Intravascular Lymphoma with Progressive CNS Hemorrhage and Multiple Dissections

Chen, Ricky; Singh, Gurjeet; McNally, J. Scott; Palmer, Cheryl A.; Havenon, Adam de

doi:10.1155/2020/6134830

Cited by 6 publications

(7 citation statements)

References 14 publications

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“…Patients may develop subacute encephalopathy or dementia, paralysis, seizures, or multifocal cerebrovascular events. Systemic symptoms vary, but fever and skin lesions are the most common, whereas lymphadenopathy is usually absent (Chen et al, 2020). The clinical signs of IVL are generally non-specific and can progress very rapidly.…”

Section: Discussionmentioning

confidence: 99%

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Intravascular Large Cell non-Hodgkin Lymphoma in Subacute-Chronic Subdural Hematoma: a case report

Saputra

Sriwidyani

Paskarani

et al. 2022

RSD

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Introduction: Intravascular lymphoma (IVL) is a rare subtype of non-Hodgkin extranodal lymphoma with characterized by a positive CD20 B cell proliferation in small lumens and medium-sized blood vessels, except veins and large arteries. Blood vessels in the central nervous system (CNS) and the skin is most often affected. These tumors usually occur in older adults and aggressive. Methodology: Descriptive study of the case report type, whose data were obtained from the patient’s medical record and has received the patient's consent to be published. Case presentation: This paper reports a 63-year-old man, who suffered Parkinson disease and neurological symptoms for 6 months. From imaging, there is a chronic subacute subdural hematoma in the right frontotemporoparietal area. Operation performed, histopathological examination of the tissue with Hematoxylin-Eosin staining and immunohistochemical examination confirmed diagnosis Intravascular Large Cell non-Hodgkin Lymphoma (IVLCL) type B-cell CD20 (+) in subacute-chronic subdural hematoma (SDH). Discussion: This tumor is characterized by selective growth of lymphoma cells within the lumen of blood vessels, particularly capillaries, and with the exception of the larger arteries and veins, occurred in adults, with a median age of 67 years. Sixty five percent show neurological symptoms with rapidly progressive cognitive dysfunction or subacute dementia. The cause of chronic SDH in this patient is unknown, but it can occur due to increasing age, brain atrophy, and enlargement of the subdural space, relatively minor trauma. Conclusion: This lymphoma is aggressive with a poor prognosis but a chemotherapy regimen with rituximab significantly improves the clinical outcome of this patient, with an overall survival of 3 years 60-81%.

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Section: Discussionmentioning

confidence: 99%

“…and Development, v. 11, n. 13, e10111332411, 2022 (CC BY 4.0) | ISSN 2525-3409 | DOI: http://dx.doi.org/10.33448/rsd-v11i13.32411 7 central nervous system has various neurological manifestations that often hinder the diagnosis(Chen et al, 2020).…”

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confidence: 99%

Intravascular Large Cell non-Hodgkin Lymphoma in Subacute-Chronic Subdural Hematoma: a case report

Saputra

Sriwidyani

Paskarani

et al. 2022

RSD

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“…Fifty-three cases of brain MRI showed either diffusion restriction (39.6%) or abnormal T2-lesions (56.6%), which were mostly located in the subcortical regions (58.5%). The dynamic pattern of MRI diffusion-weighted imaging (DWI)/T2 lesions was noted in multiple studies (n=23) where serial neuroimaging was performed [11,12,15,16,18,[20][21][22][23][24][26][27][28][29]31,32,[34][35][36][38][39][40]44,45]. Cerebral hemorrhages were noted in 11.3% of cases (n=53) [19,25,28,39,43,46].…”

Section: Figure 3: Frequency Of Non-lateralizing Symptoms Of All Casesmentioning

confidence: 99%

“…The dynamic pattern of MRI diffusion-weighted imaging (DWI)/T2 lesions was noted in multiple studies (n=23) where serial neuroimaging was performed [11,12,15,16,18,[20][21][22][23][24][26][27][28][29]31,32,[34][35][36][38][39][40]44,45]. Cerebral hemorrhages were noted in 11.3% of cases (n=53) [19,25,28,39,43,46]. About 30.2% of cases had enhancing lesions in brain MRI [11,13,15,16,18,30,36,39,43,45,46].…”

Section: Figure 3: Frequency Of Non-lateralizing Symptoms Of All Casesmentioning

confidence: 99%

“…Cerebral hemorrhages were noted in 11.3% of cases (n=53) [19,25,28,39,43,46]. About 30.2% of cases had enhancing lesions in brain MRI [11,13,15,16,18,30,36,39,43,45,46]. Cerebral vessel imaging was mostly unremarkable in 72.7% of cases (n=33), while predominant abnormalities include multifocal stenosis (21.2%) [20,23,[32][33][34]36,39], while two cases had large/medium vessel occlusion [12,19], and one case had distal M1 aneurysm [19].…”

