Intravascular Large B Cell Lymphoma as a Rare Cause of Reversed Halo Sign

Abstract

Intravascular large B cell lymphoma (IVLBCL) is a rare type of extranodal diffused large B-cell lymphoma. IVLBCL with primary lung lesion is very rare and it is very difficult to diagnose. Radiographic findings of pulmonary IVLBCL are nonspecific and resembling interstitial lung diseases. Reversed halo sign (RHS) was initially reported in patients diagnosed with cryptogenic organizing pneumonia and then described in a variety of diseases with inflammatory, infectious, autoimmune, and malignant causes. This is the first case of IVLBCL that has presented with RHSs on CT scan.A 59-year-old Chinese man presented with a 4-month history of a nonproductive cough and a weight loss of 5 kg. Physical examination was unremarkable. High-resolution computed tomography scan of the chest showed bilateral patchy ground glass opacities (GGOs) and RHSs. Laboratory tests were unremarkable except elevated serum lactate dehydrogenase (LDH). Surgical lung biopsy was performed. Light microscopic examination of the specimen disclosed diffuse alveolar septal widening caused by neoplastic lymphocytes, which were positive for CD20 and infiltrated in the alveolar capillaries. The patient was diagnosed with IVLBCL and underwent chemotherapy and autologous blood stem cell transplantation. The patient is still alive 5 years after diagnosis.IVLBCL is a rare cause of RHS and should be considered in differential diagnosis of RHS. An increased serum LDH concentration is another important clue.

Pulmonary mucosa-associated lymphoid tissue lymphoma forming a reversed halo sign from ground-glass opacity

“…Subsequently, it has been associated with several pulmonary diseases, including infectious diseases, such as paracoccidioidomycosis, tuberculosis, pulmonary mucormycosis, invasive pulmonary aspergillosis, Pneumocystis jirovecii pneumonia, and COVID-19, as well as noninfectious pathologies such as sarcoidosis, pulmonary embolism, granulomatosis with polyangiitis, and lung adenocarcinoma [9] , [10] , [11] . The RHS has been reported in a patient with intravascular large B cell lymphoma [12] and primary pulmonary diffuse large B cell lymphoma [13] ; however, there have been no previous reports on pulmonary MALT lymphoma exhibiting the RHS.…”

Timely Diagnosis and Successful Treatment of Intravascular Large B-Cell Lymphoma in an Elderly Patient with Poor Performance Status

“…Among the several biopsy options of transbronchial, open lung, or video-assisted thoracoscopic surgery, we chose TBLB because of the general condition of the patient. TBLB is less invasive and is performed without general anesthesia; although its sensitivity might be lower than that of the other options [6,7], it remains an important diagnostic option.…”

Pulmonary Intravascular Large B-cell Lymphoma (IVLBCL) Disguised as an Asthma Exacerbation in a Patient with Asthma

“…Furthermore, there were 13 previous case reports of pulmonary IVLBCL with FDG-PET/CT ( Table 2 ) ( 10 - 12 , 14 , 29 , 37 , 39 , 43 , 50 ). These reports suggested that 18 F-FDG PET-CT scanning may facilitate suspicion of IVLBCL with pulmonary involvement, even in the absence of radiological findings ( 11 , 12 , 14 , 42 ).…”