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Takeshige T, Harada N, Sekimoto Y, Kanemaru R, Tsutsumi T, Matsuno K, Shiota S, Masuda A, Gotoh A, Asahina M, Uekusa T, Takahashi K. Pulmonary Intravascular Large B-cell Lymphoma (IVLBCL) Disguised as an Asthma Exacerbation in a Patient with Asthma. Intern Med 2017; 56:1885-1891. [PMID: 28717087 PMCID: PMC5548684 DOI: 10.2169/internalmedicine.56.7613] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A 62-year-old man with asthma presented with a 1-month history of wheezing and exertional dyspnea. Although the wheezing symptoms disappeared after systemic corticosteroid therapy, the exertional dyspnea and hypoxemia did not improve. A diagnosis of intravascular large B-cell lymphoma (IVLBCL) with pulmonary involvement was suspected because of the increased serum lactic dehydrogenase (LDH) and soluble interleukin-2 receptor (sIL-2R) level, increased alveolar-arterial oxygen difference (AaDO2), decreased pulmonary diffusing capacity for carbon monoxide (DLCO) and scintigraphic, computed tomography (CT) and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)-CT findings. The patient was diagnosed as having IVLBCL with pulmonary involvement based on a pathological analysis of a random skin biopsy and a transbronchial lung biopsy. IVLBCL should be considered in patients with symptoms of asthma that are refractory to corticosteroid treatment.
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Affiliation(s)
- Tomohito Takeshige
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Norihiro Harada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Yasuhito Sekimoto
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Ryota Kanemaru
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Takeo Tsutsumi
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Kei Matsuno
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Satomi Shiota
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Azuchi Masuda
- Department of Hematology, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Akihiko Gotoh
- Department of Hematology, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Miki Asahina
- Department of Human Pathology, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
| | - Toshimasa Uekusa
- Department of Pathology, Labour Health and Welfare Organization Kanto Rosai Hospital, Japan
| | - Kazuhisa Takahashi
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Japan
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Abstract
Intravascular large B cell lymphoma (IVLBCL) is a rare type of extranodal diffused large B-cell lymphoma. IVLBCL with primary lung lesion is very rare and it is very difficult to diagnose. Radiographic findings of pulmonary IVLBCL are nonspecific and resembling interstitial lung diseases. Reversed halo sign (RHS) was initially reported in patients diagnosed with cryptogenic organizing pneumonia and then described in a variety of diseases with inflammatory, infectious, autoimmune, and malignant causes. This is the first case of IVLBCL that has presented with RHSs on CT scan.A 59-year-old Chinese man presented with a 4-month history of a nonproductive cough and a weight loss of 5 kg. Physical examination was unremarkable. High-resolution computed tomography scan of the chest showed bilateral patchy ground glass opacities (GGOs) and RHSs. Laboratory tests were unremarkable except elevated serum lactate dehydrogenase (LDH). Surgical lung biopsy was performed. Light microscopic examination of the specimen disclosed diffuse alveolar septal widening caused by neoplastic lymphocytes, which were positive for CD20 and infiltrated in the alveolar capillaries. The patient was diagnosed with IVLBCL and underwent chemotherapy and autologous blood stem cell transplantation. The patient is still alive 5 years after diagnosis.IVLBCL is a rare cause of RHS and should be considered in differential diagnosis of RHS. An increased serum LDH concentration is another important clue.
