Intravascular large B-cell lymphoma or intravascular lymphomatosis: report of a case diagnosed by testicle biopsy

Droogenbroeck, Jan Van; Altıntaş, Sevilay; Pollefliet, C.; Schroyens, Wilfried; Berneman, Zwi

doi:10.1007/s002770000268

Cited by 21 publications

(13 citation statements)

References 19 publications

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“…Diagnosis is made mostly by biopsy of the skin or brain, but IVL has been reported after biopsy of the prostate, kidney, gallbladder, testis, lung [15,16], and bone marrow as in our case [17]. In most of the reported cases, malignant lymphocytes usually show B-cell lineage, and T lymphocyte IVL is rare [18].…”

Section: Discussionmentioning

confidence: 98%

Usefulness of FDG‐PET to diagnose intravascular lymphomatosis presenting as fever of unknown origin

et al. 2004

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Intravascular lymphomatosis (IVL) is a rare systemic disease characterized by proliferation of lymphoid cells within the lumina of small arteries, veins, and capillaries. Diagnosis requires skin, liver, lung, bone marrow, renal, meningeal, or brain vessel biopsy but is often made only when the illness has progressed or post mortem because early involvement of organs was not evident. We report a case of IVL presenting as fever of unknown origin (FUO). In this case, gallium scintigraphy and computed tomography (CT) showed no evidence of malignancy, whereas 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) showed increased FDG uptake in the sternum, left and right vertebra, humerus, femur, and especially ilium. The diagnosis was made on iliac bone marrow biopsy examination. FDG-PET was useful for the detection of spread of disease in a patient with IVL suffering from FUO. Am.

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Section: Discussionmentioning

confidence: 98%

Usefulness of FDG‐PET to diagnose intravascular lymphomatosis presenting as fever of unknown origin

et al. 2004

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“…It has been reported that about 15% of IVL patients have had a previous or concomitant malignancy with NHL being the most commonly associated hematopoietic malignancy [6]. Clinical features are heterogeneous and frequently include B symptoms, fever of unknown origin, and poor performance status [6][7][8][9][10][11]. Edema, however, has been reported only as a rare associated symptom at the time of presentation [8].…”

Section: Commentarymentioning

confidence: 99%

“…Laboratory abnormalities frequently include anemia, an elevated LDH and an elevated ESR [6][7][8][9]. Diffuse organ involvement has been documented with cutaneous and CNS manifestations being most prevalent [6][7][8][9][10][11][12]. A common feature of this disease, however, is the surprising degree of sparing of the surrounding tissue and absence of lymphoma cells in the lymph nodes and reticuloendothelial system [6][7][8][9].…”

