Intravascular Large B-Cell Lymphoma: A Report of Five Cases Initially Diagnosed by Bone Marrow Biopsy

Estalilla, Oscar C; Koo, Chae H.; Brynes, Russell K.; Medeiros, L. Jeffrey

doi:10.1093/ajcp/112.2.248

Cited by 83 publications

(47 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…19,28 However, subsequent studies indicate that this disease involves the marrow with greater frequency than originally suggested. 20,25 In our patients with diffuse splenic involvement by LBCL, there was a predominant, but not exclusive intrasinusoidal pattern of marrow infiltration. Detection of marrow involvement by LBCL in our cases was greatly facilitated by anti-CD20 immunoperoxidase staining as morphologic clues to the diagnosis were obscured both by the pattern of marrow involvement and the associated prominent erythroid hyperplasia.…”

Section: Discussionmentioning

confidence: 57%

“…4 An intrasinusoidal pattern of marrow infiltration has been described in intravascular LBCL as well as in a number of other lymphoproliferative disorders including splenic marginal zone B-cell lymphoma, hepatosplenic T-cell lymphoma, and T-cell large granular lymphocytic leukemia. [21][22][23][24][25][26][27] These latter disorders share as a unifying feature prominent splenic involvement. It is recognized that morphologic detection of intrasinusoidal marrow involvement by these disorders is exceedingly difficult.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Diffuse large B-cell lymphoma with distinctive patterns of splenic and bone marrow involvement: clinicopathologic features of two cases

2005

View full text Add to dashboard Cite

Two unusual cases of large B-cell lymphoma with predominant splenic and bone marrow (BM) involvement and similar clinical and histopathologic features are described. Both patients presented with nonspecific constitutional symptoms, unexplained cytopenias, and splenomegaly. Splenectomy revealed diffuse red pulp involvement by large B-cell lymphoma. The perisplenic lymph nodes were also involved diffusely with effacement of normal nodal architecture, excluding a diagnosis of intravascular large B-cell lymphoma. BM biopsies revealed striking erythroid hyperplasia without overt morphologic evidence of involvement by lymphoma. Immunoperoxidase staining of the marrow biopsies with antibodies to CD20 and erythroidassociated antigens revealed involvement by large B-cell lymphoma morphologically resembling the early pronormoblasts. In both cases there was prominent, but not exclusive, intravascular/intrasinusoidal lymphomatous marrow infiltration. These cases represent an unusual variant of large B-cell lymphoma with distinctive patterns of splenic and BM involvement. Furthermore, they underscore the difficulties in identifying intrasinusoidal marrow infiltration by lymphoma in H&E-stained biopsy slides and demonstrate that this pattern of marrow infiltration may be seen in cases of large B-cell lymphoma distinct from the intravascular variant. Keywords: diffuse large B-cell lymphoma; intravascular lymphoma; spleen; bone marrow; erythroid hyperplasia; non-Hodgkin lymphoma Diffuse large B-cell lymphoma (LBCL) can involve nodal or extranodal sites; however, initial presentation in the spleen occurs infrequently. 1 Typically when diffuse LBCL involves the spleen it forms discrete tumoral masses within the splenic parenchyma. 2 A recent report detailed other less common patterns of splenic involvement by LBCL including diffuse infiltration of the splenic red pulp. 3 The clinicopathologic features of diffuse LBCL with these unusual patterns of splenic involvement have yet to be fully elucidated. Described herein are the distinctive clinical and histopathologic features of two cases of splenic LBCL with diffuse red pulp infiltration and concurrent involvement of lymph nodes and bone marrow (BM). These cases had strikingly similar clinical presentations chiefly characterized by dyspnea, unexplained cytopenias, and splenomegaly. In both instances, splenectomy performed to alleviate the cytopenias revealed diffuse, homogeneous involvement of the splenic red pulp by diffuse LBCL. Although the pattern of splenic red pulp involvement and the clinical features raised the possibility of intravascular LBCL, in both cases there was parenchymal involvement of splenic hilar lymph nodes, excluding this diagnosis as defined by the most recent WHO criteria. 4 Furthermore, both cases had prominent BM involvement by lymphoma, which was difficult to detect by routine morphologic evaluation of hematoxylin and eosin (H&E)-stained biopsy slides. This difficulty was due both to the presence of prominent erythroid hyperplasia as well as a predominan...

show abstract

Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Diffuse large B-cell lymphoma with distinctive patterns of splenic and bone marrow involvement: clinicopathologic features of two cases

2005

View full text Add to dashboard Cite

show abstract

“…24 However, it is not clear what proportion of intravascular large B-cell lymphomas lack these adhesions molecules, nor whether additional mechanisms may be responsible for the intravascular location of these neoplasms. In addition, although other cases of CD5-positive intravascular large B-cell lymphoma have been reported in the literature, [25][26][27] it remains unclear whether there is any mechanistic relationship between CD5 coexpression and intravascular localization in these lymphomas. Although one study of intravascular lymphoma identified bone marrow involvement in four of five cases, and peripheral blood involvement in all five cases, 25 we have not been able to detect the neoplastic cells in the peripheral blood or bone marrow by flow cytometry in case 2, even though this patient has been extensively followed by our institution because of the recurrent lesion.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, although other cases of CD5-positive intravascular large B-cell lymphoma have been reported in the literature, [25][26][27] it remains unclear whether there is any mechanistic relationship between CD5 coexpression and intravascular localization in these lymphomas. Although one study of intravascular lymphoma identified bone marrow involvement in four of five cases, and peripheral blood involvement in all five cases, 25 we have not been able to detect the neoplastic cells in the peripheral blood or bone marrow by flow cytometry in case 2, even though this patient has been extensively followed by our institution because of the recurrent lesion. The staging bone marrow in case 1 was reportedly negative by morphology; however, to our knowledge, neither that patient's blood nor bone marrow was ever evaluated by flow cytometry.…”

