinical, undiagnosed intraocular involvement that was retrospectively detected on post-mortem ocular histopathology. The male to female ratio was 1.08:1 with a mean presenting age of 65.1 ± 11.7 years (range 38-82 years). The majority of cases had bilateral involvement (21/25 patients, 84%). Extraocular manifestations included diplopia, ptosis and ophthalmoplegia. Intraocular manifestations included serous retinal detachment (13/28, 46%), retinal hemorrhages (9/28, 32%), vascular changes (9/28, 32%), retinal pigment epithelial changes (7/28, 25%), thickened choroid (6/28, 21%), vitritis (5/28, 17%), cotton-wool spots (3/28, 10%), and a subretinal lesion (1/28, 3%). Histopathological diagnosis was most commonly confirmed on post-mortem enucleation (8/25 patients, 32%), skin (6/25 patients, 24%) or brain biopsy (6/25 patients, 24%). CONCLUSION The presence of intra-retinal hemorrhages, cotton wool spots and/or Roth spots help differentiate IVLBCL from other similarly presenting diseases such as central serous chorioretinopathy and Vogt-Koyanagi-Harada disease. New signs not previously described in IVLBCL include macular bacillary layer detachment and hypo-cyanescent spots on ultra-wide field indocyanine green angiography. The diagnosis is elusive and requires tissue biopsy, but systemic chemotherapy and rituximab can lead to rapid improvement of the eye.
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Affiliation(s)
- Eduardo Roditi
- Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Shyam Panicker
- Department of Haematology, Blood Transplant and Cellular Therapies, Westmead Hospital, Sydney, New South Wales, Australia
| | - Adrian T Fung
- Department of Ophthalmology, Westmead Hospital, Sydney, New South Wales, Australia; Westmead and Central Clinical Schools, Specialty of Ophthalmology and Eye Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University Hospital, Sydney, New South Wales, Australia.
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Yamamoto R, Okagaki N, Sakamoto H, Tanaka Y, Takeda A, Maruguchi N, Nakamura S, Matsumura K, Ueyama M, Ikegami N, Kaji Y, Hashimoto S, Tanaka E, Taguchi Y, Maruyama W, Katsuragawa H, Sumiyoshi S, Hajiro T. Intravascular Large B-cell Lymphoma Presenting as Pulmonary Ground-glass Nodules That Progressed Slowly over Several Months with No Overt Symptoms. Intern Med 2024; 63:559-563. [PMID: 37407462 PMCID: PMC10937140 DOI: 10.2169/internalmedicine.2040-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/28/2023] [Indexed: 07/07/2023] Open
Abstract
A 74-year-old man with no overt symptoms was referred for a chest computed tomography (CT) that revealed multiple bilaterally pulmonary ground-glass nodules (GGNs) with subtle changes in size over eight months. Surgical lung biopsies were performed in the left upper lobe. A pathologic study confirmed the intravascular large B-cell lymphoma (IVLBCL). This lesion was a nodule-like cluster of atypical cells, meaning that it had been localized for several months. Pulmonary IVLBCL may form focal lesions presenting as GGN on chest CT and progress slowly without apparent symptoms.
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Affiliation(s)
- Ryo Yamamoto
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | | | | | - Yuuma Tanaka
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | - Atsushi Takeda
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | | | | | | | | | - Naoya Ikegami
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | - Yusuke Kaji
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | | | - Eisaku Tanaka
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | - Yoshio Taguchi
- Department of Respiratory Medicine, Tenri Hospital, Japan
| | | | - Hiroyuki Katsuragawa
- Department of Diagnostic Pathology, Graduate School of Medicine, Kyoto University, Japan
- Department of Clinical Pathology, Tenri Hospital, Japan
| | | | - Takashi Hajiro
- Department of Respiratory Medicine, Tenri Hospital, Japan
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Cox MF, Mackenzie S, Low R, Brown M, Sanchez E, Carr A, Carpenter B, Bishton M, Duncombe A, Akpabio A, Kulasekararaj A, Sin FE, Jones A, Kavirayani A, Sen ES, Quick V, Dulay GS, Clark S, Bauchmuller K, Tattersall RS, Manson JJ. Diagnosis and investigation of suspected haemophagocytic lymphohistiocytosis in adults: 2023 Hyperinflammation and HLH Across Speciality Collaboration (HiHASC) consensus guideline. THE LANCET. RHEUMATOLOGY 2024; 6:e51-e62. [PMID: 38258680 DOI: 10.1016/s2665-9913(23)00273-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/01/2023] [Accepted: 10/04/2023] [Indexed: 01/24/2024]
Abstract
Haemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome characterised by persistently activated cytotoxic lymphocytes and macrophages, which, if untreated, leads to multiorgan dysfunction and death. HLH should be considered in any acutely unwell patient not responding to treatment as expected, with prompt assessment to look for what we term the three Fs-fever, falling blood counts, and raised ferritin. Worldwide, awareness of HLH and access to expert management remain inequitable. Terminology is not standardised, classification criteria are validated in specific patient groups only, and some guidelines rely on specialised and somewhat inaccessible tests. The consensus guideline described in this Health Policy was produced by a self-nominated working group from the UK network Hyperinflammation and HLH Across Speciality Collaboration (HiHASC), a multidisciplinary group of clinicians experienced in managing people with HLH. Combining literature review and experience gained from looking after patients with HLH, it provides a practical, structured approach for all health-care teams managing adult (>16 years) patients with possible HLH. The focus is on early recognition and diagnosis of HLH and parallel identification of the underlying cause. To ensure wide applicability, the use of inexpensive, readily available tests is prioritised, but the role of specialist investigations and their interpretation is also addressed.
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Affiliation(s)
- Miriam F Cox
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Strachan Mackenzie
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ryan Low
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Michael Brown
- Division of Infection, University College London Hospitals NHS Foundation Trust, London, UK
| | - Emilie Sanchez
- Department of Clinical Virology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Aisling Carr
- Centre for Neuromuscular Diseases, National hospital of Neurology and Neurosurgery, London, UK
| | - Ben Carpenter
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mark Bishton
- Department of Haematology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrew Duncombe
- Department of Haematology, University Hospital Southampton, Southampton, UK
| | - Akpabio Akpabio
- Department of Rheumatology, Royal National Hospital for Rheumatic Diseases, Bath, UK
| | | | - Fang En Sin
- Department of Rheumatology, North Bristol NHS Trust, UK
| | - Alexis Jones
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Akhila Kavirayani
- Department of Paediatric Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ethan S Sen
- Department of Paediatric Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Vanessa Quick
- Department of Rheumatology, Bedfordshire Hospitals NHS Trust, Luton, UK
| | - Gurdeep S Dulay
- Department of Rheumatology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Sam Clark
- Department of Critical Care, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kris Bauchmuller
- Department of Critical Care, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rachel S Tattersall
- Department of Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Jessica J Manson
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.
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Jin H, Liao W, Yang S, Peng L, Xing W. Clinical features and imaging manifestations for intravascular large B-cell lymphoma. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2023; 48:1920-1928. [PMID: 38448386 PMCID: PMC10930742 DOI: 10.11817/j.issn.1672-7347.2023.230305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Intravascular large B-cell lymphomas are a rare group of extranodal non-Hodgkin's lymphomas with no apparent specificity of symptoms and often a poor prognosis. This study aims to investigate the clinical features and imaging manifestations of intravascular large B-cell lymphoma, to improve the awareness of clinicians and imaging physicians and to reduce the underdiagnosis and misdiagnosis of this disease. METHODS Five patients with pathologically confirmed intravascular large B-cell lymphoma diagnosed between December 2011 and February 2022 at Xiangya Hospital of Central South University were retrospectively analyzed for clinical features and imaging manifestations. RESULTS The age range for the 5 patients in this paper was 44-72 years at an average of (55.4±11.2) years, 2 were male and 3 were female. There were 4 patients with fever, 3 patients with cough, 3 patients with fatigue, and 2 patients with neurological symptoms. The primary sites of lesions were bilateral adrenal glands (2 cases), liver (1 case), central nervous system (1 case), lung (1 case). Imaging of the corresponding site was performed in 5 cases. When the primary site is the adrenal gland, it appears as bilateral adrenal masses or bilateral adrenal thickening with clear contours. When the primary site is the liver, it appears as a hypodense lesion in the right lobe of the liver with "vascular floating sign". When the primary site is the central nervous system, it appears as multiple tumor-like lesions in the frontal-parietal-occipital lobe, right temporal lobe and bilateral cerebellar hemispheres with multiple hemorrhages within the lesions. When the primary site is the lung, it appears as multiple ground glass shadows and solid changes in both lungs with localized lobular septal thickening. The final pathological diagnosis was intravascular large B-cell lymphoma in all 5 patients, one of whom had a good prognosis after chemotherapy, 2 of whom died within 3 days of discharge, and two of whom were lost to follow-up. CONCLUSIONS Intravascular large B-cell lymphoma can involve multiple tissues and organs, and its prognosis is often poor, and its imaging manifestations possess certain specificity. When this disease is highly suspected, a biopsy of the corresponding organ should be performed as soon as possible to clarify the diagnosis.
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Affiliation(s)
- Hong Jin
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha 410008, China.
| | - Weihua Liao
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha 410008, China
| | - Shuai Yang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha 410008, China
| | - Lushan Peng
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha 410008, China
| | - Wu Xing
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha 410008, China.
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Xu H, Li JC, Lin LJ, Liu XH, Gu T, Zhang XM, Wang XM, Gong T, Xiu JJ. Multiple white matter lesions combined with subcortical microbleeds in patients with intravascular large B-cell lymphoma. Quant Imaging Med Surg 2023; 13:8807-8816. [PMID: 38106330 PMCID: PMC10722021 DOI: 10.21037/qims-23-528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/24/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Han Xu
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jia-Cun Li
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | | | - Xiao-Hui Liu
- Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Tao Gu
- Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiao-Ming Zhang
- Department of Radiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xi-Ming Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Tao Gong
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Jian-Jun Xiu
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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Yanagisawa K, Kameyama A, Miyama H, Mori K, Hattori M, Imamura H, Nitta K. Intravascular Large B-Cell Lymphoma in Acute Hypoxic Respiratory Failure. Case Rep Crit Care 2023; 2023:9192396. [PMID: 37601817 PMCID: PMC10439831 DOI: 10.1155/2023/9192396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/24/2023] [Accepted: 08/02/2023] [Indexed: 08/22/2023] Open
Abstract
Intravascular large B-cell lymphoma, an extranodal large B-cell lymphoma, is a rare hematological malignancy with only a few reports of lung involvement. We report a case of intravascular large B-cell lymphoma with acute hypoxic respiratory failure and interstitial lung disease diagnosed via random skin biopsies. A 54-year-old woman presented with fever, cough, and dyspnea. Computed tomography imaging revealed findings concerning interstitial lung disease. The patient's respiratory status worsened despite the treatment with antibiotics and steroids. Generalized edema and thrombocytopenia also developed. Intravascular large B-cell lymphoma was clinically suspected and ultimately diagnosed by skin biopsy, although she had no apparent skin lesions. The patient's condition considerably improved after chemotherapy. Intravascular large B-cell lymphoma should be considered in patients with acute respiratory failure and interstitial lung lesions.
