Intravascular lymphomatosis: a clinicopathological study of two cases presenting as an interstitial lung disease

Ko, Young‐Hyeh; Han, Joung-Ho; Go, Jai Hyang; Kim, D.S.; Kwon, O Jung; Yang, Woo Ick; Shin, Dong Hwan; Ree, H. J.

doi:10.1046/j.1365-2559.1997.3310898.x

Cited by 54 publications

(43 citation statements)

References 37 publications

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“…In fact, some patients presenting with pulmonary symptoms were initially treated under the impression of pneumonia or interstitial lung disease. Likewise, previous case reports describe the interstitial lung disease-like pulmonary presentation of IVLBCL [18,19,20,21,22]. As shown by patients in this study, IVLBCL should be considered in the differential diagnosis of unexplained pulmonary presentations such as unexplained hypoxemia, interstitial lung disease or ground-glass opacity accompanied by systemic symptoms or signs of multi-organ involvement.…”

Section: Discussionsupporting

confidence: 77%

Clinical Features and Treatment Outcomes of Intravascular Large B-Cell Lymphoma: A Single-Center Experience in Korea

Hong

Kim²,

Ko³

et al. 2013

Acta Haematol

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Background: Clinical features and treatment outcomes of intravascular large B-cell lymphoma (IVLBCL) have rarely been reviewed due to its rarity and pathologic obscurity. Methods: We analyzed 20 patients who were pathologically diagnosed with IVLBCL at the Samsung Medical Center. Results: Initial manifestations were nonspecific, such as fever with cytopenia, elevated serum lactate dehydrogenase and hypoalbuminemia. Hemophagocytosis was frequent and bone marrow was the most common site of pathologic diagnosis in our series. Hepatosplenomegaly, pleural effusion and ground-glass opacity in the lungs were also commonly found, and positron emission tomography imaging showed increased ¹⁸F-fluorodeoxyglucose uptake in the involved organs. All patients received CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) or rituximab-CHOP. The median overall survival (OS) was 38.9 months (95% confidence interval 6.7-71.1). Rituximab-containing chemotherapy compared to chemotherapy alone resulted in higher 3-year OS (71.4 and 25.0%; p = 0.027). Patients with hemophagocytosis had a poorer 3-year OS compared to patients without hemophagocytosis (29.6 and 75%; p = 0.046). Prognostic factor analysis showed the association of pleural effusion with worse OS (p = 0.002). Conclusions: Treatment with rituximab-containing chemotherapy can improve the treatment outcome of IVLBCL. Pleural effusion may be a poor prognostic factor in patients with IVLBCL.

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Section: Discussionsupporting

confidence: 77%

Clinical Features and Treatment Outcomes of Intravascular Large B-Cell Lymphoma: A Single-Center Experience in Korea

Hong

Kim²,

Ko³

et al. 2013

Acta Haematol

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“…Only a few cases have been reported in Korea, and these have involved nonspecific radiological findings, including diffuse interstitial infiltrates, pleural effusion, signs of pulmonary hypertension, and tumor-like consolidation in the lungs. [4][5][6][7][8] No PET images of pulmonary IVL have been reported. Interestingly, two recent reports suggest that PET is useful for evaluating IVL.…”

Section: Discussionmentioning

confidence: 99%

“…Most patients with pulmonary IVL show nonspecific radiological findings, including diffuse interstitial infiltrates, pleural effusion, signs of pulmonary hypertension, and tumor-like consolidation in the lungs. [4][5][6][7][8] The usefulness of positron emission tomography (PET) in diagnosing IVL has not been established, but Odawara et al and 2. Lung window of a coronal reformatted CT scan shows extensive ground-glass opacity in both lungs except for some areas (arrows).…”

Section: Introductionmentioning

confidence: 99%

Relapsed Intravascular Large B-cell Lymphoma in the Lungs

et al. 2008

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Intravascular lymphoma (IVL) is a rare form of non-Hodgkin's lymphoma that is characterized by the preferential growth of malignant lymphocytes within blood vessels. Pulmonary presentation of IVL is uncommon, and only a few cases have been reported in Korea. Here, we report on a 59-year-old woman with relapsed intravascular large B-cell lymphoma in the lungs. She had been treated with 6 cycles of rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone (R-CHOP) combination chemotherapy for intravascular large B-cell lymphoma in the nasal cavity, and was followed up regularly with no evidence of disease recurrence. About 1 year later, her chest computed tomography showed extensive ground-glass opacity, suggesting interstitial lung disease and, interestingly, diffuse pulmonary fluorodeoxyglucose (FDG) uptake was observed in positron emission tomography (PET). We performed bronchoscopy, bronchoalveolar lavage, and transbronchial lung biopsy. Pathology revealed relapsed intravascular large B-cell lymphoma in the lungs, and she commenced ifosfamide, methotrexate, etoposide, prednisolone (IMVP-16/PD) salvage chemotherapy. After 3 cycles of chemotherapy, PET showed no abnormal FDG uptake. We suggest that a primary or relapsed pulmonary IVL should be considered in the differential diagnosis of unexplained interstitial lung disease and that PET appears be useful in evaluating pulmonary IVL. (Korean J Hematol 2008;43:113-117.)

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“…However, IVL with primary lung lesion is very rare and it is very difficult to diagnose before death. Ko et al [9]has reported 2 cases of IVL with primary pulmonary lesion. They also studied 204 cases of previously reported IVL and of these there were only 10 cases of IVL with primary pulmonary lesion [8, 10, 11, 12, 13, 14, 15].…”

Section: Discussionmentioning

confidence: 99%

A Case of Pulmonary Intravascular Lymphomatosis Diagnosed by Thoracoscopic Lung Biopsy

Yamagata

Okamoto²,

Ota³

et al. 2003

Respiration

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Intravascular lymphomatosis with primary pulmonary lesion is an extremely rare disease. Although the major clinical symptoms include fever, cough, dyspnea and loss of body weight, these are not diagnostic. Chest radiograph findings are also nonspecific and include bilateral reticular shadow, reticulonodular shadow, ground-glass opacity or wedge-shaped subpleural opacities. Therefore, the antemortem diagnosis is relatively difficult. It is considered that intravascular lymphomatosis is a high-grade malignant lymphoma. However, it has been shown recently that a good response and long-term survival may possibly be obtained through systemic combination chemotherapy. We report a case of intravascular lymphomatosis with primary pulmonary lesion where an early diagnosis was obtained through thoracoscopic lung biopsy and subsequent systemic chemotherapy proved to be quite effective. Because the clinical symptoms or chest radiograph findings are usually nonspecific, it was thought that thoracoscopic lung biopsy could be a useful procedure for early and reliable diagnosis of primary pulmonary intravascular lymphomatosis and that it might contribute to an improved prognosis.

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Intravascular lymphomatosis: a clinicopathological study of two cases presenting as an interstitial lung disease

Abstract: These cases and 10 previous reports illustrate the need to include intravascular lymphomatosis in the differential diagnosis of interstitial lung disease.

Cited by 54 publications

References 37 publications

Clinical Features and Treatment Outcomes of Intravascular Large B-Cell Lymphoma: A Single-Center Experience in Korea

Clinical Features and Treatment Outcomes of Intravascular Large B-Cell Lymphoma: A Single-Center Experience in Korea

Relapsed Intravascular Large B-cell Lymphoma in the Lungs

A Case of Pulmonary Intravascular Lymphomatosis Diagnosed by Thoracoscopic Lung Biopsy

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