Intravascular Large B-Cell Lymphoma Mimicking Temporal Arteritis

Abstract

Intravascular lymphoma is a rare type of lymphoma, characterized by growth of lymphoma cells within the microvasculature. The majority of the cases are of B-cell lineage, although rare examples of T or NK lineage have also been reported. The lymphoma is usually widely disseminated in the vascular spaces of any organ at the time of diagnosis including the skin and bone marrow. Lymph nodes are typically spared. The clinical picture depends on the specific organ involvement making the correct diagnosis very difficult. Here, we report a case of intravascular large B-cell lymphoma diagnosed postmortem on a 69-year-old African-American male who presented with unilateral proptosis and visual loss. An initial diagnosis of temporal arteritis was made and the patient received corticosteroids. However, the patient developed multiorgan failure and expired. On autopsy, there was disseminated intravascular lymphoma involving predominantly vessels within the heart, kidneys, liver, stomach, lungs, adrenal glands, small intestine, bladder, thyroid, and brain. Interestingly, there was also partial involvement of the retroperitoneal lymph nodes which is an unusual presentation in this disorder. Immunohistochemical staining showed that the lymphoma cells were positive for CD20, indicating B-cell phenotype. This case supports the “mimicking nature” of this rare entity with an unusual presentation with proptosis and visual loss, simulating temporal arteritis and a rare involvement of the retroperitoneal lymph nodes. The presentation of intravascular large B-cell lymphoma can vary, and the key to diagnosis is dependent on histopathology and immunohistochemistry. Increased awareness, early tissue diagnosis, and prompt chemotherapy are crucial for this otherwise lethal disease.

Intravascular Large B-cell lymphoma: A case series and review of literatures

“…(p13; ? ), −2, −4, add(4) (q31), −6, add(6) (p23), del(6) (q11q24), −7, −8, −9, −11, −11, −12, −13, −14, −15, −15, add(17) (p13), +18, −19, add(19) (p13), −20, −21,-21, −22, +9mar [ 19 ]/46, XX [ 6 ] 4 94, XX, -X, -X, −1, +i(3) (q10), +add(3) (p25), del(4) (q31.3)x2, del(6) (q16), −10, −13, −15, +16, −17, −17, +18 × 4, +20, +20, −22, −22, +3mar [ 20 ]/97, XX, -X, -X, −1, +i(3) (q10), +add(3) (p25), del(4) (q31.3)x2, +del(6) (q16), +9, −10, −13, −15, +16, −17, −17, +18 × 5, +20, −22, −22, +4mar [ 6 ] 7 45, Y, -X, add(1) (p36.1), add(3) (q21), der(3)add(3) (p25)add(3) (q21), −6, add(6) (q25), del(7) (p15), del(8) (p21), add(9) (p220, add(11) (q23), add(17) (q25), add(19) (q13.3), +mar [ 5 ]/45, X, -Y [ 5 ]/46, XY [ 7 ] …”

“…Other than these defined variants of IVLBCL, several case reports described unusual clinical features with difficulties in diagnosis [ [7] , [8] , [9] ]. Therefore, the diagnosis of IVLBCL still remains a challenge because of heterogeneity among patients.…”

Successful Treatment of Diffuse Large B-cell Lymphoma Involving Multiple Renal and Bone Infiltrations Presenting with Giant Cell Arteritis-like Manifestations

“…It usually presents with a fever, night sweats, and weight loss, known as B symptoms, and is frequently discovered by palpating superficial lymph nodes (4,5). However, hematogenous spread rarely involves renal or bone lesions (6)(7)(8)(9)(10)(11)(12)(13), and only a few cases of malignant lymphoma with GCA-like presentations have been reported (14)(15)(16)(17)(18)(19)(20)(21)(22).…”