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Affiliation(s)
- Kei Yanagisawa
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Akiko Kameyama
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Hiroshi Miyama
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Koutarou Mori
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Masao Hattori
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Hiroshi Imamura
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
| | - Kenichi Nitta
- Department of Emergency and Critical Care Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
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Lv Y, Xu L, Liu X, Wang Y. Random Skin Biopsy for Diagnosis of Intravascular Large B-Cell Lymphoma: A Case Report and Literature Review. Am J Dermatopathol 2023; 45:320-322. [PMID: 36939136 DOI: 10.1097/dad.0000000000002406] [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: 03/21/2023]
Abstract
BACKGROUND Intravascular large B-cell lymphoma (IVLBCL) is a rare, aggressive B-cell lymphoma. The heterogeneity of its clinical symptoms makes it hard to be diagnosed. The diagnosis is followed by pathological examination of affected tissues and organs including skin, central nervous system, and bone marrow. Random skin biopsy (RSB) with high sensitivity and less invasiveness becomes a common method for diagnosis in suspected patients without skin lesions. CASE REPORT We reported the case of a 67-year-old man who complained of fever, dizziness, unsteady gait, numbness in both lower extremities, and incontinence. Blood routine examination suggested elevated levels of lactate dehydrogenase. Enhanced magnetic resonance imaging of the head and thoracolumbosacral spine, next-generation sequencing in blood, cerebrospinal fluid collection, bone marrow aspiration, and positron emission tomography-computed tomography presented no evidence of solid tumors. However, there were intravascular tumor cell growth and morphosis as determined by RSB. CD20, CD79a, CD5, BCL-6, and BCL-2 were positive as tested by immunohistochemistry, and Ki-67 showed high proliferative activity. Taking the medical history as an element, the patient received a diagnosis of IVLBCL. After he completed 3 cycles of RCDOP + orelabrutinib, his general condition improved. CONCLUSION IVLBCL is an aggressive, lethal cancer that is difficult to diagnose; therefore, it is recommended for the suspected patients to receive RSB promptly and early treatment at the earliest opportunity to achieve amelioration in prognosis.
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Affiliation(s)
- Yuanjie Lv
- Department of Infection, Xinchang Hospital of Traditional Chinese Medicine, Shaoxing City, Zhejiang Province, China; and
| | - Lingen Xu
- Intensive Care Unit, Xinchang Hospital of Traditional Chinese Medicine, Shaoxing City, Zhejiang Province, China
| | - Xiaoping Liu
- Department of Infection, Xinchang Hospital of Traditional Chinese Medicine, Shaoxing City, Zhejiang Province, China; and
| | - Yaling Wang
- Intensive Care Unit, Xinchang Hospital of Traditional Chinese Medicine, Shaoxing City, Zhejiang Province, China
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Mattei C, Oevermann A, Schweizer D, Guevar J, Maddox TW, Fleming KL, Ricci E, Rosati M, Biserni R, Iv JFG, Rupp A, Gutierrez-Quintana R, Masseau I, Newkirk KM, Hecht S, Specchi S. MRI ischemic and hemorrhagic lesions in arterial and venous territories characterize central nervous system intravascular lymphoma in dogs. Vet Radiol Ultrasound 2023; 64:294-305. [PMID: 36329600 DOI: 10.1111/vru.13165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 08/02/2022] [Accepted: 08/06/2022] [Indexed: 11/06/2022] Open
Abstract
Intravascular lymphoma (IVL) is characterized by the proliferation of large malignant lymphocytes within the lumen of blood vessels. This retrospective, multi-center, case series study aimed to describe the MRI features of confirmed central nervous system IVL in dogs and compare them with histopathological findings. Medical record databases from seven veterinary centers were searched for cases of histologically confirmed IVL. Dogs were included if an MRI was performed. The MRI studies and histopathology samples were reviewed to compare the MRI changes with the histopathological findings. Twelve dogs met the inclusion criteria (12 brains and three spinal cords). Imaging of the brains revealed multifocal T2-weighted/FLAIR hyperintense and T1-weighted iso-hypointense lesions, with variable contrast enhancement; areas of abnormal diffusion both in arterial and venous territories in diffusion-weighted imaging; and meningeal enhancement. On gradient echo images (GRE), the changes comprised tubular susceptibility artifacts, consistent with the "susceptibility vessel sign", and additional variably sized/shaped intraparenchymal susceptibility artifacts. Spinal cord lesions presented as fusiform T2-weighted hyperintensities with scattered susceptibility artifacts on GRE and variable parenchymal and meningeal contrast enhancement. On histopathology, subarachnoid hemorrhages and neuroparenchymal areas of edema and necrosis, with or without hemorrhage, indicating ischemic and hemorrhagic infarctions, were found. These lesions were concurrent with severely dilated meningeal and parenchymal arteries and veins plugged by neoplastic lymphocytes and fibrin. Due to the unique angiocentric distribution of IVL, ischemic and hemorrhagic infarcts of variable chronicity affecting both the arterial and venous territories associated with thrombi formation can be detected on MRI.
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Affiliation(s)
- Chiara Mattei
- Diagnostic Imaging Department (Mattei, Specchi) and Neurology Department (Biserni), Ospedale Veterinario "I Portoni Rossi", Anicura Italy, Zola Predosa, Italy
| | - Anna Oevermann
- Division of Neurological Sciences, Department of Clinical Research and Veterinary Public Health (Oevermann), Division of Clinical Radiology, Department of Clinical Veterinary Medicine (Schweizer), Division of Small Animal Surgery, Department of Clinical Veterinary Sciences (Guevar), Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Daniela Schweizer
- Division of Neurological Sciences, Department of Clinical Research and Veterinary Public Health (Oevermann), Division of Clinical Radiology, Department of Clinical Veterinary Medicine (Schweizer), Division of Small Animal Surgery, Department of Clinical Veterinary Sciences (Guevar), Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Julien Guevar
- Division of Neurological Sciences, Department of Clinical Research and Veterinary Public Health (Oevermann), Division of Clinical Radiology, Department of Clinical Veterinary Medicine (Schweizer), Division of Small Animal Surgery, Department of Clinical Veterinary Sciences (Guevar), Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | - Thomas W Maddox
- Department of Musculoskeletal and Ageing Sciences- Institute of Life Course and Medical Science- Faculty of Health & Life Sciences (Maddox), Department of Veterinary Science- School of Veterinary Science (Fleming), Department of Veterinary Anatomy- Physiology and Pathology- Institute of Infection- Veterinary and Ecological Sciences (Ricci), University of Liverpool, Neston, UK
| | - Kathryn L Fleming
- Department of Musculoskeletal and Ageing Sciences- Institute of Life Course and Medical Science- Faculty of Health & Life Sciences (Maddox), Department of Veterinary Science- School of Veterinary Science (Fleming), Department of Veterinary Anatomy- Physiology and Pathology- Institute of Infection- Veterinary and Ecological Sciences (Ricci), University of Liverpool, Neston, UK
| | - Emanuele Ricci
- Department of Musculoskeletal and Ageing Sciences- Institute of Life Course and Medical Science- Faculty of Health & Life Sciences (Maddox), Department of Veterinary Science- School of Veterinary Science (Fleming), Department of Veterinary Anatomy- Physiology and Pathology- Institute of Infection- Veterinary and Ecological Sciences (Ricci), University of Liverpool, Neston, UK
| | - Marco Rosati
- Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität, Munich, Germany
| | - Roberta Biserni
- Diagnostic Imaging Department (Mattei, Specchi) and Neurology Department (Biserni), Ospedale Veterinario "I Portoni Rossi", Anicura Italy, Zola Predosa, Italy
| | - John F Griffin Iv
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA
| | - Angie Rupp
- Small Animal Hospital (Gutierrez-Quintana), Division of Pathology, Public Health and Disease Investigation (Rupp), School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Rodrigo Gutierrez-Quintana
- Small Animal Hospital (Gutierrez-Quintana), Division of Pathology, Public Health and Disease Investigation (Rupp), School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Isabelle Masseau
- Department of Clinical Sciences, Faculty of Veterinary Medicine, University of Montreal, Saint-Hyacinthe, Quebec, Canada
| | - Kimberly M Newkirk
- Department of Biomedical and Diagnostic Sciences (Newkirk), Department of Small Animal Clinical Sciences (Hecht), University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, USA
| | - Silke Hecht
- Department of Biomedical and Diagnostic Sciences (Newkirk), Department of Small Animal Clinical Sciences (Hecht), University of Tennessee College of Veterinary Medicine, Knoxville, Tennessee, USA
| | - Swan Specchi
- Diagnostic Imaging Department (Mattei, Specchi) and Neurology Department (Biserni), Ospedale Veterinario "I Portoni Rossi", Anicura Italy, Zola Predosa, Italy
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12
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Aggressive Cutaneous Lymphomas and Their Mimics. Surg Pathol Clin 2023; 16:361-383. [PMID: 37149363 DOI: 10.1016/j.path.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Cutaneous lymphomas encompass a heterogeneous group of neoplasms with a wide spectrum of clinical presentations, histopathologic features, and prognosis. Because there are overlapping pathologic features among indolent and aggressive forms and with systemic lymphomas that involve the skin, clinicopathologic correlation is essential. Herein, the clinical and histopathologic features of aggressive cutaneous B- and T-cell lymphomas are reviewed. Indolent cutaneous lymphomas/lymphoproliferative disorders, systemic lymphomas, and reactive processes that may mimic these entities are also discussed. This article highlights distinctive clinical and histopathologic features, increases awareness of rare entities, and presents new and evolving developments in the field.
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13
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Sánchez-Vicente JL, De Las Morenas-Iglesias J, Franco-Ruedas C, Rueda-Rueda T, Moruno-Rodríguez A, Lechón-Caballero B, Romero-Martínez A, Del Estad-Caballero A, González-Jauregui B, Cabrera-Pérez R, López-Herrero F. Ocular Involvement in a Patient with Intravascular Large B-Cell Lymphoma: A Diagnostic Challenge. Clinical Case Report and Literature Review. Ocul Immunol Inflamm 2023:1-8. [PMID: 36745689 DOI: 10.1080/09273948.2022.2103712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 05/30/2022] [Accepted: 07/14/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE To describe the ophthalmic findings and diagnosis of a case of intravascular large B-cell lymphoma. METHODS Clinical case observational report. CLINICAL CASE A Spanish 51-year-old man referred to our hospital with a diagnosis of panuveitis. The patient presented with blurred vision, photophobia, fever, and weight loss. Ocular examination revealed anterior uveitis, vitritis, and multiple round and oval creamy spots on the posterior pole. Fluorescein angiography, optical coherence tomography (OCT), and angio-OCT were used for the ocular examination. The diagnosis of lymphoma was formulated on the basis of a random normal skin biopsy, which showed significant CD20 cellularity within the vessels and extensive CD3 expression. CONCLUSIONS Intravascular lymphoma is a rare form of extranodal diffuse large B-cell lymphoma, often with delayed diagnosis because of the nonspecific symptoms. Hence, random skin biopsy could be useful in the diagnosis.
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Affiliation(s)
| | | | | | - Trinidad Rueda-Rueda
- Department of Ophthalmology, Virgen Del Rocío University Hospital, Seville, Spain
| | | | | | | | | | | | - Rocío Cabrera-Pérez
- Department of Anathomical Pathology, Virgen Del Rocío University Hospital, Seville, Spain
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14
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SALEEM KAINAT, NASRAZADANI AZADEH, KUANG CHAOYUAN, JAITLY VANYA, HO JONHAN, RAPTIS ANASTASIOS, SMITH ROY, SEAMAN CRAIG. Intravascular Lymphoma - The Creepy Crawler: A Case Series and Brief Literature Review. CANCER DIAGNOSIS & PROGNOSIS 2023; 3:31-37. [PMID: 36632582 PMCID: PMC9801442 DOI: 10.21873/cdp.10176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/14/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of extranodal B-cell lymphoma, which has traditionally been associated with poor outcomes. Despite increasing recognition, IVLBCL requires a high degree of clinical suspicion on the part of the clinician for its diagnosis. CASE SERIES We present four patient cases: A 69-year-old female with constitutional symptoms and cognitive decline; a 78-year-old female with kidney injury and constitutional symptoms whose disease rapidly progressed to multiorgan failure and death; a 70-year-old asymptomatic female with an incidentally found, enlarged thyroid; and a 63-year-old male with cytopenia and constitutional symptoms. Retrospective chart analysis was performed on these four patients diagnosed with IVLBCL at our Institute to identify the pathognomonic features of the disease and compare these to the published evidence. IVLBCL has a heterogeneous presentation, as seen in our four patients. The disease is characterized by the exclusive presence of malignant cells inside the blood vessels and lack of organ infiltration. Traditional preliminary diagnostic modalities such as imaging are usually inconclusive, given the paucity of lymphomatous aggregates. A bone marrow biopsy, random skin biopsies, or a focal organ biopsy in appropriate cases is required for diagnosis. Immunosuppression might play a role in the pathogenesis. Timely initiation of aggressive cancer-directed therapy was associated with improved outcomes. Monitoring for disease response and relapse continues to be a challenge. CONCLUSION Our mini-series highlights the significance of timely diagnosis and intervention in IVLBCL and emphasizes the importance of further research to determine its association with immunosuppression.
