Incisional random skin biopsy, not punch biopsy, is an appropriate method for diagnosis of intravascular large B‐cell lymphoma: a clinicopathological study of 25 patients

Enzan, Naoko; Kitadate, Akihiro; Tanaka, Atsushi; Matsue, Kosei

doi:10.1111/bjd.17603

Cited by 27 publications

(35 citation statements)

References 7 publications

(21 reference statements)

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“…One important reason that RSB has not been widely used in Western countries might be its limited diagnostic capability for IVLBCL, probably because those samples are collected by punch biopsy (Gill et al , ; Cho et al , ), which, despite being easy to perform, might not contain sufficient amounts of hypodermal adipose tissue for diagnosis. We recently reported the low frequency of IVLBCL lesions in the dermis and showed that most IVLBCL lesions can be found mainly in the hypodermic adipose tissues (Enzan et al , ). Hence, punch biopsy might miss the IVLBCL lesion in approximately more than half of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…RSB was performed by the dermatology department and specimens were usually obtained from 3 separate, fat‐containing areas of the skin before the start of treatment. Given that intravascular IVLBCL lesions usually present in the capillaries of subcutaneous adipose tissues, the RSB sample was taken from the thigh, abdomen or upper arm, because these areas contain enough width and depth of subcutaneous adipose tissues (Asada et al , ; Matsue et al , ; Sitthinamsuwan et al , ; Enzan et al , ).…”

Section: Methodsmentioning

confidence: 99%

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Diagnosis of intravascular large B cell lymphoma: novel insights into clinicopathological features from 42 patients at a single institution over 20 years

et al. 2019

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Summary This study aimed to clarify the comprehensive clinical, laboratory, pathological and imaging features of intravascular large B‐cell lymphoma (IVLBCL) using data on 42 IVLBCL patients diagnosed at our hospital over the past 20 years. The majority of patients were diagnosed via random skin biopsy (29/42, 69·0%) followed by bone marrow biopsy alone (8/42, 19·0%). Characteristic features included persistent fever (41/42, 97·6%), decreased performance status (≥2) (100%), hypoxaemia (32/40, 80·0%), impaired consciousness (19/42, 45·2%), hypoalbuminemia (42/42, 100%) and extreme elevation of lactate dehydrogenase and soluble interleukin 2 receptor levels. Brain magnetic resonance imaging showed abnormal findings in 32/37 patients (86·4%). Hyperintense lesion in the pons was a peculiar finding that was unrelated to the neurological deficits. Positron emission tomography‐computed tomography revealed a high incidence of bone marrow (26/34, 76·5%), spleen (19/34, 55·9%) and adrenal gland (9/34, 26·5%) involvement. Neurolymphomatosis was noted in 6 patients during the course of the disease. About 60% of IVLBCL patients in whom in vivo diagnosis was possible survived more than 5 years with combination chemotherapy. Our observations provide additional insight into the diagnosis of IVLBCL and indicate that early disease recognition via random skin biopsy combined with imaging, enables in vivo diagnosis of the disease and improved survival for many patients.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Diagnosis of intravascular large B cell lymphoma: novel insights into clinicopathological features from 42 patients at a single institution over 20 years

et al. 2019

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“…12 Although punch biopsy with 4 to 5 mm depth is traditionally used, a more recent report has suggested that approximately one-half of the patients diagnosed with IVLBCL only have lesions in deep adipose tissues found via incisional biopsy. 13 ( Fig. 3).…”

Section: Discussionmentioning

confidence: 97%

Going Skin Deep: Excavating a Diagnosis of Intravascular Large B Cell Lymphoma

et al. 2020

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A fever of unknown origin is often pursued diagnostically under the framework of infectious, rheumatologic, and neoplastic causes. When encephalopathy ensues, the differential diagnosis narrows, but can remain elusive, particularly when dealing with rare diseases. We present the case of a patient with fever of unknown origin and intermittent encephalopathy that spanned multiple hospital admissions and ultimately yielded a diagnosis of intravascular large B cell lymphoma complicated by hemophagocytic lymphohistiocytosis. We review the varying presentations of this disease, when to consider this as a diagnosis, and how to most accurately make the diagnosis.

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“…While abdominal FPB has been used to diagnose amyloidosis as a less invasive approach; it was also useful in diagnosis of IVLBCL [ 17 ]. In addition, although punch biopsy is easily performed, if not deep enough, it may not contain sufficient amounts of hypodermal adipose tissue for diagnosis [ 18 ]. This finding was consistent with our case series.…”

Section: Discussionmentioning

confidence: 99%

Intravascular large B-cell lymphoma in Hispanics: a case series and literature review

Nguyen

Pakbaz

2020

Journal of Community Hospital Internal Medicine Perspectives

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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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Incisional random skin biopsy, not punch biopsy, is an appropriate method for diagnosis of intravascular large B‐cell lymphoma: a clinicopathological study of 25 patients

Cited by 27 publications

References 7 publications

Diagnosis of intravascular large B cell lymphoma: novel insights into clinicopathological features from 42 patients at a single institution over 20 years

Diagnosis of intravascular large B cell lymphoma: novel insights into clinicopathological features from 42 patients at a single institution over 20 years

Going Skin Deep: Excavating a Diagnosis of Intravascular Large B Cell Lymphoma

Intravascular large B-cell lymphoma in Hispanics: a case series and literature review

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