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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] [What about the content of this article? (0)] [Affiliation(s)] [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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2
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Naito K, Suzuki S, Ohwada C, Ishiwata K, Ruike Y, Ishida A, Deguchi-Horiuchi H, Fujimoto M, Koide H, Sakaida E, Horiguchi K, Iwadate Y, Tatsuno I, Inoshita N, Ikeda JI, Tanaka T, Yokote K. ICAM1-Negative Intravascular Large B-Cell Lymphoma of the Pituitary Gland: A Case Report and Literature Review. AACE Clin Case Rep 2021; 7:249-255. [PMID: 34307847 PMCID: PMC8282537 DOI: 10.1016/j.aace.2021.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/27/2021] [Indexed: 11/25/2022] Open
Abstract
Objective Intravascular large B-cell lymphoma (IVLBCL) is a rare and aggressive type of B-cell lymphoma with large cells growing within the lumen of blood vessels. Although previous reports revealed highly variable symptoms resulting from small-vessel occlusion by neoplastic cells in a variety of organs, there are few reports of IVLBCL with pituitary involvement. Method We present a case of IVLBCL with pituitary infiltration from our institution together with a literature review of similar cases to better understand this rare case of IVLBCL involving the pituitary gland. Results Our case and the pertinent literature demonstrated that IVLBCL with pituitary involvement predominantly occurred in women at a mean age of 64 years, and most of them showed panhypopituitarism that was reversible after standard therapy of rituximab-containing chemotherapy with intrathecal methotrexate. Notably, the pituitary biopsy in our case revealed that atypical large B-cells found within blood vessels and the pituitary gland were negative for intercellular adhesion molecule 1. Intercellular adhesion molecule 1-negative lymphoid cells may have contributed to panhypopituitarism by extravasation into the pituitary tissues, which do not have a blood-brain barrier and receive abundant blood flow. Conclusion IVLBCL of the pituitary gland is a rare lymphoma with nonspecific manifestations and a dismal prognosis. Recognition of the clinicopathological features is necessary for early clinical diagnosis and appropriate treatment.
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Key Words
- ACTH, adrenocorticotropic hormone
- BAL, bronchoalveolar lavage fluid analysis
- CRH, corticotropin-releasing hormone
- FDG, 18F-fluorodeoxyglucose
- FSH, follicle-stimulating hormone
- GH, growth hormone
- GHRP2, growth hormone-releasing peptide 2
- ICAM1
- ICAM1, intercellular adhesion molecule 1
- IVLBCL, intravascular large B-cell lymphoma
- LDH, lactate dehydrogenase
- LH, luteinizing hormone
- LHRH, luteinizing hormone-releasing hormone
- MEAM, ranimustine, etoposide, cytarabine, and melphalan
- MTX, methotrexate
- R-CHOP, rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone
- R-hyper-CVAD/MA, rituximab plus hyper-fractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone alternating with methotrexate and cytarabine
- TBLB, transbronchial lung biopsy
- TRH, thyrotropin-releasing hormone
- TSH, thyrotropin
- hypopituitarism
- intravascular
- large B-cell lymphoma
- pituitary
- sIL2R, soluble IL-2 receptor
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Affiliation(s)
- Kumiko Naito
- Department of Endocrinology, Hematology and Gerontology, Chiba University Hospital, Chiba, Japan.,Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Sawako Suzuki
- Department of Endocrinology, Hematology and Gerontology, Chiba University Hospital, Chiba, Japan.,Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Chikako Ohwada
- Department of Endocrinology, Hematology and Gerontology, Chiba University Hospital, Chiba, Japan.,Department of Hematology, Chiba University Hospital, Chiba, Japan
| | - Kazuki Ishiwata
- Department of Endocrinology, Hematology and Gerontology, Chiba University Hospital, Chiba, Japan.,Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Yutaro Ruike
- Department of Endocrinology, Hematology and Gerontology, Chiba University Hospital, Chiba, Japan.,Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Akiko Ishida
