Reactive Intralymphovascular Immunoblastic Proliferations Mimicking Aggressive Lymphomas

Abstract

Reactive intralymphovascular immunoblastic proliferations (ILVIPs) may mimic aggressive lymphomas and are rarely reported. Herein, we characterize the clinicopathologic features of 8 patients with ILVIPs. No patients had lymphadenopathy, hepatosplenomegaly, or other findings suggestive of lymphoma. The ILVIPs involved the small or large intestine (n=5) and appendix (n=3). Patients were evaluated for abdominal pain, suspected appendicitis, intestinal obstruction, diverticulitis, volvulus, or tumor resection. Histologic sections showed expanded lymphovascular spaces filled by intermediate to large immunoblasts, positive for CD38, CD43, CD45, CD79a, and MUM1/IRF4 in all cases tested. Five of 6 (83%) cases were positive for CD30. CD20 was weakly positive in a subset of cells in 2 (25%) cases, and PAX5 was weakly positive in 4 (50%) cases. The immunoblasts expressed polytypic light chains in all cases tested. In 1 case, a subset of immunoblasts expressed T-cell markers indicating the presence of a T-cell component. The immunoblasts were negative for ALK, BCL-2, BCL-6, CD10, CD56, CD138, and Epstein-Barr virus–encoded small RNA in all cases assessed. The proliferation index shown by Ki-67 was high with a median of 80%. In all 6 cases tested, the immunoblasts were shown within lymphatic channels highlighted by D2-40. In conclusion, ILVIPs can be rarely observed in patients with inflammatory or infectious conditions, especially in gastrointestinal tract surgical specimens. The immunoblasts are predominantly of B-lineage with a postgerminal center immunophenotype and are located within lymphatic channels. It is essential to distinguish reactive ILVIPs from aggressive lymphomas to avoid unnecessary therapy.

An atypical plasmablastic proliferation — should we suspect vedolizumab?

“…Primarily found within inflammatory processes of the GI tract, these intravascular infiltrates are predominantly comprised of B-lineage intermediate to large immunoblasts and express polytypic light chains. A number of ILVIPs on presentation were initially felt to be neoplastic, mimicking aggressive lymphomas, but they lacked any clonal gene rearrangement [6]. In contrast, the presence of light chain restriction and positive finding of a MYC translocation highlights the more atypical nature of the infiltrate in our case, raising the possibility that an early plasmablastic lymphoma or precursor lesion, lacking the usual aggressive features of this lesion, cannot be excluded.…”

EBV-Positive Intravascular Large B-Cell Lymphoma of the Small Intestine: A Case Report and Literature Review

“…CD20 and CD30 can be used to identify them apart. 51 IVLBCL can happen in many parts of the body, but the main symptoms are problems with the nervous system and skin, with no obvious lymphadenopathy. The disease is easily misdiagnosed, and if the patient is not diagnosed in a timely manner, the disease will proceed swiftly, resulting in a terrible prognosis for the patient.…”

Insulin-like Growth Factor II mRNA-binding Protein 3 is a Highly Sensitive Marker for Intravascular Large B-cell Lymphoma

“…As controls, negative biopsies from patients without IVLBCL in Kyoto University Hospital were collected; we included patients who were initially suspected to have IVLBCL and excluded those with other B-cell lymphomas. In addition, histologic mimics of IVLBCL, such as intravascular natural killer (NK)/T-cell lymphoma 23 and reactive intravascular and intralymphatic lymphocyte proliferation, 24,25 were searched as negative controls. Clinical and pathological information was obtained from pathology reports and patient charts.…”