Abstract
A 53-year-old man was hospitalized for the scrutinization of urinary disturbance. Although vertebral X-ray did not show bone destruction, magnetic resonance imaging (MRI) revealed multiple lesions in thoracic and lumbar vertebrae. Bone marrow aspiration and biopsy of the ilium showed no abnormality. Bone marrow biopsy of the fifth lumbar vertebra was performed, and the diagnosis of diffuse large B cell lymphoma was made. As subacute ascending myelopathy of flaccid paraparesis developed, intravascular lymphoma was suspected. Random skin biopsy was then performed from normal-appearing skin. Hematoxylin-eosin staining allowed the visualization of the intravascular lymphoma lesions, and staining with anti-CD20 monoclonal antibody highlighted the atypical lymphoid cells in the capillary vessels. These findings led to the diagnosis of intravascular large B cell lymphoma (IVLBCL). The patient responded well to combination chemotherapy containing rituximab. Intravascular lymphoma should be suspected in any patients with the unexplained progressive neurologic dysfunction, and a random skin biopsy is useful for early diagnosis and treatment.
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References
Asada N, Odawara J, Kimura S, Aoki T, Yamakura M, Takeuchi M, Seki R, Tanaka A, Matsue K (2007) Use of random skin biopsy for diagnosis of intravascular large B-cell lymphoma. Mayo Clin Proc 82(12):1525–1527
Beristain X, Azzarelli B (2002) The neurological masquerade of intravascular lymphomatosis. Arch Neurol 59(3):439–443
Chapin JE, Davis LE, Kornfeld M, Mandler RN (1995) Neurological manifestations of intravascular lymphomatosis. Acta Neurol Scand 91(6):494–499
Ferreri AJM, Campo E, Symour JF, Willemze R, Ilariucci F, Ambrosetti A, Zucca E, Rossi G, Lopez-Guillermo A, Pavlovsky MA, Geerts ML, Candoni A, Lestani M, Asioli S, Milani M, Piris MA, Pileri S, Facchetti F, Cavalli F, Ponzoni M, International Extranodal Lymphoma Study Group (IELSG) (2004) Intravascular lymphoma: clinical presentation, natural history, management and prognostic factors in a series of 38 cases, with special emphasis on the cutaneous variant. Br J Haematol 127:173–183
Gill S, Melosky B, Haley L, ChanYan C (2003) Use of random skin biopsy to diagnose intravascular lymphoma presenting as fever of unknown organ. Am J Med 114(1):56–58
Glass J, Hochberg FH, Miller DC (1993) Intravascular lymphomatosis. Cancer 71(10):3156–3164
Le K, Lim A, Bullpitt P, Wood G (2005) Intravascular B-cell lymphoma diagnosed by skin biopsy. Australas J Dermatol 46(4):261–265
Legeais M, Gallas S, Cottier JP, Herbreteau D (2004) Paraplegia and sensory deficit caused by angiotropic large cell lymphoma. Am J Neuroradiol 25(10):1831–1835
Matsue K, Asada N, Odawara J, Aoki T, Kimura S, Iwama K, Fujiwara H, Yamakura M, Takeuchi M (2011) Random skin biopsy and bone marrow biopsy for diagnosis of intravascular large B cell lymphoma. Ann Hematol 90:417–421
Nakahara T, Saito T, Muroi A, Sugiura Y, Ogata M, Sugiyama Y, Yamamoto T (1999) Intravascular lymphomatosis presenting as an ascending cauda equine conus medullaris syndrome: remission after biweekly CHOP therapy. J Neurol Neurosurg Psychiatry 67:403–406
Savard M, Verreault S, Gould PV, Bernier V, Bouchard JP (2008) Intravascular lymphoma with conus medullaris syndrome followed by encephalopathy. Can J Neurol Sci 35:366–371
Schwarz S, Zoubaa S, Knauth M, Sommer C, Storch-Hagenlocher B (2002) Intravascular lymphomatosis presenting with a conus medullaris syndrome mimicking disseminated encephalomyelitis. Neuro Oncol 4:187–191
Shimada K, Kinoshita T, Naoe T, Nakamura S (2009) Presentation and management of intravascular large B-cell lymphoma. Lancet Oncol 10:895–902
Tsugawa J, Tsuboi Y, Inoue H, Ishizuka K, Takeshita S, Yamada T (2010) A case of intravascular malignant lymphomatosis presenting with epicornus syndrome and diagnosed by bone marrow biopsy. Brain Nerve 62(3):269–272
Yamashiro K, Mori H, Suzuki A, Mori K, Hamano Y, Mizuno Y (2001) A patient with intravascular malignant lymphomatosis presenting subacute dementia one year after sustained urinary retention and high serum LDH activity from the onset. Rinsho Shinkeigaku 41(11):784–791
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Uryu, H., Komeno, Y., Yokokura, S. et al. Intravascular lymphoma preceded by urinary retention and diagnosed by random skin biopsy. Comp Clin Pathol 25, 177–181 (2016). https://doi.org/10.1007/s00580-015-2164-2
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DOI: https://doi.org/10.1007/s00580-015-2164-2