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Affiliation(s)
- KAINAT SALEEM
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, U.S.A
| | - AZADEH NASRAZADANI
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, U.S.A
| | - CHAOYUAN KUANG
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, U.S.A
| | - VANYA JAITLY
- Division of Hematopathology, Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, U.S.A
| | - JONHAN HO
- Division of Dermatopathology, Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, PA, U.S.A
| | - ANASTASIOS RAPTIS
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, U.S.A
| | - ROY SMITH
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, U.S.A
| | - CRAIG SEAMAN
- Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, U.S.A
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15
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Ridha Z, Zargham H, Chergui M, Netchiporouk E. Intravascular diffuse large B-cell lymphoma with acquired ichthyosis: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231163630. [PMID: 37025247 PMCID: PMC10071209 DOI: 10.1177/2050313x231163630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Intravascular diffuse large B-cell lymphoma is an exceedingly rare subtype of B-cell lymphomas. This cancer is often associated with poor prognosis and can be lethal if left untreated. Intravascular diffuse large B-cell lymphoma is divided into three variants: the 'classical variant', the hemophagocytic syndrome-associated variant or 'Asian variant', and the 'cutaneous variant', according to the clinical presentation and affected organs. We present a unique case of 'classic variant' intravascular diffuse large B-cell lymphoma with cutaneous findings, peripheral nervous system involvement and acquired ichthyosis in a patient of Asian descent. This case highlights the importance of a prompt dermatology consultation in the diagnosis of intravascular diffuse large B-cell lymphoma. As bone marrow biopsy is often negative, clinicians must recognize the cutaneous findings and acknowledge that skin biopsy can be an essential tool to establish the diagnosis rapidly. Additional finding making this case unique is the concurrent presence of acquired ichthyosis, which has only been previously reported in one case of intravascular diffuse large B-cell lymphoma.
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Affiliation(s)
- Zainab Ridha
- Division of Dermatology, Department of
Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Hanieh Zargham
- Division of Dermatology, Department of
Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - May Chergui
- Department of Pathology, McGill
University Health Centre, Montreal, QC, Canada
| | - Elena Netchiporouk
- Division of Dermatology, Department of
Medicine, McGill University Health Centre, Montreal, QC, Canada
- Elena Netchiporouk, Division of
Dermatology, Department of Medicine, McGill University Health Centre, Montreal,
QC, Canada.
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16
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Terao T, Tsushima T, Ikeda D, Fukumoto A, Kamura Y, Kuzume A, Tabata R, Miura D, Narita K, Takeuchi M, Matsue K. Limited efficacy of high-dose methotrexate to prevent the central nervous system relapse in patients with IVLBCL. Leuk Lymphoma 2022; 63:3394-3401. [PMID: 36111741 DOI: 10.1080/10428194.2022.2123239] [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: 01/26/2023]
Abstract
To evaluate the efficacy of high-dose methotrexate (HD-MTX, ≥1 g/m2) for the prevention of central nervous system (CNS) recurrence in patients with intravascular large B-cell lymphoma (IVLBCL), we reviewed 51 patients with pathologically diagnosed untreated IVLBCL. In total, there were five cases of CNS relapse (9.8%), and the 12-month CNS relapse rate was 9.2%. No statistical difference in CNS relapse rate (p = 0.86) was observed between patients with and without HD-MTX (n = 20 and 31, respectively). Furthermore, the composite endpoint defined as either CNS and/or neurolymphomatosis relapse was not significant in terms of the administration of HD-MTX (p = 0.25). No significant predictor of CNS relapse was found. In conclusion, patients with IVLBCL are at high risk of CNS recurrence; however, HD-MTX administration may not be effective for CNS recurrence prophylaxis. Key pointsThe administration of HD-MTX for patients with untreated IVLBCL may not be effective for preventing CNS relapse.
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Affiliation(s)
- Toshiki Terao
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Takafumi Tsushima
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Daisuke Ikeda
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Ami Fukumoto
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Yuya Kamura
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Ayumi Kuzume
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Rikako Tabata
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Daisuke Miura
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Kentaro Narita
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Masami Takeuchi
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Kosei Matsue
- Division of Hematology/Oncology, Department of Internal Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
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17
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Dong J, Barnett D, Adjei-Kyeremeh N, Bartz H. Diagnosing Intravascular Large B-Cell Lymphoma: A Tale of Hide and Seek. Case Rep Oncol 2022; 15:936-941. [PMID: 36636672 PMCID: PMC9830303 DOI: 10.1159/000525843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 06/20/2022] [Indexed: 11/10/2022] Open
Abstract
We are reporting the first documented case of intravascular large B-cell lymphoma (IVLBCL) manifesting in the endomysial and perimysial capillaries with its associated diagnostic dilemma. Our patient presented with progressive paraplegia. Initial laboratories were remarkable for hyponatremia, hypochloremia, lactic acidosis, elevated C-reactive protein, and lactate dehydrogenase. The bone marrow biopsy was unrevealing. However, a subsequent muscle biopsy confirmed the diagnosis of IVLBCL. As hyponatremia, endocrinopathies, connective tissue disease, rheumatological disorders, and occult cancer could all present similarly, our patient is a unique diagnostic dilemma. Randomized skin biopsy remains the best way to diagnose this disease, and rituximab-based chemotherapy with high-dose intrathecal methotrexate has proven to be a safe and effective regimen. With this initial evidence of IVLBCL involving the endomysial and perimysial capillary, we believe that muscle biopsy could be of value in diagnosing IVLBCL patients with neuromuscular symptoms.
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18
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MacGillivary ML, Purdy KS. Recommendations for an Approach to Random Skin Biopsy in the Diagnosis of Intravascular B-Cell Lymphoma. J Cutan Med Surg 2022; 27:44-50. [PMID: 36205174 PMCID: PMC9902969 DOI: 10.1177/12034754221130257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Intravascular B-Cell Lymphoma (IVBCL) is a rare type of extranodal large B-cell lymphoma where clonal B-cells selectively home to and replicate in the lumen of small vessels. Random skin biopsy (RSB) of uninvolved skin is a reputable tool to diagnose this protean entity and thus dermatologists are involved in its diagnosis. A literature review was completed to derive an approach to RSB in these patients to maximize diagnostic yield of IVBCL and minimize morbidity. Based on this review, data from 27 patients where clinical signs and symptoms and results of investigations were able to be linked to a positive diagnosis of IVBCL from RSB from 11 papers from 2003 to 2021 were analyzed. Following this analysis, RSB should be considered when there are no clinical skin findings and there is an elevated lactate dehydrogenase in the absence of lymphadenopathy and presence of fever of unknown origin, thrombocytopenia, anemia, and ferritinemia. Three to four RSBs from the thigh, abdomen and/or posterior upper arm should be performed via either incisional or telescoping punch biopsies and should include senile/cherry angioma(s) if present. If RSB results in a diagnosis of IVBCL, hematology should be consulted for further management. Consideration of a false negative biopsy or alternative diagnoses should be explored if RSB is negative for IVBCL. Following a standard approach for RSB in these patients will increase diagnostic yield of IVBCL while decreasing the risk of harm to the patient.
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Affiliation(s)
- Michael L. MacGillivary
- Division of Dermatology, Dalhousie University, Halifax, Canada,Michael L. MacGillivary, Division of Dermatology, Dalhousie University, Suite 4-193 Dickson Building, 5820 University Avenue, Halifax, NS B3H 2Y9, Canada;
| | - Kerri S. Purdy
- Division of Dermatology, Dalhousie University, Halifax, Canada
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19
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Rehabilitation Course and Management of Intravascular Lymphoma Presenting as Recurrent Strokes: A Case Report. REHABILITATION ONCOLOGY 2022. [DOI: 10.1097/01.reo.0000000000000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Miao Y, Zhang J, Chen Q, Xing L, Qiu T, Zhu H, Wang L, Fan L, Xu W, Li J. Spectrum and trigger identification of hemophagocytic lymphohistiocytosis in adults: A single-center analysis of 555 cases. Front Immunol 2022; 13:970183. [PMID: 36032133 PMCID: PMC9411524 DOI: 10.3389/fimmu.2022.970183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
Limited data are available about the underlying causes of hemophagocytic lymphohistiocytosis (HLH) in adults. We collected and analyzed the data of 555 cases of adult HLH. HLH in 242 patients were malignancies-related and lymphoid malignancies (42.0%, 233/555) were the most common causes. Aggressive natural killer-cell leukemia, diffuse large B-cell lymphoma, and extranodal natural killer/T-cell lymphoma, nasal type were the most common specified pathological subtypes. Epstein-Barr virus (EBV) (69.0%, 100/145) was the most common pathogen among the cases of infections-related HLH (26.1%, 145/555). Malignancies-related HLH showed male preponderance, more common splenomegaly, more severe anemia and thrombocytopenia, and significantly elevated soluble CD25. In patients with abnormal lymphoid cells in the bone marrow (BM) and increased EBV DNA copy number, 48.9% (45/92) of them were aggressive natural killer-cell leukemia. In patients with abnormal lymphoid cells in the BM and normal EBV DNA copy number, 66.2% (47/71) of them were B-cell non-Hodgkin lymphoma. In patients with elevated EBV DNA copy number but no abnormal lymphoid cells in the BM, 71.0% (98/138) of these cases were EBV infection. In conclusion, lymphoid malignancy is the most common underlying cause of adult HLH, followed by EBV infection. Based on the BM morphology and EBV load, we developed a diagnostic flow for rapid determination of the triggers for HLH.
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Affiliation(s)
- Yi Miao
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China
- Pukou Chronic Lymphocytic Leukemia (CLL) Center, Nanjing, China
| | - Jing Zhang
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China
- Pukou Chronic Lymphocytic Leukemia (CLL) Center, Nanjing, China
| | - Qingqing Chen
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China
- Pukou Chronic Lymphocytic Leukemia (CLL) Center, Nanjing, China
| | - Lingxiao Xing
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China
- Pukou Chronic Lymphocytic Leukemia (CLL) Center, Nanjing, China
| | - Tonglu Qiu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China
- Pukou Chronic Lymphocytic Leukemia (CLL) Center, Nanjing, China
| | - Huayuan Zhu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China
- Pukou Chronic Lymphocytic Leukemia (CLL) Center, Nanjing, China
| | - Li Wang
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China
- Pukou Chronic Lymphocytic Leukemia (CLL) Center, Nanjing, China
| | - Lei Fan
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China
- Pukou Chronic Lymphocytic Leukemia (CLL) Center, Nanjing, China
| | - Wei Xu
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China
- Pukou Chronic Lymphocytic Leukemia (CLL) Center, Nanjing, China
- *Correspondence: Wei Xu, ; Jianyong Li,
| | - Jianyong Li
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
- Key Laboratory of Hematology of Nanjing Medical University, Nanjing, China
- Pukou Chronic Lymphocytic Leukemia (CLL) Center, Nanjing, China
- National Clinical Research Center for Hematologic Diseases, the First Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Wei Xu, ; Jianyong Li,
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21
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Yokota K, Umeda M, Hongo S, Tsuchida T, Umemori Y, Fujita N. [A case of intravascular large B-cell lymphoma manifested as lacunar infarction]. Rinsho Shinkeigaku 2022; 62:492-495. [PMID: 35644581 DOI: 10.5692/clinicalneurol.cn-001704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A 79-year-old man was admitted to our hospital because of sudden onset of left ataxic hemiparesis. Brain MRI diffusion weighted images showed typical lacunar infarction on the right internal capsule. He had no risk factors of cerebrovascular disorder such as hypertension, diabetes mellitus, hyperlipidemia and arrhythmia. On admission, he had a slight fever and his laboratory data showed anemia, thrombocytopenia and elevation of CRP and LDH. Intravascular large B-cell lymphoma (IVLBCL) was suspected because the serum level of soluble IL-2 receptor was also elevated. Pathological diagnosis of IVLBCL was underwent by the skin biopsy from his senile hemangiomas. Although IVLBCL was known to demonstrate various CNS lesions, it is extremely rare to be manifested as a single lacunar infarction, and this case must be important for the differential diagnosis.