- Department of Endocrinology, Hematology and Gerontology, Chiba University Hospital, Chiba, Japan.,Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Hanna Deguchi-Horiuchi
- Department of Endocrinology, Hematology and Gerontology, Chiba University Hospital, Chiba, Japan.,Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Masanori Fujimoto
- Department of Endocrinology, Hematology and Gerontology, Chiba University Hospital, Chiba, Japan.,Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Hisashi Koide
- Department of Endocrinology, Hematology and Gerontology, Chiba University Hospital, Chiba, Japan.,Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
| | - Emiko Sakaida
- Department of Endocrinology, Hematology and Gerontology, Chiba University Hospital, Chiba, Japan.,Department of Hematology, Chiba University Hospital, Chiba, Japan
| | - Kentaro Horiguchi
- Department of Neurological Surgery, Chiba University Hospital, Chiba, Japan
| | - Yasuo Iwadate
- Department of Neurological Surgery, Chiba University Hospital, Chiba, Japan
| | - Ichiro Tatsuno
- Center for Diabetes, Metabolism and Endocrinology, Toho University Sakura Medical Center, Chiba, Japan
| | - Naoko Inoshita
- Department of Pathological Diagnosis, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Jun-Ichiro Ikeda
- Department of Pathology, Chiba University Hospital, Chiba, Japan
| | - Tomoaki Tanaka
- Department of Molecular Diagnosis, Chiba University, Chiba, Japan
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Hospital, Chiba, Japan.,Department of Diabetes, Metabolism and Endocrinology, Chiba University Hospital, Chiba, Japan
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3
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Fischer M, Iglseder S, Grams A, Matosevic B, Moser P, Stockhammer G, Pfausler B. Intravascular large B-cell lymphoma mimicking central nervous system vasculitis. Human Pathology: Case Reports 2017. [DOI: 10.1016/j.ehpc.2016.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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4
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Sawada Y, Ishii S, Koga Y, Tomizawa T, Matsui A, Tomaru T, Ozawa A, Shibusawa N, Satoh T, Shimizu H, Hirato J, Yamada M. Reversible Hypopituitarism Associated with Intravascular Large B-Cell Lymphoma: Case Report of Successful Immunochemotherapy. TOHOKU J EXP MED 2017; 238:197-203. [PMID: 26936510 DOI: 10.1620/tjem.238.197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of diffuse large B-cell lymphoma. There have been only a limited number of reports regarding pituitary dysfunction associated with IVLBCL. We present a 71-year-old woman with hypopituitarism without any hypothalamic/pituitary abnormalities as assessed by magnetic resonance imaging. She presented with edema, abducens palsy, and elevated levels of lactate dehydrogenase and soluble interleukin-2 receptor. Provocative testing showed that the peaks of luteinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone and adrenocorticotropic hormone were evoked to normal levels by simultaneous administration of luteinizing hormone-releasing hormone, thyrotropin-releasing hormone and corticotropin-releasing hormone, but the responses of these four pituitary hormones showed a delayed pattern. She was diagnosed with IVLBCL with cerebrospinal invasion by pathological findings of the bone marrow, skin, and cerebrospinal fluid. She achieved hematological remission after immunochemotherapy. Pituitary function was also restored without hormonal replacement, and the improvement of the pituitary function was confirmed by dynamic testing. We reviewed the literature with respect to hypopituitarism associated with IVLBCL. There were less than 20 case reports and most of the patients died. Endocrinological course was described in only two cases, and both of them required hormonal supplementation. To our knowledge, this is the first case of hypopituitarism induced by IVLBCL that was successfully managed by immunochemotherapy alone. This case suggests that early diagnosis and treatment of IVLBCL might improve anterior pituitary function and enable patients to avoid hormone replacement therapy.
