Korean J Hematol.  2008 Jun;43(2):113-117. 10.5045/kjh.2008.43.2.113.

Relapsed Intravascular Large B-cell Lymphoma in the Lungs

Affiliations
  • 1Department of Medicine, Radiology, Samsung Medical Center, Sungkunkwan University School of Medicine, Seoul, Korea. wskimsmc@skku.edu
  • 2Department of Medicine, Pathology, Samsung Medical Center, Sungkunkwan University School of Medicine, Seoul, Korea.

Abstract

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.

Keyword

Intravascular lymphoma; Interstitial lung disease; Positron emission tomography

MeSH Terms

Antibodies, Monoclonal, Murine-Derived
B-Lymphocytes
Biopsy
Blood Vessels
Bronchoalveolar Lavage
Bronchoscopy
Cyclophosphamide
Diagnosis, Differential
Doxorubicin
Drug Therapy, Combination
Etoposide
Female
Humans
Ifosfamide
Korea
Lung
Lung Diseases, Interstitial
Lymphocytes
Lymphoma
Lymphoma, B-Cell
Lymphoma, Non-Hodgkin
Methotrexate
Middle Aged
Nasal Cavity
Positron-Emission Tomography
Prednisolone
Recurrence
Thorax
Vincristine
Rituximab
Antibodies, Monoclonal, Murine-Derived
Cyclophosphamide
Doxorubicin
Etoposide
Ifosfamide
Methotrexate
Prednisolone
Vincristine

Figure

  • Fig. 1 Linear atelectasis in the right lower lung zone.

  • Fig. 2 Lung window of a coronal reformatted CT scan shows extensive ground-glass opacity in both lungs except for some areas (arrows). Ground-glass opacity lesions suggest the presence of interstitial disease process.

  • Fig. 3 Maximum intensity projection image of PET demonstrates diffuse FDG uptake in both lungs (arrows). Abbreviation: L, liver.

  • Fig. 4 Small and medium-sized blood vessels of the lung filled with intravascular lymphoma cells. Hematoxylin and eosin staining, ×400.

  • Fig. 5 Immunohistochemical staining for CD20 in neoplastic cells, ×400.

  • Fig. 6 Follow-up PET scan shows reduced lung lesions with nearly complete disappearance of FDG.


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