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Affiliation(s)
| | - Maiko Umeda
- Department of Neurology, Nagaoka Red Cross Hospital
| | - Shoko Hongo
- Department of Neurology, Nagaoka Red Cross Hospital
| | | | - Yukie Umemori
- Department of Dermatology, Nagaoka Red Cross Hospital
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22
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Kosaka T, Honda Y, Homma Y, Nakata M. Intravascular large B-cell lymphoma causing hypopituitarism and respiratory failure due to infiltration into pulmonary capillaries. BMJ Case Rep 2022; 15:e247880. [PMID: 35609931 PMCID: PMC9131056 DOI: 10.1136/bcr-2021-247880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2022] [Indexed: 11/03/2022] Open
Abstract
We report a rare case of intravascular large B-cell lymphoma (IVLBCL) with hypopituitarism and respiratory failure. A man in his 80s presented with hypotension and respiratory failure but was unsuccessfully treated for septic shock. Biological investigations were performed, and he was diagnosed with hypopituitarism due to insufficient secretion of anterior pituitary hormone. Although his condition temporarily improved following hormone replacement therapy, he eventually died of progressive respiratory failure. The lymphoma was only discovered during the autopsy, where it was observed to have spread to the pituitary gland and lung capillaries. Therefore, we concluded that the lymphoma had caused respiratory failure and hypopituitarism. The patient was thus diagnosed with IVLBCL posthumously. In conclusion, IVLBCL can cause hypopituitarism and respiratory failure due to pituitary and pulmonary capillary invasion by lymphoma cells.
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Affiliation(s)
- Tatsuaki Kosaka
- General Internal Medicine, Seirei Hamamatsu Hospital, Hamamatsu, Shizuoka, Japan
| | - Yuki Honda
- General Internal Medicine, Seirei Hamamatsu Hospital, Hamamatsu, Shizuoka, Japan
| | - Yoichiro Homma
- General Internal Medicine, Seirei Hamamatsu Hospital, Hamamatsu, Shizuoka, Japan
| | - Masanobu Nakata
- Hematology, Seirei Hamamatsu Hospital, Hamamatsu, Shizuoka, Japan
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Han Y, Li Q, Wang D, Peng L, Huang T, Ou C, Yang K, Wang J. Case Report: Intravascular Large B-Cell Lymphoma: A Clinicopathologic Study of Four Cases With Review of Additional 331 Cases in the Literature. Front Oncol 2022; 12:883141. [PMID: 35646671 PMCID: PMC9135977 DOI: 10.3389/fonc.2022.883141] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare and highly malignant non-Hodgkin B-cell lymphoma with uncommon clinical presentation and poor prognosis. The diagnostic pitfall of IVLBCL is mainly due to the fact that subtle histological changes could be easily overlooked, in addition to its rare occurrence, non-specific and variable clinical presentations, and the absence of significant mass lesions. The purpose of this study is to further explore the clinicopathologic and molecular features of IVLBCL to ensure an accurate diagnosis of this entity. Here, we retrospectively present the data of the four new cases and the literature cases. The age ranged from 23 to 92, with a medium age of 67 and a male-to-female ratio of 1:1. The clinical manifestations are extremely variable, including fever, night sweats, weight loss, anemia, thrombocytopenia, unexplained hypoxemia, impaired consciousness, and skin lesions, as well as the extremely low levels of serum albumin, high levels of serum lactate dehydrogenase (LDH), soluble interleukin-2 receptor (sIL2R), and ferritin. Morphologically, 99.9% of cases showed a selective growth pattern with large, atypical lymphocytes within the lumen of small blood vessels. In addition, vast majority of cases were positive for CD20, CD79a, PAX5, MUM1, and BCL6, and a subset of cases expressed BCL2 and CD5, whereas CD3 and CD10 were typically negative. Ki-67 proliferative index ranged from 20% to 100%. To sum up, we have conducted comprehensive case reports, to the best of our knowledge, this is the largest reported cohort of IVLBCL cases. Comprehensive assessments and more IVLBCL cases are required for early diagnosis and prompt treatment.
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Affiliation(s)
- Yingying Han
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
- Department of Pathology, School of Basic Medicine, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Qingjiao Li
- Department of Pathology, Hunan Provincial People’s Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China
| | - Dan Wang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
- Department of Pathology, School of Basic Medicine, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Lushan Peng
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
- Department of Pathology, School of Basic Medicine, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Tao Huang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
- Department of Pathology, School of Basic Medicine, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Chunlin Ou
- Department of Pathology, School of Basic Medicine, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Keda Yang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
- Department of Pathology, School of Basic Medicine, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Junpu Wang, ; Keda Yang,
| | - Junpu Wang
- Department of Pathology, Xiangya Hospital, Central South University, Changsha, China
- Department of Pathology, School of Basic Medicine, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Junpu Wang, ; Keda Yang,
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24
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Takahashi H, Nishimaki H, Nakanishi Y, Hamada T, Nakagawa M, Iizuka K, Uchino Y, Iriyama N, Miura K, Nakayama T, Masuda S, Hatta Y, Nakamura H. Clinical impact of central nervous system-directed therapies on intravascular large B-cell lymphoma: A single institution's experience. EJHAEM 2022; 3:467-470. [PMID: 35846032 PMCID: PMC9176124 DOI: 10.1002/jha2.380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/05/2022] [Accepted: 01/06/2022] [Indexed: 01/08/2023]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of B-cell lymphoma characterized by aggressive disease progression with a high incidence of central nervous system (CNS) involvement. We retrospectively analyzed 16 patients with de novo IVLBCL treated at our hospital between 2004 and 2018 with either standard therapy plus CNS-directed therapy or standard therapy alone. CNS-directed therapy was associated with a significantly better 2-year CNS-free survival (100% vs. 63%, p = 0.0191), despite no significant effects on progression-free or overall survival. Further studies should assess CNS-focused treatment in patients with IVLBCL with or without primary CNS involvement.
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Affiliation(s)
- Hiromichi Takahashi
- Department of MedicineDivision of Hematology and RheumatologyNihon University School of MedicineTokyoJapan
- Department of Pathology and MicrobiologyDivision of Laboratory MedicineNihon University School of MedicineTokyoJapan
| | - Haruna Nishimaki
- Department of Pathology and MicrobiologyDivision of Oncologic PathologyNihon University School of MedicineTokyoJapan
| | - Yoko Nakanishi
- Department of Pathology and MicrobiologyDivision of Oncologic PathologyNihon University School of MedicineTokyoJapan
| | - Takashi Hamada
- Department of MedicineDivision of Hematology and RheumatologyNihon University School of MedicineTokyoJapan
| | - Masaru Nakagawa
- Department of MedicineDivision of Hematology and RheumatologyNihon University School of MedicineTokyoJapan
| | - Kazuhide Iizuka
- Department of MedicineDivision of Hematology and RheumatologyNihon University School of MedicineTokyoJapan
- Department of Pathology and MicrobiologyDivision of Laboratory MedicineNihon University School of MedicineTokyoJapan
| | - Yoshihito Uchino
- Department of MedicineDivision of Hematology and RheumatologyNihon University School of MedicineTokyoJapan
| | - Noriyoshi Iriyama
- Department of MedicineDivision of Hematology and RheumatologyNihon University School of MedicineTokyoJapan
| | - Katsuhiro Miura
- Department of MedicineDivision of Hematology and RheumatologyNihon University School of MedicineTokyoJapan
| | - Tomohiro Nakayama
- Department of Pathology and MicrobiologyDivision of Laboratory MedicineNihon University School of MedicineTokyoJapan
| | - Shinobu Masuda
- Department of Pathology and MicrobiologyDivision of Oncologic PathologyNihon University School of MedicineTokyoJapan
| | - Yoshihiro Hatta
- Department of MedicineDivision of Hematology and RheumatologyNihon University School of MedicineTokyoJapan
| | - Hideki Nakamura
- Department of MedicineDivision of Hematology and RheumatologyNihon University School of MedicineTokyoJapan
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25
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Qiu L, Wang SA, Vega F, Khoury JD, Tang Z, Garces S, Medeiros LJ, Thakral B. From the archives of MD Anderson Cancer Center: Intravascular large B-cell lymphoma with numerous circulating lymphoma cells. Ann Diagn Pathol 2022; 58:151934. [DOI: 10.1016/j.anndiagpath.2022.151934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 02/23/2022] [Accepted: 03/04/2022] [Indexed: 11/01/2022]
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26
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Tsukamoto E, Tanei T, Kato T, Hasegawa T. Intravascular Large B-Cell Lymphoma Diagnosed by Open Brain Biopsy and Achievement of Remission After Early Initiation of Chemotherapy: Case Report. Cureus 2022; 14:e21971. [PMID: 35282552 PMCID: PMC8905658 DOI: 10.7759/cureus.21971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2022] [Indexed: 12/26/2022] Open
Abstract
A 60-year-old man presented with progressive disturbance of consciousness. His father had died of malignant lymphoma, while his mother and sister died of acute leukemia. Magnetic resonance imaging (MRI) revealed multiple high-intensity lesions in the bilateral cerebral hemispheres on diffusion-weighted images. Serum soluble interleukin 2 receptor was 5,640 U/mL. Screenings of blood antibodies known to rise in autoimmune diseases were all normal. Cerebrospinal fluid examinations demonstrated slight elevation of protein and glucose, while the oligoclonal band and myelin basic protein were not elevated. Biopsies of bone marrow and random skin did not show any malignant features. His consciousness gradually deteriorated over a week, with lesions in his right frontal, left temporal, and bilateral parietal lobes shown to be growing. Therefore, open brain biopsy was performed, and one block of the right frontal lesion was harvested. Histological examination revealed atypical large cells only in the capillaries. Although immunohistochemical examinations showed positive staining for CD20, they were negative for CD3. Histopathological diagnosis was intravascular large B-cell lymphoma. After undergoing six cycles of intravenous chemotherapy with rituximab, cyclophosphamide, doxorubicin, and prednisone, his consciousness and neurological symptoms improved, and he appeared to achieve remission. Two years later, there have been no apparent recurrences, and the brain lesions have disappeared.
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27
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Zhu D, Shen Y, Huang J, Zhao L. Intravascular large B-cell lymphoma with diffuse ground glass lesion on chest computed tomography diagnosed using transbronchial lung cryobiopsy: a case report. Transl Cancer Res 2022; 10:4571-4576. [PMID: 35116313 PMCID: PMC8798442 DOI: 10.21037/tcr-21-769] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/16/2021] [Indexed: 12/15/2022]
Abstract
A 68-year-old man was presented with high fever of unknown origin for 3 weeks and non-productive cough for 1 week. A chest computed tomography (CT) scan revealed multiple nodules and ground glass opacities (GGO) in both lungs. The patient was initially diagnosed with hypersensitivity pneumonitis based on the result of bronchoalveolar lavage fluids (BALF). After treatment with methylprednisolone for 2 weeks, the patient’s fever recurred, with no resolution of lesions on chest CT. The patient consented to positron emission tomography (PET)/CT. It showed that fluorodeoxyglucose (FDG) metabolism was significantly increased in the spleen, whole skeleton, and both lungs, suggesting a malignant hematological disease. Large B-cell lymphoma was diagnosed by bone marrow puncture and flow cytometry. Transbronchial lung cryobiopsy was performed to evaluate the diffuse lung lesion. Hematoxylin-eosin (HE) staining showed diffuse infiltration of heterotypic cells in the pulmonary interstitial capillaries. Furthermore, immunohistochemical examination results suggested lung infiltration of B lymphohematopoietic system tumors. The patient was finally diagnosed as intravascular large B-cell lymphoma (IVLBCL). IVLBCL with diffuse lung ground glass lesions is very rare and difficult to diagnose. Transbronchial lung cryobiopsy, as an emerging procedure, plays an important role in the diagnosis of interstitial lung disease and has gained popularity for a lower complication rate and acquisition of more tissue samples.