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Affiliation(s)
- Yusuke Sawada
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine
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5
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Savard M, Verreault S, Gould PV, Bernier V, Bouchard J. Intravascular Lymphoma with Conus Medullaris Syndrome Followed by Encephalopathy. Can J Neurol Sci 2008; 35:366-71. [DOI: 10.1017/s0317167100008982] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background:Intravascular large cell lymphoma (ILCL) is a diagnostic challenge, with neurological, cutaneous and constitutional symptoms. The natural history is usually an evolution to a comatose state. As invasive procedures are usually required for diagnosis, recognizing the typical clinical pattern is critical since an effective treatment is available.Method:After an extensive literature review of the subject, we report a case of ILCL, analyzing clinical, laboratory, radiological and pathological data. We will also give a special attention to the clinical picture of a conus medullaris (CM) lesion with subsequent encephalopathy in the same patient.Results:We report here a 61-year-old woman with a paraplegia caused by a CM lesion, evolving about one year latter to encephalopathy and eventual coma, with the diagnosis of ILCL confirmed by autopsy. The present case is similar to eight other cases in literature who had CM lesion associated with ILCL, knowing that 80-90% of these patients will eventually evolve to encephalopathy without treatment. Conclusions: ILCL is a recognized but rare cause of coma. Diagnosing it is tremendously important since it is fatal if left untreated. We propose that this specific picture (conus medullaris lesion, eventually evolving to encephalopathy) is quite characteristic and will directly result in better outcome if recognized.
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6
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Yanagihori H, Oyama N, Kawakami Y, Sakuma-Oyama Y, Nakamura K, Iwatsuki K, Kaneko F. A Case of Intravascular Large B-Cell Lymphoma with Multiple Organ Involvement. J Dermatol 2014; 30:910-4. [PMID: 14739519 DOI: 10.1111/j.1346-8138.2003.tb00347.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2003] [Accepted: 08/19/2003] [Indexed: 11/28/2022]
Abstract
Intravascular large B-cell lymphoma (IVL) is a rare systemic disease characterized by clonal proliferation of neoplastic lymphoid cells within the capillary lumina of small blood vessels. The most common sites of involvement are cerebrovascular or sinusoid areas, resulting in a wide variety of neurologic deficits. Herein we describe a case of IVL that presented with multiple internal and external organ involvements, including the skin, bilateral kidneys, and lung, and with an aggressive clinical course. The confirmative diagnosis was based on the microscopic findings of the skin lesion with a B-cell immunophenotype. The patient suffered from repeated severe dyspnea, hypoxemia, and high-grade fever with a simultaneous increase in serum lactate dehydrogenase and soluble IL-2 receptor levels. These manifestations responded dramatically to intravenous injection of corticosteroid (500 mg/day for 3 days). Despite various clinical presentations, no neurological abnormality was observed until the patient died 12 months after the initial combination chemotherapy.
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MESH Headings
- Diagnosis, Differential
- Fatal Outcome
- Female
- Humans
- Kidney Neoplasms/diagnosis
- Kidney Neoplasms/diagnostic imaging
- Kidney Neoplasms/drug therapy
- Kidney Neoplasms/secondary
- Lung Neoplasms/diagnosis
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/drug therapy
- Lung Neoplasms/secondary
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/diagnostic imaging
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Middle Aged
- Multiple Organ Failure
- Neoplasm Metastasis
- Skin Neoplasms/diagnosis
- Skin Neoplasms/diagnostic imaging
- Skin Neoplasms/drug therapy
- Skin Neoplasms/secondary
- Tomography, X-Ray Computed
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Affiliation(s)
- Hirokatsu Yanagihori
- Department of Dermatology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
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7
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Abstract
Intravascular lymphoma (IVL) is a rare disease form of malignant lymphoma, and it is characterised by the selective growth of lymphoma cells within the lumina of vessels. Identification of this disease at an early stage is difficult because of non-specific clinical symptoms and neuroradiological findings. Most reported IVL cases are diagnosed at post-mortem following autopsy. We report the case of a patient who presented with status epilepticus (SE) as the initial manifestation of IVL. Despite the administration of anti-convulsant agents and general care the patient's condition deteriorated rapidly after admission, culminating in death due to respiratory failure and heart failure 21 days after the onset of symptoms. Post-mortem examination revealed IVL in the brain and multiple organs. Epileptic seizures often appear during the clinical course of IVL; however, they occur most frequently at advanced stages. Diagnosis of IVL that first presents with SE is of clinical importance because the treatment and prognosis of acute SE arising from IVL are different from those of SE originating from other causes.