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Affiliation(s)
- Min Peng
- From the Department of Respiratory Medicine (MP, JS); Department of Pathology (HL), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and Department of Medicine, Division of Integrative Medicine, Mayo Clinic, Rochester, MN (GL)
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Sakamoto N, Aiba M, Takahashi M, Sakurai T, Yang KS, Tsuda H. [A case of intravascular large B-cell lymphoma with rapidly progressive cognitive impairment after cerebral infarction]. Nihon Ronen Igakkai Zasshi 2012; 49:783-7. [PMID: 23883644 DOI: 10.3143/geriatrics.49.783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 67-year-old man started to show symptoms of dementia and developed convulsions accompanied by presyncope. Since an old cerebral infarction was found, he was given a diagnosis of symptomatic epilepsy, treated with antiepileptics. Dementia progressed rapidly, resulting in admission to a dementia ward. There were no physical abnormalities, and only slight elevations of LDH and CRP were noted. He suddenly developed a fever between 38°C and 39°C. Only the serum concentration of soluble IL-2 receptor was elevated at 6,430 U/L. Although a malignant tumor of the lymphatic system was suspected, there was no swelling noted in the superficial lymph nodes. The patient suddenly developed hypoxemia, thrombocytopenia, and an increase in fibrin degradation products. Pulmonary thromboembolism was suspected, but contrast-enhanced chest CT did not reveal any abnormalities. Bone marrow aspiration did not detect any infiltrations of lymphoid cells but was suggestive of hemophagocytic syndrome. After that, a new cerebral infarction occurred. Based on the course, intravascular lymphoma, which causes microvascular occlusions in various organs, was considered probable. Prednisolone was administered at a dose of 60 mg daily and skin biopsy was scheduled. However, the patient experienced a sudden deterioration and died. In autopsy, immunostain with CD20 showed that the arteriolae, capillaries, and venulae of thoracic and abdominal organs were filled with cells of large B-cell lymphoma. The presence of similar cerebrovascular lesions was not confirmed, but can reasonably be speculated. Thus, the present case suggests that it is necessary to consider intravascular lymphoma when dementia rapidly progresses for unknown reasons.
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Affiliation(s)
- Naoharu Sakamoto
- Department of Geriatric General Medicine, Juntendo Tokyo Koto Geriatric Medical Center
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Kotake T, Kosugi S, Takimoto T, Nakata S, Shiga J, Nagate Y, Nakagawa T, Take H, Katagiri S. Intravascular large B-cell lymphoma presenting pulmonary arterial hypertension as an initial manifestation. Intern Med 2010; 49:51-4. [PMID: 20046001 DOI: 10.2169/internalmedicine.49.2774] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a 39-year-old man with intravascular large B-cell lymphoma (IVLBCL) who had been treated as a case with pulmonary arterial hypertension (PAH) for one year. After he became worse, diffuse pulmonary (18)F-fluorodeoxyglucose (FDG) uptake in positron emission tomography (PET) suggested the existence of IVLBCL in the lung showing normal CT images. The diagnosis was confirmed with random transbronchial lung biopsy, and he was then successfully treated. Since IVLBCL presenting PAH has been rare and is difficult to diagnose, early application of FDG-PET may provide early recognition of the disorder, leading to a better outcome.
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Affiliation(s)
- Takeshi Kotake
- Department of Internal Medicine, Toyonaka Municipal Hospital, Toyonaka, Japan.
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Kitanaka A, Kubota Y, Imataki O, Ohnishi H, Fukumoto T, Kurokohchi K, Tanaka T. Intravascular large B-cell lymphoma with FDG accumulation in the lung lacking CT/67gallium scintigraphy abnormality. Hematol Oncol 2009; 27:46-9. [DOI: 10.1002/hon.876] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Lymphoid lesions of the lung produce a complex of problems for the practicing pathologist. Although these lesions are eventually referred to hematopathologists, it is still the general surgical pathologist who first encounters them and confronts the problem of formulating an initial diagnosis. Over the last 20 years there has been a revolution in our knowledge of the classification and natural history of the pulmonary lesions, a plethora of information which warrants a thorough review. The purpose of this discussion is to report the clinical features and courses, pathologic features and, when known, etiologies or pathogenesis of the major "primary" pulmonary lymphoid lesions and present a brief approach to differential diagnosis. I will divide the lesions into malignant and benign, discussing each in turn.
