[Intravascular lymphoma treated with anti CD20 monoclonal antibodies. Report of one case].
Alfaro Jorge,Espinoza Arturo,Manŕiquez María,Moyano Leonor,González Néstor,Larrondo Milton,Figueroa Gastón
Revista medica de Chile
We report a 78 year old male with prostatism, that was subjected to a prostate biopsy. The pathological study showed a microvascular lymphocytic infiltration. Four months later, the patients presented with reduced alertness, cough, dyspnea, fever and elevation of lactic dehydrogenase and erythrocyte sedimentation rate. Chest and abdominal CAT scans, bone marrow aspirate, protein electrophoresis and prostate specific antigen were normal. A re-evaluation of prostate biopsy showed an intravascular lymphoid infiltration, positive for CD45 and CD20, compatible with the diagnosis of intravascular lymphoma. Chemotherapy was started, but it was not tolerated by the patient and the response was partial. Therefore, treatment with monoclonal antibodies anti CD20 (Rituximab) was started. The tumor had a complete and prolonged (24 months) remission after the treatment
10.4067/s0034-98872004001100010
[Intravascular lymphomatosis: a rare etiology of recurrent cerebral ischemia].
Arboix A,Costa I,Besses C
Revista de neurologia
INTRODUCTION:Intravascular lymphomatosis is a rarely seen clinicopathological condition. OBJECTIVE:To review the literature on cerebral ischemia and intravascular lymphomatosis. DEVELOPMENT:Intravascular lymphomatosis is usually caused by an uncommon type of non-Hodgkin lymphoma, usually of B cells, characterized by the localization of predominantly neoplastic cells within the small calibre blood vessels (arterioles, venules and capillaries). Therefore, it tends to cause multifocal vascular occlusions, with symptoms generally limited to the central nervous system, in the form of recurrent, multifocal cerebral infarcts--one in every 5,000 consecutive cases is usually of this aetiology--or rapidly progressive encephalopathy. Cerebral or meningeal biopsy, or biopsy of peripheral nerve, muscle, adrenal or lymphoid tissue, prostate or lung is usually diagnostic. The differential diagnosis is with vasculitis, multi-infarct dementia, occult neoplasia or infections. In spite of starting suitable treatment with chemotherapy or radiotherapy, the average survival from onset of symptoms is usually four months. CONCLUSION:Intravascular lymphomatosis should be taken into account in the differential diagnosis of repeated cerebral ischaemia of unusual aetiology.
Prostatic acid phosphatase: a possible diagnostic marker of intravascular large B-cell lymphoma.
Kishi Yukiko,Kami Masahiro,Kusumi Eiji,Mineyama Tomoka,Kato Daisuke,Hamaki Tamae,Ueyama Jun-ichi,Miyakoshi Shigesaburo,Morinaga Shin-ichi,Muto Yoshitomo,Taniguchi Shuichi
Haematologica
BACKGROUND AND OBJECTIVE:Intravascular large B-cell lymphoma (IVL) has been treated as fever of unknown origin (FUO), and many patients have been treated inadequately based on incorrect diagnoses. We previously cares for a patient with IVL who tested positive for prostatic acid phosphatase (PAP), a marker of prostate cancer. Since then, we have regularly examined this mather when IVL was suspected to investigate the usefulness of PAP as a diagnostic marker for IVL. We retrospectively evaluated the usefulness of PAP as diagnostic marker of IVL. DESIGN AND METHODS:We reviewed the clinical courses of 5 patients with IVL (3 males, 2 females) in comparison with 23 controls with hematologic malignancies other than IVL. RESULTS:Serum levels of PAP were elevated in all 5 patients with IVL and 2 of the 23 controls. The difference was statistically significant using a chi-squared test (p=0.0002). The sensitivity and specificity of PAP were 100% and 91%, respectively, in the diagnosis of IVL. Its serum levels were closely associated with disease status. INTERPRETATION AND CONCLUSIONS:This study suggests that PAP might be a useful marker for the screening and assessment of disease activity and responses to the treatment of IVL.
Angiotropic large cell lymphoma of the prostate gland: an immunohistochemical study.
Ben-Ezra J,Sheibani K,Kendrick F E,Winberg C D,Rappaport H
Human pathology
Malignant angioendotheliomatosis (MAE) is a rare disorder characterized by the intravascular proliferation of neoplastic mononuclear cells. Until recently, the cell of origin was uncertain; some investigators reported MAE to be lymphomatous in nature, while others claimed it to be of endothelial derivation. In the present unusual case, MAE was an incidental findings in the prostate of a patient with prostatic adenocarcinoma; it is shown to be a lymphoma of B-cell origin.