Section: Discussionmentioning

confidence: 99%

Intravascular large B-cell lymphoma involving hemangiomas: an unusual presentation of a rare neoplasm

et al. 2005

View full text Add to dashboard Cite

We report the clinicopathological features of two cases of intravascular large B-cell lymphoma involving cutaneous hemangiomas. The cases were identified from the consultation files of two of the authors. Both patients were women, 64 and 55 years of age, who presented with long-standing cutaneous hemangiomas of the posterior scalp and left shoulder, respectively. The lesions were brought to medical attention by an increase in size and change in color. Biopsies and immunohistochemical evaluation of the hemangiomas revealed extensive involvement by intravascular large B-cell lymphoma. The neoplastic cells were diffusely positive for CD20 in both cases and negative for CD3, pan-cytokeratin (AE1/AE3), epithelial membrane antigen, S-100, Factor VIII-related antigen, CD34 and CD31. Disease was limited to the hemangiomas in both patients. Treatment consisted of chemotherapy (both patients) and adjuvant radiation therapy (one patient). One patient had a recurrence of disease 33 months after initial diagnosis, leading to an autologous stem cell transplant. The other patient is without evidence of disease 27 months after initial diagnosis. Although this is a rare neoplasm, it is important to consider intravascular large B-cell lymphoma in the differential diagnosis of vascular lesions containing intravascular neoplastic cells.

show abstract

“…[6][7][8][9][10] Estalilla et al 6 reported five cases, initially diagnosed by bone marrow biopsy, and speculated that involvement of bone marrow and peripheral blood might be more common than has been reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of intravascular malignant lymphomatosis with high-dose chemotherapy and autologous peripheral blood stem cell transplantation

Koizumi

Nishimura

Yokota

et al. 2001

Bone Marrow Transplant

View full text Add to dashboard Cite

Summary:Intravascular malignant lymphocytosis (IML) is a rare systemic disease characterized by proliferation of malignant B (rarely T) lymphoid cells within the lumina of small arteries, veins, and capillaries. Diagnosis requires skin, liver, renal, meningeal, or brain biopsy, but is rarely made ante mortem. In this report, we describe a patient who had an ante mortem diagnosis of IML as a result of a skin biopsy. Autologous peripheral blood stem cell transplantation (auto-PBSCT) was successfully performed after chemotherapy. The patient has survived for more than 30 months since the onset of the disease and maintains complete remission on the 450th day post PBSCT. To our knowledge, this is the first case of IML treated by auto-PBSCT. Bone Marrow Transplantation (2001) 27, 1101-1103. Keywords: intravascular malignant lymphocytosis (IML); skin biopsy; CHOP; auto-PBSCT Case reportA 52-year-old man presented to our hospital in September 1998 with a 9-month history of progressive dementia, hemiparesia, urinary retention, and weight loss. Hasegwa dementia scale (HDS), that is the scale to evaluate the degree of dementia, was 12 point. He had reddish indurated macules scattered over the anterior chest surface. Routine hematological, biochemical and serological values were all within normal limits. Examination of bone marrow showed no abnormal cells. Magnetic resonance imaging (MRI) of the brain demonstrated an increased periventricular signal on T2-weighted images. Computed tomography (CT) scans of the brain disclosed low density areas in the corresponding section. Positron emission tomography of the brain showed degraded blood flow in the left temporal and frontal lobe and right cerebellum. Results of bone marrow biopsy, cerebrospinal fluid examination, CT scans of chest and abdomen, abdominal ultrasound sonography and whole body gallium scintigram were normal. A skin biopsy specimen of the anterior chest eruption revealed atypical hyperchromatic large lymphoid cells within the lumena of capillary vessels. These cells also infiltrated the extravascular spaces. Immunohistochemical study showed that these cells were positive for a B cell marker L26 (CD20), but not for a T cell marker MT-l (CD43) nor endothelial cell marker (CD34). DNA obtained from these cells and bone marrow cells at the time of lymphoma diagnosis showed no immunoglobulin gene rearrangements by reverse transcription polymerase chain reaction (RT-PCR). In addition, the serum soluble interleukin 2 receptor (s-IL2R) value was elevated to 1610 U/ml. Based on the results stated above a diagnosis of IML (B cell type) was established.The clinical course is shown in Figure 1. The patient was treated with a standard regimen comprising doxorubicin, cyclophosphamide, vincristine and prednisone (CHOP). Amnesia, hallucinations, dementia and skin macules regressed after one cycle and the patient achieved a complete response after three cycles, although urinary incontinence and hemiparesis remained. Positron emission tomography of the brain showed normal blood flow...

show abstract

Intravascular Large B-Cell Lymphoma: A Report of Five Cases Initially Diagnosed by Bone Marrow Biopsy

Abstract: A b s t r a c tWe report 5

Cited by 83 publications

References 4 publications

Diffuse large B-cell lymphoma with distinctive patterns of splenic and bone marrow involvement: clinicopathologic features of two cases

Diffuse large B-cell lymphoma with distinctive patterns of splenic and bone marrow involvement: clinicopathologic features of two cases

Intravascular large B-cell lymphoma involving hemangiomas: an unusual presentation of a rare neoplasm

Successful treatment of intravascular malignant lymphomatosis with high-dose chemotherapy and autologous peripheral blood stem cell transplantation

Contact Info

Product

Resources

About