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Affiliation(s)
- Michael N Koss
- Department of Pathology, Keck School of Medicine, University of Southern California, Hoffman Medical Research Building Room 209, 2011 Zonal Avenue, Los Angeles, CA 90033, USA
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Chim CS, Choy C, Ooi GC, Chung LP, Wong KK, Liang R. Two unusual lymphomas. Case 2: pulmonary intravascular lymphomatosis. J Clin Oncol 2000; 18:3733-5. [PMID: 11054448 DOI: 10.1200/jco.2000.18.21.3733] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- C S Chim
- Queen Mary Hospital, The University of Hong Kong, Hong Kong
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Walls JG, Hong YG, Cox JE, McCabe KM, O'Brien KE, Allerton JP, Derdak S. Pulmonary intravascular lymphomatosis: presentation with dyspnea and air trapping. Chest 1999; 115:1207-10. [PMID: 10208234 DOI: 10.1378/chest.115.4.1207] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Intravascular lymphomatosis (IVL) is a rare lymphoid neoplasm that is typically of B-cell lineage and characterized by proliferation of malignant cells within small arterioles, capillaries, and venules. We report a patient with pulmonary IVL who presented clinically with progressive dyspnea, fever, and a dry cough. Pulmonary function tests revealed a marked decrease in diffusion capacity with airflow obstruction and severe air trapping. High-resolution CT (HRCT) of the chest with inspiratory and expiratory images revealed mosaic attenuation consistent with air trapping. Transbronchial biopsies revealed the diagnosis of IVL with capillary expansion in the alveolar and peribronchiolar interstitial tissue. IVL should be considered in the differential diagnosis of a patient with an interstitial lung disease, air trapping on pulmonary function tests, and mosaic attenuation on HRCT. Transbronchial biopsies may be the initial diagnostic procedure of choice.
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Affiliation(s)
- J G Walls
- Department of Pulmonary/Critical Care, Wilford Hall, USAF Medical Center, Lackland AFB, San Antonio, TX 78236, USA
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Kreiss Y, Schwartz E, Kaminski N, Raanani P, Schiby G, Zvas Z, Sidi Y. Unique pulmonary presentation of intravascular large cell lymphoma. Respir Med 1998; 92:1087-9. [PMID: 9893783 DOI: 10.1016/s0954-6111(98)90362-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Y Kreiss
- Department of Medicine C, Sheba Medical Center, Tel Hashomer, Israel
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Affiliation(s)
- H J Jang
- Department of Radiology, Samsung Medical Center, College of Medicine, Sung Kyun Kwan University, Seoul, South Korea
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Abstract
An unusual case of intravascular lymphomatosis caused by small noncleaved, non-Burkitt's lymphoma, which presented with adult respiratory distress syndrome, is described. Extensive invasion of the small- and medium-size blood vessels of the lung, liver, spleen, kidneys, heart, esophagus, stomach, small and large intestines, bladder, and brain-but not the bone marrow or peripheral blood-is documented. The possible mechanism and the unusual features of this case are discussed in comparison with previously reported cases. The pertinent literature is reviewed. The problem of diagnosing this pathological entity is emphasized.
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Affiliation(s)
- E P Gabor
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Kaphan R, Taillan B, Boscagli A, Bianchi D, Perrin C, Hoffman P, Dujardin P. Une pneumopathie interstitielle récidivante de cause inhabituelle. Rev Med Interne 1996. [DOI: 10.1016/0248-8663(96)86461-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
The spectrum of lymphoproliferative disorders is truly a continuum from benign diseases to malignant aggressive lymphomas. Remarkable advances in laboratory techniques of monoclonal antibody production and molecular biology over the last decade allow more sophisticated analysis of these diseases. It is now apparent that some entities previously labeled "benign" are actually non-Hodgkin's lymphomas. We review the current knowledge of this spectrum including the histopathologic and clinical findings, as well as the radiographic characteristics. Understanding the diseases, treatment challenges, and follow-up requirements aids the radiologist in a more efficient and cost-effective evaluation of these patients.
