Simultaneous Thrombosis of the Mesenteric Artery and Vein as a Novel Clinical Manifestation of Intravascular Large B-Cell Lymphoma

Abstract

A 79-year-old man with a 2-month history of fever and weight loss was admitted to our hospital because of an acute abdomen. Abdominal CT scans showed marked sectional thickening and edema of the small intestine. On laparotomy, a 16-cm section of the small intestine was ischemic and necrotic; therefore, segmentectomy of the intestine was performed. A thrombus was noted at the stump of the mesenteric artery branch. Histopathological analysis of the resected intestine revealed fibrin thrombi in both mesenteric arteries and veins. Furthermore, a cluster of large, abnormal lymphoid cells bordering the intima of most branches of the mesenteric veins and small vessels was observed. Immunohistochemical analysis revealed that these abnormal cells were positive for CD20, leading to a diagnosis of intravascular large B-cell lymphoma (IVLBCL). The patient was successfully treated with standard R-CHOP chemotherapy; however, the lymphoma recurred in the central nervous system 18 months after the initial diagnosis, and the patient died. Simultaneous thrombosis of the mesenteric artery and vein is unusual as a clinical manifestation of IVLBCL. However, IVLBCL should be taken into consideration when ischemic disorders of unknown cause, accompanied by fever of unknown origin, are encountered.

Echocardiographic measures associated with the presence of left ventricular thrombus in patients with chemotherapy‐related cardiac dysfunction

“…In addition, cancer is known to induce prothrombotic and hypercoagulability state . This is especially true for breast cancer, lymphoma, and leukemia patients who formed majority of our patient population. Although less common than venous thrombosis, arterial thrombosis and thromboembolism have been reported in cancer patients .…”

Primary Intra-aortic Epstein-Barr Virus–Positive Large B-Cell Lymphoma Presenting as Aortic Mural Thrombosis: An Entity Distinct From Intravascular Large B-Cell Lymphoma

“…4 Therefore, IVLBCL is a bona fide, although sometimes occult, histologically disseminated disease, which lacks detectable tumor masses. In our literature search from PubMed, we found a few cases of primary B-cell lymphoma involving the lumina of the large vessels, such as 2 SVC-involved cases, 2,3 4 mesenteric and portal vessel cases, [5][6][7][8] and 1 saphenous vein case. 9 However, it is controversial whether these cases are included in the entity of IVLBCL.…”

EBV-positive intravascular large B-cell lymphoma of the small intestine: a case report and literature review

“…This disease is relatively rare in the gastrointestinal tract, but some studies have found that 8% (3/38) of IVLBCL case appear in the gastrointestinal tract [10] . According to the literature we collected, there are 12 literature reports of IVLBCL occurring in the gastrointestinal tract, including 15 cases, of which 5 cases occurred in the small intestine [10,[21][22][23][24][25][26][27][28][29][30][31] . The clinicopathological features are shown in Table 3.…”