J Pathol Transl Med.  2017 May;51(3):284-291. 10.4132/jptm.2017.02.16.

A Small Case Series of Intravascular Large B-Cell Lymphoma with Unexpected Findings: Subset of Cases with Concomitant Extravascular Central Nervous System (CNS) Involvement Mimicking Primary CNS Lymphoma

Affiliations
  • 1Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. kate.poropatich@northwestern.edu

Abstract

BACKGROUND
Intravascular large B-cell lymphoma (IVLBCL) is a rare type of extranodal lymphoma with growth mainly in the lumina of vessels. We studied a small series of IVLBCL and focused on its central nervous system (CNS) involvement.
METHODS
Searching the medical records of Northwestern Memorial Hospital, we identified five cases of IVLBCL from January 2007 to January 2015. Clinical information, hematoxylin and eosin stained histologic slides and immunohistochemistry studies were reviewed for all cases. Polymerase chain reaction (PCR) analysis for the immunoglobulin (Ig) heavy and light chain gene rearrangement was performed on all five cases.
RESULTS
Three of the five cases of IVLBCL were autopsies. Patients' age ranged from 56 to 84. CNS involvement was present in two cases"โ€in both patients, the CNS involvement showed an extravascular pattern with confluent sheet-like formation. PCR analysis confirmed that in one case the systemic intravascular and CNS extravascular components were clonally identical.
CONCLUSIONS
In a small case series of IVLBCL, we observed that CNS involvement by IVLBCL often has an extravascular morphology, but is clonally identical to the intravascular counterpart by PCR analysis. As IVLBCL can have a rapidly progressing poor outcome, it should be kept in the differential diagnoses for patients presenting with lymphoma of the CNS. The presence of extravascular growth patterns in the CNS should not exclude IVLBCL as a diagnosis.

Keyword

Intravascular large B-cell lymphoma

MeSH Terms

Autopsy
B-Lymphocytes*
Central Nervous System*
Diagnosis
Diagnosis, Differential
Eosine Yellowish-(YS)
Gene Rearrangement
Hematoxylin
Humans
Immunoglobulins
Immunohistochemistry
Lymphoma*
Lymphoma, B-Cell*
Medical Records
Polymerase Chain Reaction
Eosine Yellowish-(YS)
Hematoxylin
Immunoglobulins
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