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Affiliation(s)
- K A Murray
- University of Utah Health Sciences Center, Salt Lake City, USA
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Abstract
BACKGROUND Intravascular lymphoma (IVL) is an uncommon malignancy defined pathologically by neoplastic proliferation of lymphoid cells within the lumens of capillaries, small veins, and arteries, with little or no adjacent parenchymal involvement. The nature of IVL has been the subject of considerable controversy. Recent immunohistochemical studies have demonstrated clearly that the tumors bear the immunophenotype of neoplastic lymphoid cells of either B-cell or T-cell lineage. IVL commonly affects the central nervous system, resulting in progressive dementia and multiple neurologic deficits; skin is the second most common site of involvement, in the form of cutaneous plaques and nodules. METHODS In a retrospective review of all cases of non-Hodgkin's lymphoma seen at our institution, four cases of IVL were identified. Case 1 was fixed in methacarin, and Cases 2-4 were fixed in 10% formalin. Standard fixation, tissue processing, sectioning, and hematoxylin and eosin staining were used. Immunophenotypic studies were performed using a modified avidin-biotin complex technique. The specimen in Case 1 was stained by Giemsa stain using standard techniques. RESULTS Four cases of IVL are presented. One patient experienced hypoxemia and fevers of unknown origin; the second, dementia and a vasculitislike illness; the third rapidly progressive dementia, nonlocalizing neurologic deficits, and panhypopituitarism; the fourth Kaposi-like skin lesions. Case 1 relapsed shortly after completing chemotherapy. Salvage chemotherapy has yielded good initial response. Autopsy findings in cases 2, 3 and 4 confirmed IVL in many vessels, including the brain, lung, liver, heart, gastrointestinal tract, glomerulus, central nervous system, and skin. Malignant lymphoid cells marked as B-cells in all cases. CONCLUSIONS Unusual and interesting clinical presentations may occur in patients with IVL. The medical literature indicates that few cases are diagnosed ante mortem. Although isolated patients may respond favorably to chemotherapy, most will deteriorate rapidly and the diagnosis of IVL not contemplated until necropsy.
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Affiliation(s)
- T Demirer
- Division of Oncology, Virginia Mason Medical Center, Seattle, WA 98111
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Abstract
BACKGROUND Intravascular lymphomatosis (IL) is a systemic neoplasm that often involves the nervous system, inducing progressive neurologic deficits in the setting of undiagnosed or quiescent extranodal non-Hodgkin lymphoma. METHODS The clinical and pathologic files of the Massachusetts General Hospital and New York University Medical Center and the English language literature were reviewed to identify all reports of intravascular lymphomatosis (angioendotheliomatosis) or other examples of a diffuse proliferation of neoplastic cells filling capillaries, arterioles, and venules. RESULTS The authors report seven patients with IL and note 114 patients reported in the literature. Almost two-thirds (63%) of patients had neurologic manifestations, without abnormalities on bone marrow biopsy, chest and abdominal tomographic examinations for adenopathy, and cerebrospinal fluid (CSF) analysis. All patients had one or more of four syndromes, each reflecting a vascular occlusive process: progressive, multifocal cerebrovascular events; paraparesis, pain, and incontinence; a subacute encephalopathy; and peripheral or cranial neuropathies. CONCLUSIONS The unexplained presence of any one or more of these neurologic syndromes should alert the physician to the possible presence of this disease.
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Affiliation(s)
- J Glass
- Department of Neurology, Temple University Health Sciences Center, Philadelphia, Pennsylvania 19140
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Curtis JL, Warnock ML, Conrad DJ, Helfend LK, Boushey HA. Intravascular (angiotropic) large-cell lymphoma ('malignant angioendotheliomatosis') with small vessel pulmonary vascular obstruction and hypercalcemia. West J Med 1991; 155:72-6. [PMID: 1877242 PMCID: PMC1002926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- J L Curtis
- Department of Medicine, University of California, San Francisco, School of Medicine
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Tateyama H, Eimoto T, Tada T, Kamiya M, Fujiyoshi Y, Kajiura S. Congenital angiotropic lymphoma (intravascular lymphomatosis) of the T-cell type. Cancer 1991; 67:2131-6. [PMID: 2004333 DOI: 10.1002/1097-0142(19910415)67:8<2131::aid-cncr2820670821>3.0.co;2-i] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The autopsy of a stillborn infant showed an extensive intravascular proliferation of atypical cells throughout the body. There was no infiltration by these cells of the parenchyma of the bone marrow, lymph nodes, or thymus. By histochemistry, these cells were negative for naphthol-ASD-chloroacetate esterase, a marker of granulocytes. By immunohistochemistry, they were reactive with MT-1 and anti-Leu-22, but unreactive with MB-1, L26, anti-Leu-M1, Tü-9, and antihemoglobin antibodies. A few cells reacted with antileukocyte common antigen and UCHL-1. Based on these findings, the lesion was diagnosed as angiotropic lymphoma (intravascular lymphomatosis) of the T-cell type, which occurred congenitally. Most angiotropic lymphomas in the literature are of the B-cell type, and no leukemia virus type I antibody was negative in the mother.
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Affiliation(s)
- H Tateyama
- Department of Pathology, Nagoya City University School of Medicine, Japan
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