Random Skin Biopsies Before Brain Biopsy for Intravascular Large B-Cell Lymphoma

Yamada, Erika; Ishikawa, Eiichi; Watanabe, Rei; Matsumura, Hideaki; Sakamoto, Noriaki; Ishii, Akiko; Tamaoka, Akira; Hattori, Keiichiro; Obara, Naoshi; Nakamagoe, Kiyotaka; Matsuda, Masahide; Tsurubuchi, Takao; Akutsu, Hidenori; Zaboronok, Alexander; Shibuya, Makoto; Takano, Shingo; Matsumura, Akira

doi:10.1016/j.wneu.2018.09.110

Cited by 15 publications

(18 citation statements)

References 8 publications

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“…Figure 1 is a composite of photographs of our patients' biopsy specimens, which shows the presence of lymphoma cells within the vasculature of affected organs (skin, liver, thyroid, and bone marrow). As described in our patients, distinct lymphomatous masses are usually not seen 3 . Symptoms are caused by occlusion of blood vessels, and thus extravascular infiltration of tissues does not occur.…”

Section: Discussionsupporting

confidence: 70%

Intravascular lymphoma - The creepy crawler: A case series and brief literature review

Saleem

Nasrazadani

Kuang

et al. 2021

Preprint

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Section: Discussionsupporting

confidence: 70%

Intravascular lymphoma - The creepy crawler: A case series and brief literature review

Saleem

Nasrazadani

Kuang

et al. 2021

Preprint

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“…Some experts recommend deep skin biopsies or at least three specimens of random skin biopsies. As in the present case with brain involvement, other experts recommend obtaining a skin biopsy followed by a brain biopsy [15]. Considering that many organs might be affected, biopsies can be obtained from other tissues if the skin biopsy is non-diagnostic [1,13].…”

Section: Discussionmentioning

confidence: 87%

A Rare Case of Intravascular Large B-cell Lymphoma Presenting With Bilateral Ophthalmoplegia, Along With a Literature Review

Allen¹,

Shaikh²,

Laurent-Ariot³

et al. 2022

Cureus

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Intravascular large B-cell lymphoma (IVLBCL) is a subtype of extranodal lymphoma that characteristically contains malignant lymphocytes within blood vessels. The clinical presentation of IVLBCL has high variability. In our case, the patient's initial presentation involved bilateral ptosis, restricted extraocular movements, periorbital pain, and bitemporal headache. The patient denied the classic "B symptoms" such as fever, night sweats, or weight loss. The patient also denied a family history of malignancy. Initial imaging studies were unremarkable, making diagnosis particularly challenging. Ultimately, functional endoscopic sinus surgery was performed. Pathological examination of the intraoperative specimen revealed a CD5+ large B-cell lymphoma within the vessels involving the left ethmoid sinus, respiratory mucosa, and nasal septum. The patient underwent steroid therapy prior to diagnosis, which led to rapid improvement in headache and mild improvement in extraocular function and ptosis. Following diagnosis, the patient underwent chemotherapy with supportive medications. Our case report may be considered a reference for cases presenting with extensive bilateral extraocular muscle deficits and levator palpebrae dysfunction in the absence of notable initial imaging findings, "B symptoms," or positive family history. The teaching point from this case is to demonstrate the difficulty of diagnosis and our train of thought in investigating an abnormal presentation with no clearly identifiable etiology following initial diagnostic workup and treatment.

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“…Diagnosis of IVLBCL is made by identification of large lymphoma cells within small blood vessels of affected tissue. In cases with both cutaneous and CNS involvement, skin biopsy should be considered prior to brain biopsy given the less invasive nature of the procedure [6,7].…”

Section: Discussionmentioning

confidence: 99%

Clinical Reasoning: A 66-Year-Old Woman With Progressive Encephalopathy and Bilateral Hearing Loss

et al. 2023

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Section 1A 66-year-old woman with no medical history presented to an outside hospital for an acute alteration in cognition described as wandering aimlessly, combative behavior and incomprehensible speech that progressed over three days. Upon arrival she had altered cognition, psychomotor agitation and inability to follow commands, but no weakness, dysarthria, sensation loss, vision loss or meningismus. Vital signs and laboratory studies including complete blood count, comprehensive metabolic panel, urinalysis, and urine drug screen were normal. Questions for Consideration:1. What is the localization for her presentation? 2. What is the initial differential diagnosis? 3. What studies should be conducted? Section 2

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Random Skin Biopsies Before Brain Biopsy for Intravascular Large B-Cell Lymphoma

Cited by 15 publications

References 8 publications

Intravascular lymphoma - The creepy crawler: A case series and brief literature review

Intravascular lymphoma - The creepy crawler: A case series and brief literature review

A Rare Case of Intravascular Large B-cell Lymphoma Presenting With Bilateral Ophthalmoplegia, Along With a Literature Review

Clinical Reasoning: A 66-Year-Old Woman With Progressive Encephalopathy and Bilateral Hearing Loss

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