Intravascular large b-cell lymphoma diagnosed via transjugular liver biopsy in a patient with liver dysfunction and thrombocytopenia

Abstract

Rationale:Intravascular large B-cell lymphoma (IVLBCL) is an extremely rare subtype of large B-cell lymphoma characterized by the presence of lymphoma cells within the lumen of small blood vessels. IVLBCL presents with nonspecific symptoms such as fever, weight loss, and bleeding. Because of its rarity and unremarkable clinical presentation, a timely diagnosis is very challenging.Patient concerns:A 71-year-old Korean man complained of fever, but apart from pretibial pitting edema and mild thrombocytopenia, the physical examination and laboratory test findings were unremarkable.Diagnoses:A bone marrow biopsy was also nonspecific. The fever persisted and his thrombocytopenia became more pronounced, prompting further laboratory tests that indicated infiltrative liver disease.Interventions:Because of coagulopathy, a liver biopsy was performed using a transjugular instead of apercutaneous approach.Outcomes:The procedure was performed without complications, and the pathologic examination findings were consistent with IVLBCL. Unfortunately, the patient died because of disease progression before treatment could be administered.Lessons:Given that an early diagnosis can affect the prognosis of IVLBCL, quickly and safely obtaining a biopsy specimen is very important. The case presented here shows that a liver biopsy obtained via a transjugular approach is safe and could be preferentially considered when there is a high risk for bleeding complications.

EBV-positive intravascular large B-cell lymphoma of the liver: a case report and literature review

“…Because of the absence of severe coagulopathy, ultrasonography-guided percutaneous liver biopsy was performed in our patient. Up to present, only 12 cases of IVLBCL diagnosed by liver biopsies have been described in the literature [10][11][12][13][14][15][16][17][18][19][20][21]. The clinical and immunohistochemical features of the reported cases and our case are summarized in The histopathological ndings presented in our case were consistent with those described in previous reports.…”

“…Signi cantly, PET-CT is a powerful tool for the early diagnosis of IVLBCL by identifying indicated sites for biopsy because these patients usually show high FDG uptake in involved organs [8,9]. With the review of literature, liver biopsies can be performed using percutaneous, transjugular, or laparoscopic approaches, and each method has advantages and disadvantages [10]. Because of the absence of severe coagulopathy, ultrasonography-guided percutaneous liver biopsy was performed in our patient.…”

EBV-positive intravascular large B-cell lymphoma of the liver: a case report and literature review

“…Because of the absence of severe coagulopathy, ultrasonography-guided percutaneous liver biopsy was performed in our patient. Up to present, only 11 cases of IVLBCL diagnosed by liver biopsies have been described in the literature [10][11][12][13][14][15][16][17][18][19][20]. The clinical and immunohistochemical features of the reported cases and our case are summarized in Table 2 and MUM-1, negative for CD10).…”

EBV-positive intravascular large B-cell lymphoma of the liver: a case report and literature review

“…Significantly, PET-CT is a powerful tool for the early diagnosis of IVLBCL by identifying indicated sites for biopsy because these patients usually show high FDG uptake in involved organs [8,9]. With the review of literature, liver biopsies can be performed using percutaneous, transjugular, or laparoscopic approaches, and each method has advantages and disadvantages [10]. Because of the absence of severe coagulopathy, ultrasonography-guided percutaneous liver biopsy was performed in our patient.…”

“…Because of the absence of severe coagulopathy, ultrasonography-guided percutaneous liver biopsy was performed in our patient. Up to present, only 12 cases of IVLBCL diagnosed by liver biopsies have been described in the literature [10][11][12][13][14][15][16][17][18][19][20][21]. The clinical and immunohistochemical features of the reported cases and our case are summarized in Additional file 1: Table S2.…”