10.1016/s0046-8177(86)80648-7
Angiotropic (intravascular) large cell lymphoma. A clinicopathologic study of seven cases with unique clinical presentations.
Stroup R M,Sheibani K,Moncada A,Purdy L J,Battifora H
Cancer
The authors recently reported the antigenic phenotypes of three cases of so-called "malignant angioendotheliomatosis" and suggested that angiotropic large cell lymphoma (ALCL) is a more appropriate designation for this disease. The authors now report an additional seven cases of ALCL with unique clinical presentations. One patient presented with prostate enlargement, the second with lytic bone lesions and thickened nasal sinus mucosa, the third had diffuse myalgia, the fourth had dyspnea and pulmonary infiltrates, the fifth had gangrene of the lower extremities, total-body skin involvement, and pancytopenia, the sixth had a lesion of the foreskin mimicking squamous cell carcinoma, and the seventh had a mediastinal mass. In all cases histologic features were characteristic of ALCL with, in two cases, extravascular spread into soft tissue. Immunohistologic studies showed a B-cell phenotype in five cases and a T-cell phenotype in one case. Two patients received combination chemotherapy using established treatment protocol for large cell lymphoma, and remain in complete clinical remission and two patients are responding clinically to combination chemotherapy. Two patients died shortly after receiving combination chemotherapy. One patient has only recently been diagnosed as having ALCL and no long-term follow-up is available. These data indicate that, although ALCL affects predominantly the central nervous system and skin, unusual clinical presentations may occur, and patients with ALCL may respond to combination chemotherapy for large cell lymphoma.
10.1002/1097-0142(19901015)66:8<1781::aid-cncr2820660824>3.0.co;2-5
Prolonged survival using anti-CD20 combined chemotherapy in primary prostatic intravascular large B-cell lymphoma.
Csomor Judit,Kaszás Ilona,Kollár Balázs,Pajor László,Egyházi Zsolt,Fekete Sándor,Egyed Miklós,Timár Botond
Pathology oncology research : POR
Here we report a case of a 73-year-old man with primary intravascular large B-cell lymphoma localized to the prostate. Total prostatectomy was performed due to a benign adenoma suggested by ultrasonography. The diagnosis of IVLBL was obtained incidentally from the prostatectomy specimen. Eight months after the initial R-CHOP chemotherapy a relapse was detected in the left inguinal lymph node, where histologic examination revealed common diffuse large B-cell lymphoma with minimal intravascular component. The second complete remission was achieved by R-IEV therapy. Five months later a second relapse occurred and the patient died in the widespread disease and pneumonia. Primary prostate IVLBL is extremely uncommon; to date only four cases have been described. This is a well documented case, where we also confirmed that the initial primary IVLBL and the secondary lymph node involvement are clonally related. Successful treatment depends on early diagnosis of IVLBL, aggressive chemotherapy and the fact that IVLBL should be considered as a generalized disease in spite of negative staging results.
10.1007/s12253-008-9051-y
Prostatic acid phosphatase is a possible tumor marker for intravascular large B-cell lymphoma.
Seki Kunihiko,Miyakoshi Shigesaburoh,Lee Gang-Hong,Matsushita Hiroshi,Mutoh Yoshitomo,Nakase Kohji,Ida Masayoshi,Taniguchi Hirokazu
The American journal of surgical pathology
Intravascular large B-cell lymphoma (LBCL) is a rare and aggressive subtype of diffuse LBCL characterized by disseminated intravascular proliferation of neoplastic lymphocytes. Obstruction of blood flow by tumor cells in a variety of organs can cause an array of clinical changes, including alteration of the neural and spinal system and the respiratory system, as well as skin lesions. It is usually very difficult to diagnose intravascular LBCL in a patient simply from clinical symptoms or laboratory examinations. We here document our findings that serum prostatic acid phosphatase levels in both males and a female (2.2-24.0 microg/L) reflect the presence of intravascular LBCL, changing synchronously in response to chemotherapy. To determine whether prostatic acid phosphatase (PAP) might be a useful tumor marker for early diagnosis, we reviewed five intravascular LBCLs. Immunohistochemically, tumor cells in all cases were positive for anti-PAP antibody. The results were further confirmed in one case by Western-blot analysis and in another by the detection of amplified messenger RNA for PAP in microdissected tumor cells, respectively. PAP has not been detected in 17 lymphomas (diffuse LBCL, 8 cases; follicular lymphoma, 3 cases; T-cell lymphoma, 3 cases; Hodgkin lymphoma, 3 cases) by Western blot analyses. We conclude that serum PAP is a useful tumor marker for intravascular LBCL and that it deserves further investigation in this context.