Section: Commentarymentioning

confidence: 99%

A 69‐year‐old male presenting with hypotension and anasarca

et al. 2007

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A 69-year-old Caucasian male with a past medical history remarkable for hypertension and testicular nonHodgkin's lymphoma (NHL) presented to the emergency department with a 1-week history of fatigue and new onset lower extremity edema. For the past 8 months, the patient was having a nonproductive cough. Work up by his primary care physician was negative, and the patient was switched from enalapril to losartan 1 week before presentation. The cough resolved, however, 2 days later the patient began to experience fatigue and lightheadedness that persisted despite decreasing the dose of losartan. He continued to develop lower extremity edema and was again seen by his primary care physician who noted the patient to be hypotensive. He was referred to the emergency department for evaluation.In a 69-year-old male presenting with fatigue, lower extremity edema, and hypotension, our first concern was for a cardiac process such as heart failure. The differential for his hypotension also included sepsis, adrenal insufficiency, hemorrhage, or possibly an adverse drug reaction. We suspected that his cough was secondary to the enalapril as his symptoms had resolved with discontinuation of this medication; however, we remained concerned that an underlying pulmonary process could also be present.The patient denied chest pain, orthopnea, paroxysmal nocturnal dyspnea, fever, weight loss, or night sweats. His testicular NHL was treated 16 years prior with orchiectomy and four cycles of CHOP without evidence of recurrence. In addition to losartan, the patient also took a daily aspirin. He was a retired carpenter who had a 19-pack year smoking history and had quit 37 years before presentation. He occasionally drank alcohol. He denied illicit drug use. On examination, he was not in distress. His weight was 80.2 kg. His temperature was 36.48C, pulse 130 and regular, respiratory rate 18, blood pressure 78/46, and oxygen saturation was 97% while breathing ambient air. Physical examination was remarkable for a normal jugular venous pressure, tachycardia without extra heart sounds and generalized anasarca including 2+ pitting edema of his lower extremities. There was no lymphadenopathy, palpable masses, or cutaneous lesions. His neurologic examination was normal.The patient's review of systems was negative for symptoms of an acute coronary syndrome or heart failure, as well as for B-symptoms or a rapidly progesssive infectious process. On physical examination, his vital signs suggested intravascular volume depletion with tachycardia and hypotension; however, he appeared to have a component of fluid overload or third spacing of fluids with the marked degree of anasarca. His normal jugular venous pressure suggested normal right heart pressure making a cardiac cause of his anasarca less likely.The patient's white cell count was 12,300/mm 3 , with 93% neutrophils, 1% bands, and 6% monocytes. The hemoglobin level was 11.3 g/dl, with a mean corpuscular volume of 78.8 mm 3 . The platelet count was 554,000/ mm 3 . The serum sodium level was 126 mmo...

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“…Diagnosis is typically by biopsy of the skin or brain or bone marrow(5, 6) or other lesion in certain variant cases (7,8) including the adrenal grands (9), although occasional worsening has been described after brain or spinal cord biopsy (10). Skin lesions of IVL include teleangiectasias, hemorrhagic nodules and leg lymphedema(3).…”

Section: Skin Biopsymentioning

confidence: 99%

“…Such poor prognosis reflects in part delays in diagnosis. Amongthese therapies, patients treated by a combination of chemotherapy were reported to have long-term survival and to be alive in complete remission (4,(6)(7)(8)(9)(10)13). It is the most favorable therapy at present.…”

Section: Skin Biopsymentioning

confidence: 99%

Intravascular Large B Cell Lymphoma Diagnosed by Senile Angioma Biopsy.

et al. 2003

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An 82-year-old man without notable medical history was admitted to our hospital following subacute deterioration of apettite, disorientation and strange behavior. There was spasticity of the right extremities without weakness. LDHand serum soluble IL2 receptor antibody levels were elevated, and as well as the protein level and IgG levels in the cerebrospinal fluid. CT scanning of the brain revealed a lesion at the left corona radiata. The patient's level of consciousness was worsening, and follow-up study of the brain showed a new lesion in the left occipital lobe. Intravascular lymphomatosis was therefore suspected. Weperformed a skin biopsy from two typical senile angiomas. In one of these biopsy specimens, a capillary hemangiomawas present in the midreticular dermis and it was filled with abnormal B cells.The diagnosis of intravascular B cell lymphoma (IVL) was thus established. IVL is a rare subtype of extranodal diffuse large B cell lymphoma with a poor outcome.However, it is recently thought that if the diagnosis is established early, aggressive chemotherapy increases survival. Senile angioma is a skin eruption that is considered prevalent for the most part in elderly people. If a patient is suspected to have IVL, and there is no appropriate site of biopsy, it might be beneficial to try a skin biopsy aiming at senile angiomas for early diagnosis. (Internal Medicine 42: 117-120, 2003)

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Intravascular large B-cell lymphoma or intravascular lymphomatosis: report of a case diagnosed by testicle biopsy

Cited by 21 publications

References 19 publications

Usefulness of FDG‐PET to diagnose intravascular lymphomatosis presenting as fever of unknown origin

Usefulness of FDG‐PET to diagnose intravascular lymphomatosis presenting as fever of unknown origin

A 69‐year‐old male presenting with hypotension and anasarca

Intravascular Large B Cell Lymphoma Diagnosed by Senile Angioma Biopsy.

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