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Affiliation(s)
- Dongyi Zhu
- Department of Respiratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan Shen
- Department of Emergency Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jianhao Huang
- Department of Respiratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Liming Zhao
- Department of Respiratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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28
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Davis JW, Auerbach A, Crothers BA, Lewin E, Lynch DT, Teschan NJ, Schmieg JJ. Intravascular Large B-Cell Lymphoma. Arch Pathol Lab Med 2022; 146:1160-1167. [PMID: 34979566 DOI: 10.5858/arpa.2021-0165-ra] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Intravascular large B-cell lymphoma (IVLBCL) is a rare hematopathologic entity, posing both a clinical and histologic challenge for diagnosis. Numerous pitfalls can hinder making the diagnosis. OBJECTIVE.— To summarize recent developments in literature pertaining to IVLBCL and point out key pitfalls pathologists should be prepared to encounter. DATA SOURCES.— Literature review via PubMed search and hospital (Darnall Medical Library) resources. CONCLUSIONS.— The 3 primary pitfalls of IVLBCL include masking of IVLBCL, mimicry by IVLBCL, and mimicry of IVLBCL. These scenarios illustrate the importance of histologic pattern recognition and subsequent usage of immunohistochemistry, especially in context of a clinical history that may be noncharacteristic.
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Affiliation(s)
- Joshua W Davis
- From Clinical and Anatomic Pathology Residency Program, Walter Reed National Military Medical Center, Bethesda, Maryland (Davis)
| | - Aaron Auerbach
- The Joint Pathology Center, Silver Spring, Maryland (Auerbach, Crothers, Schmieg III)
| | - Barbara A Crothers
- The Joint Pathology Center, Silver Spring, Maryland (Auerbach, Crothers, Schmieg III)
| | - Eleanor Lewin
- the Department of Pathology, Women & Infants Hospital, Providence, Rhode Island (Lewin)
| | - David T Lynch
- and the Department of Pathology, Brooke Army Medical Center, Fort Sam Houston, Texas (Lynch, Teschan)
| | - Nathan J Teschan
- and the Department of Pathology, Brooke Army Medical Center, Fort Sam Houston, Texas (Lynch, Teschan)
| | - John J Schmieg
- The Joint Pathology Center, Silver Spring, Maryland (Auerbach, Crothers, Schmieg III)
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29
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Odani K, Fujimoto M, Hirata M, Nishikori M, Usui S, Yamada Y, Saeki M, Ono K, Iwasa Y, Haga H. Immunohistochemistry of the oncofetal protein IMP3 is helpful in the diagnosis of intravascular large B-cell lymphoma using skin biopsy. J Cutan Pathol 2022; 49:438-441. [PMID: 34981542 DOI: 10.1111/cup.14196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/20/2021] [Accepted: 12/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The oncofetal protein insulin-like growth factor 2 mRNA binding protein-3 (IMP3) is expressed in various cancers. In this study, we examined the diagnostic utility of IMP3 immunohistochemistry in the context of intravascular large B-cell lymphoma (IVL). METHODS We obtained 25 skin biopsy (SB) specimens diagnosed as IVL and nine IVL-negative SB specimens from 27 IVL patients. Additionally, 27 negative SB specimens from 26 non-IVL patients were obtained from our pathology archives. We performed IMP3 immunohistochemistry on these 61 SB specimens, considering IMP3 expression in any mononuclear cell as positive. In selected cases, triple immunostaining for IMP3, PAX5, and CD34 was performed to analyze the origin and location of IMP3-positive cells. RESULTS IMP3 was expressed in most intravascular lymphoma cells in all the 25 SB specimens diagnosed as IVL. Furthermore, our evaluation revealed the presence of intravascular IMP3-positive B-cells in five of the nine negative SB specimens from IVL patients; however, this was not observed in the 27 SB specimens from non-IVL patients. CONCLUSION IMP3 was expressed in most IVL cells, and IMP3 immunohistochemistry could serve as a sensitive diagnostic aid for detecting IVL cells in SB.
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Affiliation(s)
- Kentaro Odani
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Masakazu Fujimoto
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Masahiro Hirata
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Momoko Nishikori
- Department of Hematology, Kyoto University Hospital, Kyoto, Japan
| | - Shunya Usui
- Department of Dermatology, Kyoto University Hospital, Kyoto, Japan
| | - Yosuke Yamada
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Miho Saeki
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - Kazuo Ono
- Department of Diagnostic Pathology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Yoko Iwasa
- Department of Diagnostic Pathology, Shiga General Hospital, Moriyama, Japan
| | - Hironori Haga
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
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30
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Tanaka Y, Momose S, Takayanagi N, Tabayashi T, Tokuhira M, Tamaru JI, Kizaki M. Rapid deterioration of intravascular large B-cell lymphoma with mass formation in the trigeminal nerve and multiple organ infiltration: An autopsy case report. J Clin Exp Hematop 2021; 62:41-45. [PMID: 34840206 PMCID: PMC9010497 DOI: 10.3960/jslrt.21013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare lymphoma characterized by the selective growth of lymphoma cells within the lumen of vessels. We describe the case of a 69-year-old male who presented with marked pain in the left facial region. Gadolinium-enhanced magnetic resonance imaging revealed a swollen left trigeminal nerve (TN) and positron emission tomography/computed tomography demonstrated fluorodeoxyglucose-only uptake at the same site. The patient had high serum lactate dehydrogenase and soluble interleukin-2 receptor levels. As random skin biopsy and bone marrow biopsy detected no abnormal pathogenesis, open biopsy of the TN was performed, revealing diffuse large B-cell lymphoma (DLBCL). However, ground glass opacities rapidly developed in both lung fields with severe respiratory failure. The patient died of progressive disease before the initiation of chemotherapy. Postmortem examination revealed widespread lymphoma cells in the lumen of vessels in multiple organs, including the lungs, excluding the bone marrow and skin. Lymphoma cells formed a mass in the TN and left lumbar plexus. A diagnosis of IVLBCL was made based on the postmortem pathological analysis. DLBCL of abnormal sites, such as the peripheral nervous system, should be considered in cases of IVLBCL as a differential diagnosis.
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Affiliation(s)
- Yuka Tanaka
- Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Shuji Momose
- Department of Pathology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Natsuko Takayanagi
- Department of Pathology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Takayuki Tabayashi
- Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Michihide Tokuhira
- Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Jun-Ichi Tamaru
- Department of Pathology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Masahiro Kizaki
- Department of Hematology, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
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31
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Martínez-Rodríguez I, Azueta Etxebarria A, Insunza A, Gómez-de la Fuente FJ, García-Reyero J, Banzo I. Intravascular large cell lymphoma. 18F-FDG PET/CT and necropsy findings. Rev Esp Med Nucl Imagen Mol 2021; 40:380-382. [PMID: 34752375 DOI: 10.1016/j.remnie.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- I Martínez-Rodríguez
- Servicio de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Grupo de Imagen Molecular (IDIVAL), Santander, Cantabria, Spain.
| | - A Azueta Etxebarria
- Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Grupo de Imagen Molecular (IDIVAL), Santander, Cantabria, Spain
| | - A Insunza
- Servicio de Hematología, Hospital Universitario Marqués de Valdecilla, Grupo de Imagen Molecular (IDIVAL), Santander, Cantabria, Spain
| | - F J Gómez-de la Fuente
- Servicio de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Grupo de Imagen Molecular (IDIVAL), Santander, Cantabria, Spain
| | - J García-Reyero
- Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria. Grupo de Imagen Molecular (IDIVAL), Santander, Cantabria, Spain; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | - I Banzo
- Servicio de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Grupo de Imagen Molecular (IDIVAL), Santander, Cantabria, Spain
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32
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Barker JL, Swarup O, Puliyayil A. Intravascular large B-cell lymphoma: representative cases and approach to diagnosis. BMJ Case Rep 2021; 14:e244069. [PMID: 34728502 PMCID: PMC8565548 DOI: 10.1136/bcr-2021-244069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2021] [Indexed: 12/14/2022] Open
Abstract
Intravascular large B-cell lymphoma (ILBCL) is a subtype of non-Hodgkin's large B-cell lymphoma that is characterised by neoplastic lymphocyte proliferation within the lumen of small blood vessels, which may occur without an extracellular tumour mass or peripheral blood involvement. This report highlights some of the diagnostic issues for ILBCL, and how it can be approached. The two cases described below highlight two significantly different presentations, one with predominately neurological phenomena, and the other with fever of unknown origin for investigation. Both patients were managed with chemotherapy and intercalated intrathecal chemotherapy, with good clinical outcomes, without further evidence of clinical relapse. These cases along with a review of the literature highlight the key learning points in the difficulties in the diagnosis of this condition, and the appropriate use of random skin biopsy in patient suspected of having ILBCL, such as those with constitutional symptoms with otherwise negative malignancy screening, and unexplained neurological phenomena, especially if recurrent in nature.
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Affiliation(s)
- James Llewellyn Barker
- Department of Medicine, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, Albury Wodonga Health, Albury, NSW, Australia
- Border Medical Oncology and Haematology, Albury Wodonga Regional Cancer Centre, Albury, NSW, Australia
| | - Oshi Swarup
- Department of Medicine, The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, Albury Wodonga Health, Albury, NSW, Australia
| | - Anish Puliyayil
- Border Medical Oncology and Haematology, Albury Wodonga Regional Cancer Centre, Albury, NSW, Australia
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33
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Lali BS, Dey D, Bhave SJ, Parihar M, Lingegowda D, Das J, Chatterjee S. The Rare Face of an Infrequent Lymphoma Diagnosed by an Exquisite Method: Case Report with Review of Literature. Indian J Med Paediatr Oncol 2021. [DOI: 10.1055/s-0041-1735518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractLarge B-cell lymphomas include both the commonly encountered, as well as not so frequent entities. We report a rare case of hepatic intravascular large B-cell lymphoma (IVLBCL). These cases usually pose a major challenge to timely diagnosis due to the limited clinical exposure and nonspecific symptoms; however, timely diagnosis is possible with awareness of this entity and close coordination between radiology and pathology. The patient presented with pain abdomen, fever, edema, hepatomegaly but no lymphadenopathy or cutaneous lesions were identified. Blood investigations revealed pancytopenia, high lactate dehydrogenase (LDH) levels and bone marrow investigations were not helpful. Left-sided portal hypertension, coagulopathy, and hypoalbuminemia raised a clinical suspicion of chronic liver disease with high LDH levels and liver biopsy was challenging in view of very low platelet counts. The uniquely explored transjugular biopsy helped in obtaining liver tissue which showed sinusoidal large atypical lymphoid cells positive for CD20 rendering a diagnosis of IVLBCL. After administration of the R-miniCHOP chemotherapy, there was evident clinical and radiological response. This case highlights the importance of considering transjugular liver biopsy in scenarios where the clinical presentation is unusual. At the same time, a meticulous histological examination is needed to diagnose a rare yet potentially treatable large B cell lymphoma.