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Affiliation(s)
- Akiyuki Hiraga
- Departments of Neurology, Chiba Rosai Hospital, Ichihara, Chiba, Japan
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8
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Kumar N, Keegan BM, Rodriguez FJ, Hammack JE, Kantarci OH. Intravascular lymphoma presenting as a longitudinally-extensive myelitis: Diagnostic challenges and etiologic clues. J Neurol Sci 2011; 303:146-9. [DOI: 10.1016/j.jns.2010.12.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 12/17/2010] [Indexed: 11/17/2022]
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9
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Passarin MG, Wen PY, Vattemi E, Buffone E, Ghimenton C, Bontempini L, Ottaviani S, Musso AM, Pedersini R. Intravascular lymphomatosis and intracerebral haemorrhage. Neurol Sci 2010; 31:793-7. [PMID: 20517703 DOI: 10.1007/s10072-010-0284-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 04/07/2010] [Indexed: 11/27/2022]
Abstract
Intravascular lymphomatosis (IVL) is a rare, malignant B- or T-cell lymphoma with remarkable affinity for the endothelial cells of small vessels, particularly within the skin and central nervous system. It is a disease that mimics several neurological disorders, particularly those of cerebrovascular ischemic origin. The prognosis is generally poor, with a rapidly fatal outcome. As a result the diagnosis is often made at post-mortem. We report a rare case of a 73-year-old patient with IVL complicated by intracerebral haemorrhage. In literature two cases of systemic IVL complicated by intracerebral haemorrhage have been reported, but they presented initially with a disseminated intravascular coagulation (DIC). This is the first case of brain IVL complicated by intracerebral haemorrhage not associated to DIC. Increasing awareness of this disease as a differential diagnosis to a common clinical presentation may lead to more opportunities to evaluate new diagnostic and treatment approaches.
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Affiliation(s)
- Maria Grazia Passarin
- Division of Neurology, Department of Medicine, Bussolengo Hospital, Via Ospedale 2, Bussolengo, Verona, Italy.
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10
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Nafsi T, Lin MV, Stern J. Angiotropic lymphoma: A Concealed Etiology of Fever of Unknown Origin. ELECTRON J GEN MED 2010. [DOI: 10.29333/ejgm/82861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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11
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Abstract
Intravascular lymphoma is a rare aggressive systemic neoplasm with neurological and cutaneous presentation, which commonly eludes the diagnosis ante mortem. We document a case of intravascular lymphoma in a 65-year-old man who presented with altered mental status, fevers and weight loss. The diagnosis was made by random skin biopsies demonstrating an intravascular, CD20 positive cellular infiltrate. Initial treatment consisted of cyclophosphamide, vincristine, doxorubicin, prednisone and rituximab. Because of disease progression, the therapy was switched to weekly rituximab after the first cycle. A complete response was observed with resolution of symptoms and laboratory abnormalities. The patient remains in remission 3 years after completion of therapy. This is the first case report to describe a sustained remission following single-agent rituximab in the patient with neurologic involvement of intravascular lymphoma who failed antracycline-based therapy. Single-agent rituximab has activity in this disease and may be considered as a treatment option.
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12
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Blecic S. Rare causes of stroke. Handb Clin Neurol 2009; 93:955-968. [PMID: 18804688 DOI: 10.1016/s0072-9752(08)93047-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Serge Blecic
- Hôpital Erasme, Service de Neurologie, Brussels, Belgium.
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13
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Abstract
Intravascular lymphoma (malignant angioendotheliomatosis, angiotrophic lymphoma) is a rare neoplastic disorder in dogs. The literature contains few reports in dogs and a single report in a cat. Intravascular lymphoma is characterized by an intravascular proliferation of malignant lymphocytes. This unique angiocentric distribution of neoplastic cells leads to the characteristic clinicopathologic feature of thromboses and infarctions. In people, intravascular lymphoma has a predilection for vessels in the central nervous system (CNS) and skin. Typically, affected patients have episodic symptoms that coincide with the timing of infarctions. This report details the clinicopathologic description and magnetic resonance (MR) images of a dog with intravascular lymphoma that resulted in multiple CNS infarctions. Abnormalities identified with MR imaging consisted of multifocal hyperintensities observed in pre-contrast T1-weighted, T2-weighted, intermediate-weighted, and FLAIR pulse sequences. Lesions were most conspicuous on the FLAIR images. In addition, there was mild enhancement of the lesions seen in post-contrast T1 weighted images.
