Advertisement
Mayo Clinic Proceedings Home

Use of Random Skin Biopsy for Diagnosis of Intravascular Large B-Cell Lymphoma

      Intravascular lymphoma (IVL) is a rare type of extranodal lymphoma with an aggressive clinical course characterized by proliferation of large lymphoma cells within the lumina of the small vessels. Because of its varied clinical symptoms and the absence of lymphadenopathy, diagnosis of IVL is extremely difficult and requires histological confirmation. We report here 6 consecutive patients with IVL, admitted to Kameda General Hospital, Kamogawa-shi, Japan, from June 7, 2006, to February 28, 2007, whose IVL was diagnosed by random skin biopsy of healthy-appearing skin. Three patients presented with progressive neurological deterioration and 2 others with hypoxemia with interstitial infiltration on chest radiography. One patient presented with confusion and severe hypoxia without apparent interstitial infiltration. Two patients showed localized skin involvement. Irrespective of the presence of skin lesions, almost all skin biopsy specimens showed obliteration of small vessels of subcutaneous fat tissues by lymphoma cells, allowing a prompt diagnosis of IVL. Early institution of rituximab-based chemotherapy induced favorable responses in all patients treated. Because diagnosis based on tissue other than skin is usually difficult in patients with suspected IVL, random skin biopsy should be considered even in patients with no evident skin lesions.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • DiGiuseppe JA
        • Nelson WG
        • Seifter EJ
        • Boitnott JK
        • Mann RB
        Intravascular lymphomatosis: a clinicopathologic study of 10 cases and assessment of response to chemotherapy.
        J Clin Oncol. 1994; 12: 2573-2579
        • Gatter KC
        • Warnke RA
        Intravascular large B-cell lymphoma.
        in: Jaffe ES Harris NL Stein H Vardiman JW Pathology and Genetics of Tumor of Haematopoietic and Lymphoid Tissues. IARC Press, Lyon, France2001: 177-178 (World Health Organization Classification of Tumors Series.)
        • Murase T
        • Nakamura S
        • Tashiro K
        • et al.
        Malignant histiocytosis-like B-cell lymphoma, a distinct pathologic variant of intravascular lymphomatosis: a report of five cases and review of literature.
        Br J Haematol. 1997; 99: 656-664
        • Murase T
        • Nakamura S
        • Kawauchi K
        • et al.
        An Asian variant of intravascular large B-cell lymphoma: clinical, pathological and cytogenic approaches to diffuse large B-cell lymphoma associated with haemophagocytic syndrome.
        Br J Haematol. 2000; 111: 826-834
        • Ferreri AJ
        • Campo E
        • Seymour JF
        • International Extranodal Lymphoma Study Group (IELSG)
        • et al.
        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. 2004; 127: 173-183
        • Demirer T
        • Dail DH
        • Aboulafia DM
        Four varied cases of intravascular lymphomatosis and a literature review.
        Cancer. 1994; 73: 1738-1745
        • Kraus MD
        • Jones D
        • Bartlett NL
        Intravascular lymphoma associated with endocrine dysfunction: a report of four cases and a review of the literature.
        Am J Med. 1999; 107: 169-176
        • Gill S
        • Melosky B
        • Haley L
        • ChanYan C
        Use of random skin biopsy to diagnose intravascular lymphoma presenting as fever of unknown origin.
        Am J Med. 2003; 114: 56-58
        • Le K
        • Lim A
        • Bullpitt P
        • Wood G
        Intravascular B-cell lymphoma diagnosed by skin biopsy.
        Australas J Dermatol. 2005; 46: 261-265
        • Domizio P
        • Hall PA
        • Cotter F
        • Amiel S
        • Tucker J
        • Besser GM
        • Levison DA
        Angiotrophic large cell lymphoma (ALCL): morphological, immunohistochemical and genotypic studies with analysis of previous reports.
        Hematol Oncol. 1989; 7: 195-206
        • Estalilla OC
        • Koo CH
        • Brynes RK
        • Medeiros J
        Intravascular large B-cell lymphoma: a report of five cases initially diagnosed by bone marrow biopsy.
        Am J Clin Pathol. 1999; 112: 248-255
        • Ito M
        • Kim Y
        • Choi JW
        • Ozawa H
        • Fujino M
        Prevalence of intravascular large B-cell lymphoma with bone marrow involvement at initial presentation.
        Int J Hematol. 2003; 77: 159-163
        • Murase T
        • Yamaguchi M
        • Suzuki R
        • et al.
        Intravascular large B-cell lymphoma (IVLBCL): a clinicopathologic study of 96 cases with special reference to the immunophenotypic heterogeneity of CD5.
        Blood. 2007 Jan 15; 109 (Epub 2006 Sep 19.): 478-485
        • Wick MR
        • Mills SE
        • Scheithauer BW
        • Cooper PH
        • Davitz MA
        • Parkinson K
        Reassessment of malignant “angoiendotheliomatosis”: evidence in favor of its reclassification as “intravascular lymphomatosis.”.
        Am J Surg Pathol. 1986; 10: 112-123