Use of Random Skin Biopsy for Diagnosis of Intravascular Large B-Cell Lymphoma

Asada, Noboru; Odawara, Jun; Kimura, Shun; Aoki, Takatoshi; Yamakura, Masayuki; Takeuchi, Masami; Seki, Reiko; Tanaka, Atsushi; Matsue, Kosei

doi:10.1016/s0025-6196(11)61097-5

Cited by 110 publications

(110 citation statements)

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“…There were 11 patients with pathologically confirmed IVL. Nine of those 11 patients were diagnosed with IVL by random skin biopsy, and the remaining 2 patients were diagnosed by bone marrow biopsy alone 6,7 with immunohistochemistry. Diagnoses of IVL were made by an expert hematopathologist in accordance with the latest World Health Organization classification.…”

Section: Methodsmentioning

confidence: 99%

“…1,2 The variety of nonspecific clinical symptoms, including pyrexia, neurologic abnormalities, respiratory distress, and lack of lymphadenopathy, makes it difficult to diagnose lymphomas. [3][4][5] However, recent recognition of the disease and the introduction of various diagnostic modalities, including random skin biopsy, 6,7 and 18 F-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET)/computed tomography (CT) (PET/CT) 8,9 have facilitated the in vivo diagnosis of IVL and prompt initiation of chemotherapy. The use of rituximab in combination with standard cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP) 10 has resulted in a marked improvement in the survival rate of patients with IVL.…”

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confidence: 99%

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High frequency of neurolymphomatosis as a relapse disease of intravascular large B‐cell lymphoma

Matsue

Hayama

Iwama

et al. 2011

Cancer

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BACKGROUND: Intravascular large B-cell lymphoma (IVL) is characterized by lymphoma cell proliferation in the lumina of small vessels in various organs. A high incidence of neurologic symptoms associated with the central nervous system has been reported, but peripheral nerve involvement (neurolymphomatosis [NL]) rarely has been described. METHODS: The medical records from patients who were diagnosed with IVL over the past 4 years were reviewed. A diagnosis of NL was made based on the combination of neurologic symptoms and their correspondence with imaging studies, such as magnetic resonance imaging (MRI), 18 F-fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography/computed tomography (PET/CT), and/or the histologic confirmation of lymphoma cells within the peripheral nerves, nerve root/plexuses, or cranial nerves. RESULTS: Four patients with NL were identified among 11 patients who had IVL. All cases of NL occurred as relapsed disease during or shortly after the completion of chemotherapy. Although MRI studies of the brains and whole spines revealed nerve infiltration by gadolinium enhancement in 2 patients, the technology was not sensitive enough to detect such infiltration in the remaining 2 patients. In contrast, FDG-PET/CT studies successfully revealed cranial or peripheral nerve lesions in all 4 patients and was useful for evaluating therapeutic response. Patients received treatment with high-dose methotrexate with or without other systemic chemotherapy, which achieved varied success. Further studies will be needed to determine the optimal treatment. CONCLUSIONS: Considering the rarity of IVL and NL, the current observations suggested that IVL may have a predilection not only for the vessels but also for both the central and peripheral nervous systems. Cancer 2011;117:4512-

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Section: Methodsmentioning

confidence: 99%

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confidence: 99%

High frequency of neurolymphomatosis as a relapse disease of intravascular large B‐cell lymphoma

Matsue

Hayama

Iwama

et al. 2011

Cancer

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“…Because many patients with IVLBCL have accompanying multiple organ failure and hemorrhagic diathesis, it can be difficult to perform an invasive biopsy. Accordingly, as random skin biopsy is regarded as minimally invasive, it is the established diagnostic method (Gill et al 2003;Asada et al 2007;Barnett et al 2008). In our case, random skin biopsies provided findings of IVLBCL, although the patient did not show any abnormal skin lesions.…”

Section: Discussionmentioning

confidence: 99%

Reversible Hypopituitarism Associated with Intravascular Large B-Cell Lymphoma: Case Report of Successful Immunochemotherapy

Sawada

Ishii

Koga

et al. 2016

Tohoku J. Exp. Med.

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Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of diffuse large B-cell lymphoma. There have been only a limited number of reports regarding pituitary dysfunction associated with IVLBCL. We present a 71-year-old woman with hypopituitarism without any hypothalamic/pituitary abnormalities as assessed by magnetic resonance imaging. She presented with edema, abducens palsy, and elevated levels of lactate dehydrogenase and soluble interleukin-2 receptor. Provocative testing showed that the peaks of luteinizing hormone, follicle-stimulating hormone, thyroid-stimulating hormone and adrenocorticotropic hormone were evoked to normal levels by simultaneous administration of luteinizing hormone-releasing hormone, thyrotropin-releasing hormone and corticotropin-releasing hormone, but the responses of these four pituitary hormones showed a delayed pattern. She was diagnosed with IVLBCL with cerebrospinal invasion by pathological findings of the bone marrow, skin, and cerebrospinal fluid. She achieved hematological remission after immunochemotherapy. Pituitary function was also restored without hormonal replacement, and the improvement of the pituitary function was confirmed by dynamic testing. We reviewed the literature with respect to hypopituitarism associated with IVLBCL. There were less than 20 case reports and most of the patients died. Endocrinological course was described in only two cases, and both of them required hormonal supplementation. To our knowledge, this is the first case of hypopituitarism induced by IVLBCL that was successfully managed by immunochemotherapy alone. This case suggests that early diagnosis and treatment of IVLBCL might improve anterior pituitary function and enable patients to avoid hormone replacement therapy.

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“…Laboratory tests reveal the elevation of sIL2R in over 80% of IVL patients. A definitive diagnosis of IVL is usually made by bone marrow biopsy or random skin biopsy (4,5), but both procedures are painful and cause scarring. In contrast, we found that an endoscopic biopsy was useful for the definitive diagnosis of IVL in our two patients.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, however, an increasing number of living patients are diagnosed (3). While the definitive diagnosis of IVL has been achieved by bone marrow biopsy and random skin biopsy (4,5), there are no previous reports of diagnosis by endoscopic biopsy.…”

Section: Introductionmentioning

confidence: 99%

Two Cases of Intravascular Lymphoma Diagnosed by Gastrointestinal Endoscopic Biopsy

et al. 2015

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Two cases of intravascular lymphoma (IVL) were diagnosed by endoscopic biopsy. Both patients were admitted to our hospital with a fever of an unknown origin. An elevated serum level of soluble interleukin-2 receptor antibody suggested IVL. An upper gastrointestinal endoscopy was performed. A biopsy of both the reddened and normal gastroduodenal mucosa (Case 1) and a biopsy of a gastric antral ulcer, multiple polyploid lesions resembling submucosal tumors in the duodenum, and the patient's normal mucosa (Case 2) revealed vascular infiltration by CD20-positive atypical lymphocytes, confirming the diagnosis of IVL. The performance of a gastrointestinal biopsy for suspected IVL is important, even if there are no visible endoscopic abnormalities.

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Use of Random Skin Biopsy for Diagnosis of Intravascular Large B-Cell Lymphoma

Cited by 110 publications

References 12 publications

High frequency of neurolymphomatosis as a relapse disease of intravascular large B‐cell lymphoma

High frequency of neurolymphomatosis as a relapse disease of intravascular large B‐cell lymphoma

Reversible Hypopituitarism Associated with Intravascular Large B-Cell Lymphoma: Case Report of Successful Immunochemotherapy

Two Cases of Intravascular Lymphoma Diagnosed by Gastrointestinal Endoscopic Biopsy

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