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Affiliation(s)
- M Kent
- Department of Clinical Sciences, Tufts University School of Veterinary Medicine, North Grafton, MA 01536, USA
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14
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Massimino M, Giardini R, Cefalo G, Simonetti F, Pollo B, Giombini S, Tesoro-Tess JD, Ponzoni M, Patriarca C. Intravascular lymphomatosis (IL) in a child mimicking a posterior fossa tumor. J Neurooncol 2001; 51:47-50. [PMID: 11349880 DOI: 10.1023/a:1006476701534] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Intravascular lymphomatosis (IL) is a rare entity only recently included in lymphoma classification, whose main feature is the exclusive or predominant growth of neoplastic cells within blood vessels. The vast majority of the patients affected by IL belong to the 7th or 8th decade of life and present with skin rash or CNS diffuse necrotic or demyelinating lesions. Case report. SS, a 13-year-old girl, was admitted to a Neurosurgery Unit because of endocranic hypertension, where, after CT and MRI documenting a IV ventricle 3 cm diameter tumor, she was submitted to complete tumor excision: extemporary diagnosis was suggestive of medulloblastoma. When referred to us she had persistent fever with normal blood and spinal fluid cultures. Whole CNS MRI did not give evidence of residual or metastatic disease while CSF cytology showed only pleiocytosis. Treatment was started according to our ongoing protocol for medulloblastoma with pre-radiation chemotherapy. Before delivering radiotherapy (RT), upon review of histologic specimens, the definitive diagnosis of IL B-phenotype was made. The girl was re-admitted and, after a complete re-staging, chemotherapy was intensified according to our schedule for high-grade B-cell lymphoma and CNS was irradiated up to a total dose of 25 Gy. She remained alive in continuous complete remission at 21 months after diagnosis. The case here reported is unique for age, tumor presentation, and, so far, favourable outcome, in spite of the delayed histological diagnosis.
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Affiliation(s)
- M Massimino
- Unit of Pediatrics, Istituto Nazionale Tumori, Milan, Italy.
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15
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Affiliation(s)
- H Loiseau
- Clinique Universitaire de Neurochirurgie, Bordeaux, France
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16
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Ormsby A, Prayson RA, Heard R. Angiotrophic large cell lymphoma mimicking multiple sclerosis associated transverse myelitis. J Clin Neurosci 1999; 6:408-10. [DOI: 10.1016/s0967-5868(99)90036-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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17
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Abstract
Intravascular lymphomatosis (of B- or T-cell origin) is a rare lymphoproliferative disorder characterised by neoplastic proliferation of lymphoid cells within the lumen of capillaries, small veins and arteries with no or minimal involvement of the parenchyma. Its predilection sites are the skin and the brain. We studied a 44-year-old man who presented with a 2 year history of unexplained LDH elevation followed by a neurological syndrome without systemic involvement. Brain biopsy showed an intravascular lymphoma of the B-cell lineage. This report illustrates the diagnostic challenge of this rare disorder with a grim prognosis.
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Affiliation(s)
- M Vieren
- Department of Neurology and Neuropathology, University Hospital Gasthuisberg, Leuven, Belgium
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18
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19
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Abstract
Intravascular large cell lymphoma (malignant angioendotheliomatosis) is a rare, multifocal, intravascular neoplasm of lymphoid cells that preferentially involves the vasculature of the skin and central nervous system. We describe a 54-year-old man with asymptomatic purpuric patches on the lower extremities for 10 years duration and a more recent lesion on the right arm. A biopsy specimen showed intravascular collections of tumor cells with irregular nuclear contours and prominent nucleoli. These cells were leukocyte common antigen (CD45), CD20, and CDW75 positive, but CD3, CD43, CD45RO, and cytokeratin negative. Polymerase chain reaction analysis of the skin for immunoglobulin heavy chain gene rearrangement detected a clonal population of B cells, supporting the diagnosis of a B-cell lymphoma. Peripheral blood showed no abnormal circulating cells. This case of malignant angioendotheliomatosis is unusual for its prolonged clinical course and presence of purpuric patches.
