Cancer Res Treat.  2019 Oct;51(4):1666-1670. 10.4143/crt.2019.022.

Diffuse Large B-Cell Lymphoma Arising within Ileal Neobladder: An Expanding Spectrum of Diffuse Large B-Cell Lymphoma Associated with Chronic Inflammation

• Lee H
• Shin H
• Kim NY
• Park HS
• Park J

• KMID: 2460614
• DOI: http://doi.org/10.4143/crt.2019.022

Abstract

Diffuse large B-cell lymphoma associated with chronic inflammation (DLBCL-CI), specifically arising in ileal neobladder, is a rare neoplasm. We present an unusual case of Epstein-Barr virus (EBV)-positive DLBCL-CI arising within neobladder with detailed clinical, histological, and immunophenotypical features in an immunocompetent patient. An 88-year-old male was admitted for gross hematuria. He had undergone radical cystectomy and ileal neobladder 17 years ago for invasive bladder cancer. Computed tomography showed enhancing lesions on dome and posterior wall of neobladder with mucosal thickening and multiple enlarged retroperitoneal lymphadenopathies. Transurethralresection of neobladder lesion revealed the diffuse infiltration of large lymphoid cells which were positive for CD20, CD30, and multiple myeloma oncogen-1 with EBV-encoded small RNAs co-localizing, and diagnosis of EBV-positive DLBCL-CI was made. After multi-agent chemotherapy, the lesion disappeared. We suggest that clinicians should consider the possibility of DLBCL-CI in patients presented with hematuria during follow-up after bladder reconstruction.

Keyword

Diffuse large B-cell lymphoma; Epstein–Barr virus; Ileal neobladder; Bladder reconstruction; Radical cystectomy

MeSH Terms

Aged, 80 and over
B-Lymphocytes*
Cystectomy
Diagnosis
Drug Therapy
Follow-Up Studies
Hematuria
Humans
Inflammation*
Lymphocytes
Lymphoma, B-Cell*
Male
Multiple Myeloma
RNA
Urinary Bladder
Urinary Bladder Neoplasms
RNA

Figure

• 

  Fig. 1. Computed tomography (CT) scan showed enhancing lesion in the dome and posterior wall of ileal neobladder (yellow arrows) (A) and multiple retroperitoneal lymphadenopathies (orange arrows) (B). Positron emission tomography computed tomography showed localized 18F-fluorodeoxyglucose accumulation in ileal neobladder (yellow arrow) (C) and multiple retroperitoneal lymph nodes (orange arrows) (D).

• 

  Fig. 2. (A) Diffuse large atypical lymphoid cell infiltrates (×200). (B) Focal destructive vascular invasion with surrounding necrosis (×100). (C) Neoplastic lymphocytes were positive for Epstein–Barr virus encoded RNA on in situ hybridization (×100). (D-G) The lymphocytes were diffusely immunoreactive for CD20 (D, ×200) and multiple myeloma oncogen-1 (E, ×200), and showed patchy positivity for CD30 (F, ×100) and p53 (G, ×200).

• 

  Fig. 3. Follow-up computed tomography scan after transurethral surgery and six cycles of “R-CHOP” chemotherapy showed disappearance of neobladder lesion (A) and multiple retroperitoneal lymphadenopathies (B). Follow-up positron emission tomography computed tomography showed no 18F-fluorodeoxyglucose accumulation in ileal neobladder (C) and retroperitoneal lymph nodes (D), which was previously noted.

Reference

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