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Affiliation(s)
- Bhagat S. Lali
- Department of Oncopathology, Phase II, Tata Medical Center, Kolkata, West Bengal, India
| | - Debdeep Dey
- Department of Oncopathology, Phase II, Tata Medical Center, Kolkata, West Bengal, India
| | - Saurabh J. Bhave
- Department of Clinical Haematology, Tata Medical Center, Kolkata, West Bengal, India
| | - Mayur Parihar
- Department of Cytogenetics, Tata Medical Center, Kolkata, West Bengal, India
| | | | - Jayanta Das
- Department of Nuclear Medicine, Tata Medical Center, Kolkata, West Bengal, India
| | - Suvadip Chatterjee
- Department of Gastroenterology, Tata Medical Center, Kolkata, West Bengal, India
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34
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Storandt MH, Koponen MA. Intravascular large B-cell lymphoma presenting with fever and refractory acidosis. AUTOPSY AND CASE REPORTS 2021; 11:e2021324. [PMID: 34540728 PMCID: PMC8432357 DOI: 10.4322/acr.2021.324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/21/2021] [Indexed: 01/14/2023] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare form of diffuse large B-cell lymphoma, characterized by malignant B-cells primarily localized to the lumina of small- and medium-sized blood vessels without lymphadenopathy. Two patients initially presented with fever of unknown origin and persistent lactic acidosis without evidence of tissue hypoxia. Neither patient had an identifiable source of infection and both underwent peripheral blood smear demonstrating leukocytosis with a neutrophilic predominance and thrombocytopenia without evidence of hematologic malignancy. One had previously had a bone marrow biopsy which was unremarkable. Both patients’ condition deteriorated rapidly, progressing to multiorgan failure requiring pressors and mechanical ventilation, which ultimately resulted in cardiopulmonary arrest. At autopsy, each patient demonstrated malignant lymphocytoid cells, staining positive for CD20, localized to the lumina of small- and medium-sized vessels in multiple organs, including the lungs, liver, spleen, and kidneys, among others, allowing for the diagnosis of IVLBCL. IVLBCL is exceedingly rare, which in combination with significant variability in presentation, can make identification and diagnosis challenging. Diagnosis requires biopsy, therefore a high index of suspicion is needed to obtain an adequate tissue sample, whether pre- or postmortem. In the presented cases, both patients exhibited type B lactic acidosis with an unknown etiology that was ultimately determined at autopsy.
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Affiliation(s)
- Michael Harrison Storandt
- University of North Dakota School of Medicine and Health Sciences (UNDSMHS), Department of Pathology, Grand Forks, ND, USA
| | - Mark Alan Koponen
- University of North Dakota School of Medicine and Health Sciences (UNDSMHS), Department of Pathology, Grand Forks, ND, USA
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Itami H, Nakamine H, Kubo M, Ogawa K, Tani R, Nakamura S, Takeda M, Nitta Y, Uchiyama T, Fujii T, Hatakeyama K, Ohbayashi C. Diffuse large B-cell lymphoma (DLBCL) with significant intravascular invasion. Close resemblance of its clinicopathological features to intravascular large B-cell lymphoma, but not to DLBCL-not otherwise specified. J Clin Exp Hematop 2021; 61:152-161. [PMID: 34193753 PMCID: PMC8519243 DOI: 10.3960/jslrt.20066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is defined by the World Health Organization (WHO) Classification as one type of extranodal large B-cell lymphoma and it is characterized by the selective growth of lymphoma cells within blood vessels with minimal extravascular invasion. According to the criteria, however, several reported cases of IVLBCL with significant extravascular invasion cannot be classified as IVLBCL. The purpose of the present study was to assess the clinicopathological significance of the WHO criteria for IVLBCL. We characterized clinical, histopathological, and immunohistochemical features of 11 patients with extranodal diffuse large B-cell lymphoma (DLBCL) with significant intravascular invasion (DLBCL-IV), and statistically compared their features with those of 11 patients with IVLBCL and 15 patients with extranodal DLBCL with virtually no intravascular invasion (DLBCL-noIV). When compared with the DLBCL-noIV group, the DLBCL-IV group was characterized by significantly higher rates of splenomegaly, hemophagocytosis, advanced stage disease, and CD5 expression; higher average platelet count, serum lactate dehydrogenase level, and serum ferritin level. Progression-free survival was significantly shorter in the DLBCL-IV group than the DLBCL-noIV group. In contrast, there were no significant differences in clinicopathological features between the DLBCL-IV and the IVLBCL groups. Our study suggests that DLBCL-IV should be regarded as IVLBCL-related.
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Affiliation(s)
- Hiroe Itami
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Hirokazu Nakamine
- Division of Pathology and Laboratory Medicine, The Japan Baptist Hospital, Kyoto, Japan
| | - Masayuki Kubo
- Department of Hematology, Nara Medical University, Kashihara, Japan
| | - Kohei Ogawa
- Department of Dermatology, Nara Medical University, Kashihara, Japan
| | - Rina Tani
- Department of Molecular Pathology, Nara Medical University, Kashihara, Japan
| | - Shinji Nakamura
- Department of Surgery, Takanohara Central Hospital, Nara, Japan
| | - Maiko Takeda
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Yuji Nitta
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Tomoko Uchiyama
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Tomomi Fujii
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
| | - Kinta Hatakeyama
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan.,Department of Diagnostic Pathology, Minami-Nara General Medical Centre, Oyodo, Japan
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Japan
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Tokushima M, Tago M, Katsuki NE, Yamashita SI. Intravascular large B-cell lymphoma presenting with reticular telangiectasia on the trunk and panhypopituitarism: an autopsy case. BMJ Case Rep 2021; 14:14/3/e239422. [PMID: 33731406 PMCID: PMC7978074 DOI: 10.1136/bcr-2020-239422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
A 75-year-old woman developed redness and swelling on her truncal skin, spreading from the lower abdomen to left thigh, 2 months before being admitted to our hospital. She was urgently hospitalised because of her worsening respiratory condition. On admission, she had reticular telangiectasia, diffuse skin induration on the lower abdomen and panhypopituitarism. She was diagnosed with intravascular large B-cell lymphoma (IVLBCL) by the third random abdominal skin biopsy. After histopathological examination at autopsy, we made a final diagnosis of IVLBCL causing respiratory failure and panhypopituitarism. This is the rare case of IVLBCL-induced panhypopituitarism showing visible skin lesions.
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Affiliation(s)
- Midori Tokushima
- Departmet of General Medicine, Saga University Hospital, Saga, Japan
| | - Masaki Tago
- Departmet of General Medicine, Saga University Hospital, Saga, Japan
| | - Naoko E Katsuki
- Departmet of General Medicine, Saga University Hospital, Saga, Japan
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Lauw MIS, Lucas CHG, Ohgami RS, Wen KW. Primary Central Nervous System Lymphomas: A Diagnostic Overview of Key Histomorphologic, Immunophenotypic, and Genetic Features. Diagnostics (Basel) 2020; 10:diagnostics10121076. [PMID: 33322508 PMCID: PMC7764608 DOI: 10.3390/diagnostics10121076] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 02/07/2023] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare form of extranodal non-Hodgkin lymphoma that primarily arises in the brain, spinal cord, leptomeninges, and vitreoretinal compartment of the eye. The term is sometimes used interchangeably with primary central nervous system diffuse large B-cell lymphoma (PCNS DLBCL) because DLBCL comprises a great majority (90–95%) of PCNSL. Although rare, other types of lymphomas can be seen in the central nervous system (CNS), and familiarity with these entities will help their recognition and further workup in order to establish the diagnosis. The latter is especially important in the case of PCNSL where procurement of diagnostic specimen is often challenging and yields scant tissue. In this review, we will discuss the most common types of primary lymphomas that can be seen in the CNS with emphasis on the diagnostic histomorphologic, immunophenotypic, and molecular genetic features. The differential diagnostic approach to these cases and potential pitfalls will also be discussed.
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Affiliation(s)
- Marietya I. S. Lauw
- Department of Pathology, University of California, San Francisco, CA 94143, USA; (C.-H.G.L.); (R.S.O.); (K.W.W.)
- Correspondence:
| | - Calixto-Hope G. Lucas
- Department of Pathology, University of California, San Francisco, CA 94143, USA; (C.-H.G.L.); (R.S.O.); (K.W.W.)
| | - Robert S. Ohgami
- Department of Pathology, University of California, San Francisco, CA 94143, USA; (C.-H.G.L.); (R.S.O.); (K.W.W.)
- Department of Pathology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA 94158, USA
| | - Kwun Wah Wen
- Department of Pathology, University of California, San Francisco, CA 94143, USA; (C.-H.G.L.); (R.S.O.); (K.W.W.)
- Department of Pathology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA 94158, USA
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Martínez-Rodríguez I, Azueta Etxebarria A, Insunza A, Gómez-de la Fuente FJ, García-Reyero J, Banzo I. Intravascular large cell lymphoma. 18F-FDG PET/CT and necropsy findings. Rev Esp Med Nucl Imagen Mol 2020; 40:S2253-654X(20)30199-2. [PMID: 33293247 DOI: 10.1016/j.remn.2020.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/02/2020] [Accepted: 09/06/2020] [Indexed: 11/25/2022]
Affiliation(s)
- I Martínez-Rodríguez
- Servicio de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Grupo de Imagen Molecular (IDIVAL), Santander, Cantabria, España.
| | - A Azueta Etxebarria
- Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, Cantabria, España
| | - A Insunza
- Servicio de Hematología, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Cantabria, España
| | - F J Gómez-de la Fuente
- Servicio de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Grupo de Imagen Molecular (IDIVAL), Santander, Cantabria, España
| | - J García-Reyero
- Servicio de Anatomía Patológica, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, Cantabria, España; Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, España
| | - I Banzo
- Servicio de Medicina Nuclear, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Grupo de Imagen Molecular (IDIVAL), Santander, Cantabria, España
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Enzan N, Kitadate A, Suzuki H, Yoshioka M, Narita K, Tanaka A, Matsue K. Intravascular large B-cell lymphoma diagnosed by incisional random skin biopsy after failure of diagnosis using punch biopsy: A case report. J Cutan Pathol 2020; 48:589-591. [PMID: 32940371 DOI: 10.1111/cup.13877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/12/2020] [Accepted: 09/12/2020] [Indexed: 01/15/2023]
Affiliation(s)
- Naoko Enzan
- Department of Dermatology, Kameda Medical Center, Kamogawa, Japan
| | - Akihiro Kitadate
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Haru Suzuki
- Department of Dermatology, Kameda Medical Center, Kamogawa, Japan
| | - Miri Yoshioka
- Department of Dermatology, Kameda Medical Center, Kamogawa, Japan
| | - Kentaro Narita
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Atsushi Tanaka
- Department of Dermatology, Kameda Medical Center, Kamogawa, Japan
| | - Kosei Matsue
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Kamogawa, Japan
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Tudesq JJ, Valade S, Galicier L, Zafrani L, Boutboul D, de Bazelaire C, Munoz-Bongrand N, Canet E, Ardisson F, Lemiale V, Darmon M, Azoulay E, Mariotte E. Diagnostic strategy for trigger identification in severe reactive hemophagocytic lymphohistiocytosis: A diagnostic accuracy study. Hematol Oncol 2020; 39:114-122. [PMID: 33099794 DOI: 10.1002/hon.2819] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/01/2020] [Accepted: 10/19/2020] [Indexed: 12/14/2022]
Abstract
Reactive hemophagocytic lymphohistiocytosis (rHLH) management requires early recognition, trigger identification, and adequate treatment in order to reduce mortality. We assessed the diagnostic yield of tissue biopsies to identify trigger in severe rHLH. We included all consecutive patients presenting an rHLH diagnosis (HLH-2004 criteria) admitted to the intensive care unit (ICU) of a tertiary hospital. This retrospective diagnostic accuracy study was conducted according to the Standards for Reporting Diagnostic Accuracy Statement. Among the 134 included patients (median age 47 years [IQR 47-56]), an underlying immunodeficiency was previously known in 61.2%. rHLH trigger was identified in 127 patients (94.8%) (hematological disorder 75%, infection 16%, systemic disease 4%). Diagnostic yield of tissue biopsies was as follows: lymph node 75% (95% confidence interval [CI], 61-85), skin 50% (95% CI, 27-73), bone marrow 44% (95% CI, 34-55), liver 30% (95% CI, 15-49). Splenectomy (yield 77%; 95% CI, 46-95) was reserved to cases of diagnostic deadlock. Procedural severe adverse events included two cases of reversible hemorrhagic shock. Seventy-eight percent of patients received etoposide regarding to the rHLH severity, and 68% could receive trigger-specific treatment in the ICU. A comprehensive diagnostic workup led to an rHLH trigger identification in 95% of patients, allowing prompt initiation of appropriate therapy. Prospective studies to validate a standardized diagnostic approach are warranted.