A rare case of suspected intravascular large B-cell lymphoma forming nodular masses in the brain and around the prostate and seminal vesicle.
Ogasawara Takuto,Ikehata Yoshinori,Kato Ryuichi,Miyao Noriomi,Konishi Yasuhiro,Kon Shinichiro
Urology case reports
Intravascular large B-cell lymphoma (IVLBCL) is a rare subtype of diffuse large B-cell lymphoma (DLBCL). Furthermore, tumorigenesis is extremely rare. An 80-year-old man was admitted to our hospital with nervous symptoms. Imaging tests showed a brain tumor and mass lesions in the seminal vesicle and retroperitoneum. Transrectal biopsy of the seminal vesicle helped diagnose the patient with DLBCL. The patient's general status deteriorated rapidly, and he died on the 23rd day after admission. An autopsy was performed and the pathological diagnosis was DLBCL, specifically suspected as IVLBCL, with nodular masses in the brain and seminal vesicle.
10.1016/j.eucr.2018.02.002
[Clinicopathological features and MYD88 L265P mutation status of intravascular large B cell lymphoma].
Zhang D D,Zhang L,Zhou J,Jiang G Z,Li P,Zhang Y P,Wang G N,Zhao W G,Li W C
Zhonghua bing li xue za zhi = Chinese journal of pathology
To study the clinicopathologic features and MYD88 L265P mutation status of intravascular large B cell lymphoma (IVLBCL). Fourteen cases of IVLBCLs were diagnosed from March 2014 to December 2019 at the First Affiliated Hospital of Zhengzhou University. The clinicopathologic features and prognosis were analyzed. Epstein-Barr virus encoded RNAs and MYD88 L265P mutation status were detected using in situ hybridization and Sanger sequencing, respectively. The follow-up data were obtained by telephone interview. There were 6 males and 8 females with a median age of 62 years (range: 48-73 years). The involved anatomic locations were demonstrated by positron emission tomography-computed tomography, including adrenal gland (7/14), bone (6/14), central nerve system (4/14), skin (3/14), female reproductive system (3/14), local lymph nodes (3/14), prostate (2/14), liver and spleen (2/14), sphenoid sinus (1/14), penis (1/14), bladder (1/14), and right lung (1/14). Fever was the most common symptom (7/14), followed by neurologic symptoms and lower abdominal pain (2/14 each). The reminder symptoms included rash with edema, legs weakness and numbness, or postmenopausal bleeding (1/14 each). Eleven cases were at Lugano stage Ⅳ. Four cases were associated with the hemophagocytic syndrome, while 6 cases with bone marrow involved. Microscopically, the tumor cells were generally concentrated within the small-to-medium vascular lumens or sinusoids; they had centroblast-like appearance and showed large round or oval nuclei with slightly irregularities, coarse chromatin and 1-3 distinct nucleoli. One exception was the one case with an embryoid nuclei, reminiscent of anaplastic large cell lymphoma. The mitosis was not uncommon. Extravascular neoplastic cells were seen in two cases. The neutrophils could be appreciable in most of the cases (10/14). Immunophenotyping showed that CD20 and CD79α were diffusely and strongly positive in 14 cases; 12 cases were classified as the non-GCB subtype; 6 out of the 11 cases were double expressor lymphoma; 7 out of the 12 cases were CD5-positive. Twelve cases were EBER negative. The MYD88 L265P mutation was detected in 1 case (1/10). The duration of the follow-up ranged from 0.5 to 24.0 months, and 11 patients survived and 3 died. IVLBCL is rare. The most common type of IVLBCL in China is Asian type with scant tumor cells. Combination of clinical and immunohistochemical features can avoid most, if not all, misdiagnoses and missed diagnoses. Some IVLBCL cases may harbor the MYD88 L265P mutation, but the prevalence of MYD88 L265P mutation in the population still warrants additional studies.
10.3760/cma.j.cn112151-20200513-00383
A case report of primary prostate intravascular large B cell lymphoma presenting as prostatic hyperplasia.
