Diagnostic Difficulties of Pure Intrasinusoidal Bone Marrow Infiltration of Non-Hodgkin's Lymphoma: A Report of Eight Cases from India

Das, Reena; Sachdeva, Man Updesh Singh; Malhotra, Pankaj; Das, Ashim; Ahluwalia, Jasmina; Bal, Amanjit; Jain, Sanjay; Varma, Neelam; Varma, Subhash

doi:10.1093/jjco/hyr132

Cited by 6 publications

(1 citation statement)

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“…In our study, 8 patients were diagnosed via bone marrow biopsy alone. However, the diagnosis of IVLBCL by bone marrow biopsy alone is often problematic (Kajiura et al, 2007;Das et al, 2011), because the bone marrow sinusoids blend seamlessly with other haematopoietic tissues. In addition, the difference between bone marrow involvement of splenic DLBCL (Morice et al, 2005;Ponzoni & Ferreri, 2006;Iannitto & Tripodo, 2011;Shimono et al, 2017) and primary bone marrow DLBCL (Martinez et al, 2012) is not clearly defined.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of intravascular large B cell lymphoma: novel insights into clinicopathological features from 42 patients at a single institution over 20 years

et al. 2019

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Summary This study aimed to clarify the comprehensive clinical, laboratory, pathological and imaging features of intravascular large B‐cell lymphoma (IVLBCL) using data on 42 IVLBCL patients diagnosed at our hospital over the past 20 years. The majority of patients were diagnosed via random skin biopsy (29/42, 69·0%) followed by bone marrow biopsy alone (8/42, 19·0%). Characteristic features included persistent fever (41/42, 97·6%), decreased performance status (≥2) (100%), hypoxaemia (32/40, 80·0%), impaired consciousness (19/42, 45·2%), hypoalbuminemia (42/42, 100%) and extreme elevation of lactate dehydrogenase and soluble interleukin 2 receptor levels. Brain magnetic resonance imaging showed abnormal findings in 32/37 patients (86·4%). Hyperintense lesion in the pons was a peculiar finding that was unrelated to the neurological deficits. Positron emission tomography‐computed tomography revealed a high incidence of bone marrow (26/34, 76·5%), spleen (19/34, 55·9%) and adrenal gland (9/34, 26·5%) involvement. Neurolymphomatosis was noted in 6 patients during the course of the disease. About 60% of IVLBCL patients in whom in vivo diagnosis was possible survived more than 5 years with combination chemotherapy. Our observations provide additional insight into the diagnosis of IVLBCL and indicate that early disease recognition via random skin biopsy combined with imaging, enables in vivo diagnosis of the disease and improved survival for many patients.

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Section: Discussionmentioning

confidence: 99%

Diagnosis of intravascular large B cell lymphoma: novel insights into clinicopathological features from 42 patients at a single institution over 20 years

et al. 2019

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Primary Non-Hodgkin Lymphoma of the Ovary

Yadav¹,

George²,

Sharma³

et al. 2014

Seminars in Oncology

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γδ Hepatosplenic T-Cell Lymphoma in a Pediatric Patient With Crohn’s Disease on Combined Immunosuppressive and Immunomodulator Therapy

Jamali¹,

Raca²,

Rubin³

et al. 2012

Pathology Case Reviews

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Hepatosplenic T-cell lymphoma (HTCL) is a rare extranodal lymphoma arising from cytotoxic FC or rarely >A T cells of the splenic pool. The disease is characterized by predominance in young, usually male patients and an aggressive clinical course. Hepatosplenic involvement tends to be a constant, and systemic lymphadenopathy is minimal or not seen. Although diagnosis is classically established on histopathology of liver biopsy, the bone marrow is frequently involved and can offer a rapid, less invasive workup for initial diagnosis. The pattern of involvement is distinctive, with a propensity of tumor cells for the marrow sinuses with eventual spillover into the bone marrow interstitium and peripheral blood. The diagnosis can be subtle in earlier stages of the disease, which necessitates primarily considering the diagnosis as well as knowledge of the histologic, immunophenotypic and molecular/genetic features of the disease. Clinical information can be particularly valuable as almost a quarter of HTCLs arise in the setting of chronic immune suppression with data to suggest an association between this lymphoma and patients with inflammatory bowel disease receiving certain types and combinations of drug therapy. The multifaceted approach to the diagnosis of HTCL in the bone marrow and blood is discussed, as reported from a pathologist's perspective, in a young patient being treated for Crohn's disease.

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Diagnostic Difficulties of Pure Intrasinusoidal Bone Marrow Infiltration of Non-Hodgkin's Lymphoma: A Report of Eight Cases from India

Cited by 6 publications

References 10 publications

Diagnosis of intravascular large B cell lymphoma: novel insights into clinicopathological features from 42 patients at a single institution over 20 years

Diagnosis of intravascular large B cell lymphoma: novel insights into clinicopathological features from 42 patients at a single institution over 20 years

Primary Non-Hodgkin Lymphoma of the Ovary

γδ Hepatosplenic T-Cell Lymphoma in a Pediatric Patient With Crohn’s Disease on Combined Immunosuppressive and Immunomodulator Therapy

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