Random Skin Biopsy for Diagnosis of Intravascular Large B-Cell Lymphoma: A Case Report and Literature Review

Abstract

Background:Intravascular large B-cell lymphoma (IVLBCL) is a rare, aggressive B-cell lymphoma. The heterogeneity of its clinical symptoms makes it hard to be diagnosed. The diagnosis is followed by pathological examination of affected tissues and organs including skin, central nervous system, and bone marrow. Random skin biopsy (RSB) with high sensitivity and less invasiveness becomes a common method for diagnosis in suspected patients without skin lesions.Case report:We reported the case of a 67-year-old man who complained of fever, dizziness, unsteady gait, numbness in both lower extremities, and incontinence. Blood routine examination suggested elevated levels of lactate dehydrogenase. Enhanced magnetic resonance imaging of the head and thoracolumbosacral spine, next-generation sequencing in blood, cerebrospinal fluid collection, bone marrow aspiration, and positron emission tomography–computed tomography presented no evidence of solid tumors. However, there were intravascular tumor cell growth and morphosis as determined by RSB. CD20, CD79a, CD5, BCL-6, and BCL-2 were positive as tested by immunohistochemistry, and Ki-67 showed high proliferative activity. Taking the medical history as an element, the patient received a diagnosis of IVLBCL. After he completed 3 cycles of RCDOP + orelabrutinib, his general condition improved.Conclusion:IVLBCL is an aggressive, lethal cancer that is difficult to diagnose; therefore, it is recommended for the suspected patients to receive RSB promptly and early treatment at the earliest opportunity to achieve amelioration in prognosis.

Cutaneous Intravascular Hematolymphoid Entities: A Review

“…An additional study [27] concluded no utility in skin biopsy with normal LDH and sIL-2R less than 2000 U/mL. In a recent case report [28], a patient with increased LDH and CNS symptoms (negative imaging) was only diagnosed with IVLBCL after a random skin biopsy; this cautionary example highlights random skin biopsy utility. The conclusion from the literature is that adequate sampling (quantity and depth), paired with targeted biopsy (hemangiomas when available), has utility in the diagnosis of IVLBCL; however, a negative biopsy does not exclude this entity, particularly in the setting of the HPS variant [1].…”