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Affiliation(s)
- Jean-Jacques Tudesq
- Médecine Intensive - Réanimation, Hôpital Saint-Louis, AP-HP, Paris, France.,UFR Médecine Paris Nord, Université de Paris, Paris, France
| | - Sandrine Valade
- Médecine Intensive - Réanimation, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Lionel Galicier
- Immunologie Clinique, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Lara Zafrani
- Médecine Intensive - Réanimation, Hôpital Saint-Louis, AP-HP, Paris, France.,UFR Médecine Paris Nord, Université de Paris, Paris, France
| | - David Boutboul
- UFR Médecine Paris Nord, Université de Paris, Paris, France.,Immunologie Clinique, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Cédric de Bazelaire
- UFR Médecine Paris Nord, Université de Paris, Paris, France.,Imagerie Médicale, Hôpital Saint-Louis, AP-HP, Paris, France
| | | | - Emmanuel Canet
- Médecine Intensive - Réanimation, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Fanny Ardisson
- Médecine Intensive - Réanimation, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Virginie Lemiale
- Médecine Intensive - Réanimation, Hôpital Saint-Louis, AP-HP, Paris, France
| | - Michael Darmon
- Médecine Intensive - Réanimation, Hôpital Saint-Louis, AP-HP, Paris, France.,UFR Médecine Paris Nord, Université de Paris, Paris, France
| | - Elie Azoulay
- Médecine Intensive - Réanimation, Hôpital Saint-Louis, AP-HP, Paris, France.,UFR Médecine Paris Nord, Université de Paris, Paris, France
| | - Eric Mariotte
- Médecine Intensive - Réanimation, Hôpital Saint-Louis, AP-HP, Paris, France
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Nguyen S, Pakbaz Z. Intravascular large B-cell lymphoma in Hispanics: a case series and literature review. J Community Hosp Intern Med Perspect 2020; 10:562-566. [PMID: 33194130 PMCID: PMC7599000 DOI: 10.1080/20009666.2020.1811073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Intravascular large B-cell Lymphoma (IVLBCL) is a rare subtype of extra nodal non-Hodgkin’s lymphoma, which is challenging to diagnose and has a poor prognosis. Here we describe three non-White Hispanic patients newly diagnosed with IVLBCL within 14-month period. All of them presented with persistent fever of unknown origin and symptomatic severe anemia as the initial manifestations. Two out of three cases were successfully diagnosed in a timely manner by fat pad biopsy and have remained disease free up to 34 months after chemotherapy. The third case was diagnosed by bone marrow biopsy and deceased one week later after choosing home hospice care. To date, this is the largest published case series of IVLBCL in non-White Hispanics.
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Affiliation(s)
- Sonha Nguyen
- Department of Internal Medicine, University of California Riverside, Riverside, CA, USA.,Department of Internal Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Zahra Pakbaz
- Department of Internal Medicine, University of California Riverside, Riverside, CA, USA.,Division of Hematology and Oncology, Department of Internal Medicine, University of California Irvine, Irvine, CA, USA
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Yamamoto Y, Nishimura Y, Okumura M, Otsuka Y, Oka K, Ikeuchi K, Nishimori H, Taniguchi K, Otsuka F. Intravascular lymphoma presenting as spinal cord infarction. Postgrad Med J 2020; 97:672-673. [PMID: 32796108 DOI: 10.1136/postgradmedj-2020-138602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/09/2020] [Accepted: 07/18/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Yukichika Yamamoto
- Department of General Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yoshito Nishimura
- Department of General Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Misa Okumura
- Department of General Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yuki Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kosuke Oka
- Department of General Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazuhiro Ikeuchi
- Department of Hematology and Oncology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hisakazu Nishimori
- Department of Hematology and Oncology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kohei Taniguchi
- Department of Pathology, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine Dentistry and Pharmaceutical Sciences, Okayama, Japan
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Fujikura K, Yamashita D, Yoshida M, Ishikawa T, Itoh T, Imai Y. Cytogenetic complexity and heterogeneity in intravascular lymphoma. J Clin Pathol 2020; 74:244-250. [PMID: 32763919 DOI: 10.1136/jclinpath-2020-206573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 05/26/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023]
Abstract
AIMS To characterise the karyotypic abnormalities and heterogeneities in intravascular lymphoma (IVL). METHODS G-banded karyotyping was performed on biopsy specimens from a single-centre IVL cohort comprising intravascular large B-cell lymphoma (IVLBCL, n=12) and NK/T-cell lymphoma (IVNKTCL, n=1). RESULTS Five IVLBCL cases and one IVNKTCL case (total 46%) were found to have normal karyotypes, and the cytogenetic abnormalities observed in the other seven IVLBCL cases (54%) were investigated further. These seven karyotypes were uniformly complex with an average of 13 aberrations. The seven cases all had abnormalities involving chromosome 6, with 57% involving structural abnormalities at 6q13, and chromosome 8, with 43% involving abnormalities at 8p11.2. In addition, 71% had aberrations at 19q13. On average, 4.4 chromosomal gains and losses were detected per case. Cytogenetic heterogeneities were observed in six cases (86%) and tetraploidy in three cases (43%). There was no significant difference in progression-free survival (p=0.92) and overall survival (p=0.61) between the IVLBCL cases with complex and normal karyotypes. CONCLUSION Approximately half of IVLBCL cases had a highly heterogeneous pattern of karyotypes with different clonal numerical and structural chromosome aberrations.
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Affiliation(s)
- Kohei Fujikura
- Department of Pathology, Kobe City Medical Center General Hospital, Kobe, Japan .,Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Yamashita
- Department of Pathology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Makoto Yoshida
- Department of Pathology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takayuki Ishikawa
- Department of Hematology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yukihiro Imai
- Department of Pathology, Kobe City Medical Center General Hospital, Kobe, Japan
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Zamò A, Johnston P, Attygalle AD, Laurent C, Arber DA, Fend F. Aggressive B-cell lymphomas with a primary bone marrow presentation. Histopathology 2020; 77:369-379. [PMID: 32324290 DOI: 10.1111/his.14124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/28/2020] [Accepted: 04/21/2020] [Indexed: 12/11/2022]
Abstract
Aggressive B-cell lymphomas present as a heterogeneous spectrum of disease. A primary diagnosis in the bone marrow (BM) may be challenging in terms of diagnostic classification and clinical handling, owing to limited architectural information. Aggressive B-cell lymphomas can be subdivided into entities that typically present primarily in the BM, and cases with BM involvement in which the bulk of disease is present in other organs. One main topic at the 2018 BM workshop of the European Association of Haematopathology/Society of Hematopathology was therefore aggressive B-cell lymphomas with a primary BM presentation. The spectrum of cases submitted to this topic gave a good overview of commonly encountered problems, as well as unusual manifestations, and highlighted areas of imprecise disease definitions and diagnostic grey zones. The categories submitted to the workshop included cases of Burkitt lymphoma (BL) with unusual features, high-grade B-cell lymphomas (HG-BCLs) with and without so-called double/triple-hit, and diffuse large B-cell lymphomas (DLBCLs) with a primary BM presentation. Areas of difficulties included the morphological boundaries of HG-BCL not otherwise specified, cases with MYC and bcl-2 or bcl-6 translocations and terminal deoxynucleotidyl transferase (TdT) expression, which were categorised as B-cell lymphoblastic leukaemia/lymphoma if most cells showed TdT positivity, and the clinicopathological overlap between intravascular large B-cell lymphoma, CD5-positive DLBCL, and DLBCL with primary presentations in the BM, spleen, and liver. This review summarises our understanding of the main aggressive B-cell lymphoma categories with a common primary BM presentation and potential problem areas, and makes suggestions for the immunophenotypic and genetic work-up, illustrated by the interesting and challenging cases submitted to the workshop.
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Affiliation(s)
- Alberto Zamò
- Department of Oncology, University of Turin, Turin, Italy.,Institute of Pathology, University of Würzburg, Würzburg, Germany
| | - Peter Johnston
- Department of Pathology, NHS Grampian, University of Aberdeen, NHS Education for Scotland, Aberdeen, Scotland
| | | | - Camille Laurent
- Pathology and Cytology Department, Centre Hospitalo-Universitaire de Toulouse, Institut Universitaire du Cancer de Toulouse-Oncopole, Centre de Recherche en Cancerologie de Toulouse, Inserm, UMR1037 laboratoire d'excellence TOUCAN, Paul Sabatier University Toulouse III, Toulouse, France
| | - Daniel A Arber
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Falko Fend
- Institute of Pathology and Comprehensive Cancer Centre, Tübingen University Hospital, Tübingen, Germany
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46
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Matsue K, Abe Y, Narita K, Kobayashi H, Kitadate A, Miura D, Takeuchi M, Takeuchi K. Bone marrow infiltration pattern in patients with intravascular large B-cell lymphoma diagnosed by random skin biopsy. EJHAEM 2020; 1:281-285. [PMID: 35847692 PMCID: PMC9175664 DOI: 10.1002/jha2.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/08/2020] [Accepted: 07/10/2020] [Indexed: 12/14/2022]
Abstract
We retrospectively analyzed bone marrow (BM) infiltration pattern in consecutive 30 intravascular large B-cell lymphoma (IVLBCL) patients diagnosed by random skin biopsy (RSB). BM infiltration of lymphoma was observed in 18 patients (60.0%), including five patients with the intrasinusoidal pattern with minimal extravasation, eight patients with the mixed of intrasinusoidal and scattered/interstitial or nodular infiltration, and five patients with the nodular/diffuse pattern. Twelve patients were negative for lymphoma infiltration. BM histology of patients with IVLBCL were diverse and frequently discordant with those of other site of IVLBCL lesions. BM biopsy had a poorer diagnostic performance for detecting intravascular features.
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Affiliation(s)
- Kosei Matsue
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Yoshiaki Abe
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Kentaro Narita
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Hiroki Kobayashi
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Akihiro Kitadate
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Daisuke Miura
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Masami Takeuchi
- Division of Hematology/OncologyDepartment of Internal MedicineKameda Medical CenterKamogawaJapan
| | - Kengo Takeuchi
- Division of PathologyThe Cancer InstituteJapanese Foundation for Cancer ResearchTokyoJapan
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47
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Li Q, Li J, Yang K, Peng Y, Xiang Y, Sun S, Zeng J, Zhang X, Wang J. EBV-positive intravascular large B-cell lymphoma of the liver: a case report and literature review. Diagn Pathol 2020; 15:72. [PMID: 32513269 PMCID: PMC7282072 DOI: 10.1186/s13000-020-00989-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/02/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Intravascular large B-cell lymphoma (IVLBCL) is an extremely rare subtype of diffuse large B-cell lymphoma that most commonly involves the central nervous system, skin, and bone marrow. To our knowledge, Epstein-Barr virus (EBV)-positive IVLBCL in the liver has never been reported in the literature. CASE PRESENTATION We report a case of a 65-year-old Chinese man with complaint of fever for 18 days. No obvious abnormality was found by physical examination. Laboratory findings were notable for anemia, thrombocytopenia, and elevated level of serum lactate dehydrogenase. Bone marrow on smear, biopsy, and flow cytometry revealed no lymphoma. Imaging studies showed a slightly lower density lesion in the liver with high fluorodeoxyglucose uptake and hepatosplenomegaly. Percutaneous liver biopsy revealed clustering of large atypical lymphocytes within the hepatic sinusoids. Immunohistochemically, these lymphoma cells were positive for CD20, PAX-5, MUM-1, BCL-6 and CD5, but negative for CD3 and CD10. Besides, Epstein-Barr virus-encoded RNA was detected in tumor cells by in situ hybridization. BCL-2, BCL-6 and MYC genes were intact tested by fluorescence in situ hybridization analysis. The patient was diagnosed as IVLBCL and died after 1 month of hospitalization without receiving immunochemotherapy. CONCLUSIONS IVLBCL of the liver is a highly rare lymphoma with nonspecific manifestations and dismal prognosis. Full recognition of its clinicopathological features will help to better diagnose this disease.