Section: Figure 3: Frequency Of Non-lateralizing Symptoms Of All Casesmentioning

confidence: 99%

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Intravascular Lymphoma-Associated Stroke: A Systematic Review of Case Studies

Bhagat,

Shahab,

Karki

et al. 2023

Cureus

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Intravascular lymphoma (IVL) is an aggressive systemic large B-cell lymphoma that is a rare cause of stroke. The clinical characteristics of stroke associated with IVL remain underexplored, contributing to diagnostic complexities and a high mortality rate. This study endeavors to elucidate the salient clinical and investigative features of stroke linked to this condition. A systematic review was performed using the PubMed database from the incident to August 2023 including search categories for IVL and stroke. All studies, excluding review articles, were included in this study. There were 58 cases with a confirmed diagnosis of IVL associated with stroke, with a mean age of 62.9 ± 9.6 years (female 50%). Classical lateralizing stroke symptoms were noted in only 69% of cases. Other clinical syndromes included altered sensorium (31%), rapidly progressive cognitive impairment (23%), seizures (22%), and gait disturbances (19%). Common hematological abnormalities included elevated lactate dehydrogenase (LDH, 97%), erythrocyte sedimentation rate (ESR, 79%), C-reactive protein (CRP, 61%), interleukin-2, microglobulins, and cerebrospinal fluid (CSF) protein. CSF flow cytometry was not diagnostic, and cytology was mostly negative. The dynamic pattern for DWI/T2 lesions was predominant and primarily located in the subcortical regions. Diffuse background slowing (64%) was a major finding in the electroencephalogram. Seventy-one percent of cases died (n=45) mostly due to delayed diagnosis. Only 31% were treated with first-line R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, prednisone) chemotherapy, among whom 25% died. This study suggests that IVL-associated strokes carry a high mortality rate, largely due to challenges in timely diagnosis and therapy. Unlike classical stroke syndrome, key indicators to aid in early diagnosis include a clinical syndrome of multiple non-lateralizing neurological symptoms, dynamic MRI DWI/T2-lesions primarily located in subcortical regions, elevated serum LDH, ESR, CRP, interleukins, microglobulin, CSF protein, and CSF polymerase chain reaction analysis, apart from tissue examination. Larger studies should be performed to establish diagnostic and predictive scores.

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Intravascular Large B Cell Lymphoma with CNS Involvement Successfully Treated with High-Dose Methotrexate and High-Dose Ara-C Based CNS-Directed Chemoimmunotherapy Alternating with Anthracycline Based Chemoimmunotherapy

Wang¹,

Moustafa²,

Kuhlman³

et al. 2022

BLCTT

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Intravascular large B cell lymphoma (IVL) is a rare subtype of diffuse large B cell lymphoma confined to small blood vessels with a predilection for CNS involvement. The prognosis of IVL with CNS involvement (CNS-IVL) is extremely poor. The optimal treatment for CNS-IVL is not well defined. Thus, we report three patients with CNS-IVL successfully treated with a CNS-centric approach consisting of high-dose methotrexate (HDMTX) and high-dose Ara-C (HiDAC) based CNS-directed chemoimmunotherapy (CIT) alternating with anthracycline-based CIT. Our rationale for intensifying the CNS-directed therapy is the presence of intracerebral bleeding in two of our patients which would result in extravasation of lymphoma cells into the cerebral parenchyma with the development of CNS lymphoma. All three patients have achieved excellent therapeutic outcomes. Two patients with intracerebral bleeding have been in complete remission (CR) for about 11 years and 4 years. One patient was successfully induced into CR about 10 months ago and currently is in CR. This unique therapeutic approach should be further explored for CNS-IVL.

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Intravascular Lymphoma with Progressive CNS Hemorrhage and Multiple Dissections

Cited by 6 publications

References 14 publications

Intravascular Large Cell non-Hodgkin Lymphoma in Subacute-Chronic Subdural Hematoma: a case report

Intravascular Large Cell non-Hodgkin Lymphoma in Subacute-Chronic Subdural Hematoma: a case report

Intravascular Lymphoma-Associated Stroke: A Systematic Review of Case Studies

Intravascular Large B Cell Lymphoma with CNS Involvement Successfully Treated with High-Dose Methotrexate and High-Dose Ara-C Based CNS-Directed Chemoimmunotherapy Alternating with Anthracycline Based Chemoimmunotherapy

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