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MESH Headings
- Antigens, CD/analysis
- Antigens, CD20/analysis
- Humans
- Leukocyte Common Antigens/analysis
- Lymphoma, B-Cell/chemistry
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/complications
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Male
- Middle Aged
- Purpura/complications
- Purpura/pathology
- Sialyltransferases
- Skin Diseases, Vascular/complications
- Skin Diseases, Vascular/pathology
- Vascular Neoplasms/complications
- Vascular Neoplasms/immunology
- Vascular Neoplasms/pathology
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Affiliation(s)
- A Chang
- Department of Dermatology, Vanderbilt University, Nashville, Tennessee, USA
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20
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Jellinger KA. An autopsy case of intravascular malignant lymphoma presenting with intracranial B-cell type malignant lymphoma. Brain Tumor Pathol 1998; 14:85. [PMID: 9384809 DOI: 10.1007/bf02478875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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21
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Sokol DK, Azzarelli B, Smith RR, Kassing LC, Roos KL, Pascuzzi RM, Blinkhorn RJ. Primary intravascular lymphomatosis associated with Mycobacterium marinum. J Neuroimaging 1998; 8:47-9. [PMID: 9442593 DOI: 10.1111/jon19988147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Intravascular lymphomatosis (i.v.l.) is a rare condition in which neoplastic cells preferentially infiltrate blood vessels of the central nervous system. Nonspecific symptoms associated with i.v.l. include dementia, seizures, and multifocal cerebrovascular events. i.v.l. was discovered at autopsy of a patient whose neurological deficits were predated by a particularly aggressive form of Mycobacterium marinum soft-tissue infection. It is speculated that i.v.l. may have had an occult effect on the patient's cell-mediated immunity that predisposed him to this normally innocuous mycobacteria.
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Affiliation(s)
- D K Sokol
- Department of Neurology, Indiana University Medical Center, Indianapolis, USA
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22
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Abstract
Intravascular lymphomatosis is a rare fatal neoplasm characterized by malignant cells of lymphocytic lineage producing vascular occlusions. The cerebral vasculature is particularly affected. Two patients seen at our institution presented with progressive neurologic deficits including dementia, hemiparesis and myelopathy. Review of an additional 64 reported cases with neurologic involvement indicates that patients developed intermittent fevers, an encephalopathy ranging from acute disorientation to rapidly progressive dementia, and focal signs such as hemiparesis and myelopathy. Common laboratory abnormalities include elevated cerebrospinal fluid protein and a lymphocytic pleocytosis, elevated blood erythrocyte sedimentation rate and serum lactate dehydrogenase. Malignant cells are rarely seen in cerebrospinal fluid, blood or bone marrow. Neuroimaging is usually abnormal with parenchymal lesions seen on cerebral tomography and magnetic resonance imaging along with an occasional meningeal pattern of contrast enhancement. Treatment with corticosteroids, chemotherapy, radiation therapy, or plasmapheresis provided limited benefit. Intravascular lymphomatosis should be considered in the differential diagnosis of unexplained progressive encephalopathy with superimposed focal deficits.
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Affiliation(s)
- J E Chapin
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, USA
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Bergmann M, Terzija-Wessel U, Blasius S, Kuchelmeister K, Kryne-Kubat B, Gerhard L, Beneicke U, Berlit P. Intravascular lymphomatosis of the CNS: clinicopathologic study and search for expression of oncoproteins and Epstein-Barr virus. Clin Neurol Neurosurg 1994; 96:236-43. [PMID: 7988093 DOI: 10.1016/0303-8467(94)90075-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Five cases of intravascular lymphomatosis (IVL) are reported. Diffuse or focal cerebral signs suggestive of vascular disease occurred in four cases, but case 5 presented with symptoms similar to Creutzfeld-Jakob disease. Clinical course ranged from two to eight months and diagnosis was made in all cases by autopsy. Neoplastic lymphoid cells mainly lodged in lumina of small vessels in many organs, but infarction was confined to the CNS. Some extravascular tumor cells were regularly seen. All cases corresponded to high-grade Non-Hodgkin lymphomas of B-cell type and displayed high proliferation indices. Different from findings in primary cerebral and nodal lymphomas, neither p53 nor bcl-2 oncoproteins were detectable. Absence of EBV genome and EBV latent membrane protein from IVL was demonstrated for the first time.