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Affiliation(s)
- Qingjiao Li
- Department of Pathology, Xiangya Hospital, Central South University, 87 Xiangya Road, Kaifu District, Changsha City, 410008, Hunan Province, China
| | - Jinghe Li
- Department of Pathology, Xiangya Hospital, Central South University, 87 Xiangya Road, Kaifu District, Changsha City, 410008, Hunan Province, China.,Department of Pathology, School of Basic Medicine, Central South University, Changsha City, Hunan Province, China
| | - Keda Yang
- Department of Pathology, Xiangya Hospital, Central South University, 87 Xiangya Road, Kaifu District, Changsha City, 410008, Hunan Province, China.,Department of Pathology, School of Basic Medicine, Central South University, Changsha City, Hunan Province, China
| | - Ying Peng
- Department of Pathology, Xiangya Hospital, Central South University, 87 Xiangya Road, Kaifu District, Changsha City, 410008, Hunan Province, China
| | - Yao Xiang
- Department of Pathology, Xiangya Hospital, Central South University, 87 Xiangya Road, Kaifu District, Changsha City, 410008, Hunan Province, China
| | - Shuyuan Sun
- Department of Pathology, School of Basic Medicine, Central South University, Changsha City, Hunan Province, China
| | - Jian Zeng
- Department of Pathology, School of Basic Medicine, Central South University, Changsha City, Hunan Province, China
| | - Xin Zhang
- Department of Pathology, School of Basic Medicine, Central South University, Changsha City, Hunan Province, China
| | - Junpu Wang
- Department of Pathology, Xiangya Hospital, Central South University, 87 Xiangya Road, Kaifu District, Changsha City, 410008, Hunan Province, China. .,Department of Pathology, School of Basic Medicine, Central South University, Changsha City, Hunan Province, China.
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48
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Ishida T, Takase H, Arai A, Ohno-Matsui K. Multimodal imaging of secondary vitreoretinal lymphoma with optic neuritis and retinal vasculitis. Am J Ophthalmol Case Rep 2020; 18:100696. [PMID: 32322750 PMCID: PMC7163062 DOI: 10.1016/j.ajoc.2020.100696] [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] [Received: 08/29/2018] [Revised: 08/04/2019] [Accepted: 04/02/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose To report the findings determined by multimodal imaging in an eye with secondary vitreoretinal lymphoma (VRL) with optic neuritis and retinal vasculitis. Observation The case was a 71-year-old woman with a secondary VRL exhibiting optic neuritis and retinal vasculitis in her right eye. Color fundus photographs and fluorescein angiograms showed optic neuritis and vasculitis in the posterior pole of the right eye. Indocyanine green angiography showed dye staining of the retinal vein walls in the late phase. Fundus autofluorescence showed fuzzy hyper-autofluorescence surrounded by mottled hyper-and hypo-autofluorescence in the right eye. OCT showed a retina with uniform infiltration and a thickened retinal pigmented epithelium (RPE) layer, perforated RPE, small RPE detachments, and hyperrefrective or isorefrective masses on the degenerated RPE layer in the marginal area. Her left eye showed a degenerated RPE and oval shaped iso-reflective lesions on the RPE. Conclusion The findings indicate that it is important to examine the marginal areas of eyes clinically diagnosed with VRL accompanied by optic neuritis and retinal vasculitis by multimodal imaging because these images can show the inflammatory signs of typical VRL including the sub-RPE lesions.
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Affiliation(s)
- Tomoka Ishida
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Takase
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ayako Arai
- Department of Laboratory Molecular Genetics of Hematology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology & Visual Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Shimada K, Yamaguchi M, Atsuta Y, Matsue K, Sato K, Kusumoto S, Nagai H, Takizawa J, Fukuhara N, Nagafuji K, Miyazaki K, Ohtsuka E, Okamoto M, Sugita Y, Uchida T, Kayukawa S, Wake A, Ennishi D, Kondo Y, Izumi T, Kin Y, Tsukasaki K, Hashimoto D, Yuge M, Yanagisawa A, Kuwatsuka Y, Shimada S, Masaki Y, Niitsu N, Kiyoi H, Suzuki R, Tokunaga T, Nakamura S, Kinoshita T. Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone combined with high-dose methotrexate plus intrathecal chemotherapy for newly diagnosed intravascular large B-cell lymphoma (PRIMEUR-IVL): a multicentre, single-arm, phase 2 trial. Lancet Oncol 2020; 21:593-602. [PMID: 32171071 DOI: 10.1016/s1470-2045(20)30059-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Intravascular large B-cell lymphoma (IVLBCL) is a rare disease for which there is no available standard treatment. We aimed to ascertain the safety and activity of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) with high-dose methotrexate and intrathecal chemotherapy as CNS-oriented therapy for patients with previously untreated IVLBCL. METHODS PRIMEUR-IVL is a multicentre, single-arm, phase 2 trial at 22 hospitals in Japan. Eligible patients had untreated histologically confirmed IVLBCL, were aged 20-79 years, had an Eastern Cooperative Group performance status of 0-3, and had no apparent CNS involvement at diagnosis. Patients received three cycles of R-CHOP (rituximab 375 mg/m2 intravenously on day 1 [except cycle one, which was on day 8]; cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, and vincristine 1·4 mg/m2 [maximum 2·0 mg] intravenously on day 1 of cycle one and day 2 of cycles two and three; and prednisolone 100 mg/day orally on days 1-5 of cycle one and days 2-6 of cycles two and three) followed by two cycles of rituximab with high-dose methotrexate (3·5 g/m2 intravenously on day 2 of cycles four and five) every 2 weeks and three additional cycles of R-CHOP. Intrathecal chemotherapy (methotrexate 15 mg, cytarabine 40 mg, and prednisolone 10 mg) was administered four times during the R-CHOP phase. The primary endpoint was 2-year progression-free survival. Efficacy analyses were done in all enrolled patients; safety analyses were done in all enrolled and treated patients. The trial is registered in the UMIN Clinical Trials Registry (UMIN000005707) and the Japan Registry of Clinical Trials (jRCTs041180165); the trial is ongoing for long-term follow-up. FINDINGS Between June 16, 2011, and July 21, 2016, 38 patients were enrolled, of whom 37 were eligible; one patient was excluded because of a history of testicular lymphoma. Median follow-up was 3·9 years (IQR 2·5-5·5). 2-year progression-free survival was 76% (95% CI 58-87). The most frequent adverse events of grade 3-4 were neutropenia and leucocytopenia, which were reported in all 38 (100%) patients. Serious adverse events were hypokalaemia, febrile neutropenia with hypotension, hypertension, and intracerebral haemorrhage (reported in one [3%] patient each). No treatment-related deaths occurred during protocol treatment. INTERPRETATION R-CHOP combined with rituximab and high-dose methotrexate plus intrathecal chemotherapy is a safe and active treatment for patients with IVLBCL without apparent CNS involvement at diagnosis, and this regimen warrants future investigation. FUNDING The Japan Agency for Medical Research and Development, the Center for Supporting Hematology-Oncology Trials, and the National Cancer Center.
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Affiliation(s)
- Kazuyuki Shimada
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Motoko Yamaguchi
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Yoshiko Atsuta
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan
| | - Kosei Matsue
- Division of Hematology/Oncology, Internal Medicine, Kameda Medical Center, Kamogawa, Japan
| | - Keijiro Sato
- Department of Hematology, Nagano Red Cross Hospital, Nagano, Japan
| | - Shigeru Kusumoto
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hirokazu Nagai
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Jun Takizawa
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine, Niigata, Japan
| | - Noriko Fukuhara
- Department of Hematology and Rheumatology, Tohoku University Hospital, Sendai, Japan
| | - Koji Nagafuji
- Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Kana Miyazaki
- Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Eiichi Ohtsuka
- Department of Hematology, Oita Prefectural Hospital, Oita, Japan
| | - Masataka Okamoto
- Department of Hematology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yasumasa Sugita
- Department of Hematology, Oami Municipal Hospital, Oamishirasato, Japan
| | - Toshiki Uchida
- Department of Hematology and Oncology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Japan
| | - Satoshi Kayukawa
- Department of Clinical Oncology, Nagoya Memorial Hospital, Nagoya, Japan
| | - Atsushi Wake
- Department of Hematology, Toranomon Hospital Kajigaya, Kawasaki, Japan
| | - Daisuke Ennishi
- Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan
| | - Yukio Kondo
- Department of Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Tohru Izumi
- Division of Hematology, Tochigi Cancer Center, Utsunomiya, Japan
| | - Yoshihiro Kin
- Department of Hematology, Daini Osaka Police Hospital, Osaka, Japan
| | - Kunihiro Tsukasaki
- Department of Hematology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Daigo Hashimoto
- Department of Hematology, Hokkaido University Faculty of Medicine, Graduate School of Medicine, Sapporo, Japan
| | - Masaaki Yuge
- Division of Hematology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Atsumi Yanagisawa
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan
| | - Yachiyo Kuwatsuka
- Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan; Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Satoko Shimada
- Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya, Japan
| | - Yasufumi Masaki
- Department of Hematology and Immunology, Kanazawa Medical University, Uchinada, Japan
| | - Nozomi Niitsu
- International Medical Center, Saitama Medical University, Hidaka, Japan
| | - Hitoshi Kiyoi
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ritsuro Suzuki
- Department of HSCT Data Management and Biostatistics, Nagoya University School of Medicine, Nagoya, Japan
| | - Takashi Tokunaga
- Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
| | - Shigeo Nakamura
- Department of Pathology and Clinical Laboratories, Nagoya University Hospital, Nagoya, Japan
| | - Tomohiro Kinoshita
- Division of Hematology and Cell Therapy, Aichi Cancer Center, Nagoya, Japan
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Yeh WZ, Muthusamy S, McKelvie P, Collins S, French A, Filshie R, Sutherland T, Trost N, Reardon K. Lymphoma, a great imitator in neurology. J Clin Neurosci 2020; 73:308-310. [PMID: 32081598 DOI: 10.1016/j.jocn.2020.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 12/15/2019] [Accepted: 02/08/2020] [Indexed: 12/14/2022]
Abstract
The title "great imitator" refers to conditions which can cause varied manifestations and mimic many diseases. Lymphoma is worthy of this title. We describe three cases of lymphoma in which lymphoma mimicked other diseases causing neurological dysfunction, specifically sarcoidosis, vasculitis and infection respectively. Case 1 was a 66-year-old man with subacute progressive diplopia and gait disturbance and investigations revealing a supratentorial para-falcine soft tissue lesion, mid-thoracic cord enhancement and right axillary mass and an elevated serum ACE. Right axillary mass core biopsy was diagnostic of Burkitt lymphoma. Case 2 was a 50-year-old man with several weeks of constitutional symptoms and development of lower limb weakness and numbness, urinary retention and confusion while in hospital. MRI brain demonstrated multi-territory cerebral infarcts. Intravascular lymphoma was diagnosed on random skin biopsy. Case 3 was a 65-year-old man with several weeks of headache and diplopia on a background of previously treated Burkitt lymphoma. CSF analysis showed a lymphocytic pleocytosis and markedly low glucose with cytologic analysis negative for malignancy. Investigations for an infective cause were negative. FDG-PET demonstrated marked, disseminated spinal and cranial leptomeningeal disease and a multi-focal, intra-dural relapse of Burkitt lymphoma was diagnosed. The varied manifestations in our cases demonstrate the ability for lymphoma to mimic infective, inflammatory, granulomatous (including sarcoidosis) and neoplastic aetiologies. An elevated serum ACE appears insufficiently diagnostic to confirm sarcoidosis and tissue for histological examination should be sought whenever possible. When the diagnosis is uncertain, the possibility of this great imitator should be considered, especially for multi-focal disease.
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Affiliation(s)
- Wei Zhen Yeh
- Department of Neurology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia.
| | - Subramanian Muthusamy
- Department of Neurology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| | - Penny McKelvie
- Department of Anatomical Pathology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| | - Steven Collins
- Department of Neurology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| | - Ann French
- Department of Neurology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| | - Robin Filshie
- Department of Haematology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| | - Tom Sutherland
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia; Faculty of Medicine, University of Melbourne, Parkville, Australia
| | - Nicholas Trost
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| | - Katrina Reardon
- Department of Neurology, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy VIC 3065, Australia
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