Korean J Hematol.  2006 Dec;41(4):306-310. 10.5045/kjh.2006.41.4.306.

Intravascular Large B-cell Lymphoma with Bone Marrow Involvement: A Case Successfully Treated with a Rituximab-CHOP Combination Regimen

• Lee TH
• Song EK

• KMID: 2305219
• DOI: http://doi.org/10.5045/kjh.2006.41.4.306

Abstract

Intravascular large B-cell lymphoma is rare and generally fatal. It is defined pathologically by neoplastic proliferation of lymphoid cells within the lumens of capillaries, small veins, and arteries with little or no other parenchymal involvement. The diagnosis can be delayed because of the rarity of the disease and the difficulty of detection in imaging studies, and a suspicious clinical observation is warranted to make the correct diagnosis. Early diagnosis is important because delayed treatment could result in a fatal outcome. We have encountered a case of intravascular large B-cell lymphoma involving only the bone marrow. An early diagnosis was made and the patient was treated with combination chemotherapy and rituximab targeting CD20. The patient went into complete remission after the third cycle of chemotherapy and maintained a disease free state up to 6 months.

Keyword

Intravascular large B-cell lymphoma; Bone marrow; Rituximab

MeSH Terms

Arteries
B-Lymphocytes*
Bone Marrow*
Capillaries
Diagnosis
Drug Therapy
Drug Therapy, Combination
Early Diagnosis
Fatal Outcome
Humans
Lymphocytes
Lymphoma, B-Cell*
Veins
Rituximab

Figure

• 

  Fig. 1 Peripheral blood smear finding. Cluster of atypical large cells with convoluted nuclei, coarse chromatin, occasional nucleoli and some cytoplasmic vacuoles in the peripheral blood smear (Wright stain, ×100).

• 

  Fig. 2 PET-CT finding. Diffuse hypermetabolic infiltration in the bone marrow of spine suggesting FDG-avid malignancy.

• 

  Fig. 3 Bone marrow biopsy. (A) Aspiration smear: tumor cell cluster in the bone marrow smear (Wright stain, ×200). (B) Biopsy section: blood vessels filled with tumor cells which have irregular large nuclei and prominent nu-cleol in the bone marrow biopsy (H&E stain, ×400). (C) CD45 (LCA) stain: immunohistochemically, tumor cells show strong positivity for the leukocyte common antigen (CD45) (×400). (D) CD20 stain: immunohistochemically, tunor cells show strong positivity for the B-cell marker (CD20) (×400).

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