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Affiliation(s)
- M Bergmann
- Institute of Neuropathology, University of Münster, Germany
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Liszka U, Drlicek M, Hitzenberger P, Machacek E, Mayer H, Stockhammer G, Grisold W. Intravascular lymphomatosis: a clinicopathological study of three cases. J Cancer Res Clin Oncol 1994; 120:164-8. [PMID: 8263013 DOI: 10.1007/bf01202196] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
In patients with intravascular lymphomatosis (IL) a broad spectrum of neuro-psychiatric disorders including dementia, focal neurological signs and seizures has been reported. Clinical diagnosis is difficult since neuroimaging findings are nonspecific. The clinical histories, biopsy and autopsy findings of three patients with IL, one with brain biopsy, are described. Two of them presented with rapidly progressive, fluctuating dementia. The third patient suffered from seizures followed by aphasia. Histology revealed large-cell lymphoma of the B cell type. The prognosis of IL, in general, is poor.
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Affiliation(s)
- U Liszka
- Department of Pathology and Bacteriology, Psychiatric Hospital Baumgartner Hoehe, Vienna, Austria
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Torenbeek R, Scheltens P, Strack van Schijindel RJ, Algra PR, Heimans JJ, van der Valk P. Angiotropic intravascular large-cell lymphoma with massive cerebral extension. J Neurol Neurosurg Psychiatry 1993; 56:914-6. [PMID: 8350112 PMCID: PMC1015151 DOI: 10.1136/jnnp.56.8.914] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Angiotropic intravascular large-cell lymphoma (AILL) is a rare, generally fatal disease characterised by a multifocal proliferation of neoplastic mononuclear cells within small blood vessels. The diagnosis of a patient was made at necropsy. The malignant cells had infiltrated the periventricular areas of the brain.
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Affiliation(s)
- R Torenbeek
- Department of Pathology, Free University Hospital, Amsterdam, The Netherlands
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Abstract
Primary CNS lymphomas (PCNSL), until recently representing about 1% of all brain tumors, show dramatically increased incidence both in high-risk groups (immunocompromised, AIDS) and in the general population. They are extranodal diffuse non-Hodgkin's lymphomas, the morphology and classification of which are identical to those of systemic lymphomas, although PCNSL show different biological behavior and diagnosis according to the New Working Formulation and updated Kiel classification may be difficult. The majority are large B cell variants of high-grade malignancy; low-grade subtypes and T cell lymphomas are rare. Sixty per cent occur in the supratentorial space (hemispheres, periventricular) and 12% in the posterior fossa; 30% are multiple (50%-70% in AIDS). PCNSL show a male preponderance with a peak incidence in the 5th-7th decade (3rd-4th in AIDS). The duration of diffuse or focal clinical symptoms averages 1-2 months. Computed tomography and magnetic resonance imaging scans show single or multiple or diffuse, often typical lesions. Diagnosis is achieved by evaluation of stereotactic biopsy material or cerebrospinal fluid cytology using immunocytological markers. Current therapy in immunocompetent patients, radiation plus corticosteroids and pre- or postradiation polychemotherapy, shows response rates of 85% with a median survival of 17-44 months, a prognosis similar to that for glioblastoma. Meningeal PCNSL is treated with intrathecal methotrexate or cytosine arabinoside. Transliquoral seeding of PCNSL is frequent, distant metastases occurring in 6%-8%. Therapy of AIDS-related PCNSL makes use of radiation and corticosteroids, and rarely of chemotherapy. The pathogenesis of PCNSL is unknown, but Epstein-Barr virus may be a contributory factor.
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