Medicine
RATIONAL:Intravascular large B-cell lymphoma (IVLBCL) is a rare condition with a poor prognosis. The clinical presentation of primary lymphoma of the prostate is non-specific and it is difficult to distinguish from other prostatic diseases. The primary prostate IVLBCL is very rare, the diagnosis and treatment of which remains unclear. We reported a rare case to explore the diagnosis and treatment for the primary prostate IVLBCL. PATIENTS CONCERNS:This report described a case of a 71-year-old male diagnosed as primary prostate IVLBCL who presented with prostatic hyperplasia. DIAGNOSIS:The patient first visited an outpatient clinic of urinary surgery because of urinary urgency and frequency and was diagnosed as benign prostatic hyperplasia in about January 2010. Four years later, the symptoms worsened quickly within two months. The diagnosis was still prostatic hyperplasia according to the physical examination and imaging. However, histopathology showed IVLBCL of prostate after transurethral resection of the prostate. INTERVENTIONS:With the clear diagnosis of primary prostate stage I IVLBCL, the patient received immunochemotherapy of R-CHOP (rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone) for 4 cycles and intensity-modulated radiation therapy (IMRT) including the region of prostate with the dose of 45Gy/25f. OUTCOMES:The response was complete remission after all treatment. The last follow-up time of the patient was June 20th, 2019, and no evidence of disease progression was observed. The progression-free survival of the patient was about 49 months until now. LESSONS:The biopsy of prostate by prostatectomy plays an important role in the diagnosis and removal of the original lesion of primary prostate lymphoma. There is no consensus on therapeutic modalities for the treatment of primary prostate IVLBCL till now. Individual treatments include immunochemotherapy and/or radiotherapy according to the National Comprehensive Cancer Network (NCCN) practice guideline of diffuse large B cell lymphoma (DLBCL) based on the performance status and tumor staging of the patient. Timely and accurate diagnosis as well as the appropriate treatment may improve the clinical outcome.
10.1097/MD.0000000000018384
Prostate involvement by intravascular large B-cell lymphoma: a case report with literature review.
Xu Man,Yang Qingping,Li Mingxu,Geng Weipu,Huang Wenlian,Chen Yu
International journal of surgical pathology
Prostate involvement by intravascular large B-cell lymphoma (IVLBL) is extremely rare. Until now, only 6 cases have been reported in the literature. In this article, the authors report a case of a 65-year-old Chinese man with IVLBL located in the prostate. The diagnosis of IVLBL was obtained incidentally from a biopsy of his prostatectomy specimen. The patient underwent CHOP therapy for 5 cycles and had a favorable clinical outcome.
10.1177/1066896911408721
Intravascular large B-cell lymphoma diagnosed on prostate biopsy: a case report.
Özsan Nazan,Sarsık Banu,Yılmaz Asu Fergün,Şimşir Adnan,Dönmez Ayhan
Turkish journal of haematology : official journal of Turkish Society of Haematology
Intravascular large B-cell lymphoma (IVLBCL) is a very rare type of non-Hodgkin lymphoma, usually affecting elderly patients and characterized by selective infiltration of neoplastic cells within blood vessels' lumina. IVLBCL diagnosed with prostatic involvement is extremely rare. We report a patient of 65 years old, having mostly neurological complaints but diagnosed with IVLBCL upon histopathological examination of transurethral prostate resection material, which revealed large neoplastic cell infiltration totally limited within the lumens of small vessels. By immunohistochemistry, neoplastic cell infiltration was positive with MUM1, bcl-6, and bcl-2 and negative with ALK1, CD10, and CD30, with a high Ki-67 proliferation index. CD34 and CD31 staining showed expression in endothelial cells, highlighting the intravascular nature of neoplastic infiltrate. The patient unfortunately refused to receive treatment and died of the disease 8 months after the diagnosis. IVLBCL, though very rare, should be considered in differential diagnosis of all organ biopsies with intravascular infiltration. Further improvements in the understanding of the pathogenesis and biology of this rare type of lymphoma are mandatory.
10.4274/tjh.2013.0090
Intravascular large B cell lymphoma of prostate, a rare entity.
Rallabandi Hima Bindu,Thirukovela Jagadeeshwar,Swain Meenakshi,Meeramira Divya,Gowrishankar Swarnalata
Indian journal of pathology & microbiology
Intravascular large B cell lymphoma is a rare type of extranodal lymphoma characterized by selective growth of neoplastic cells in small vessels, especially capillaries, sparing larger arteries, veins and surrounding tissue. The absence of intravascular lymphoma in the traditional sites and difference in mode of presentation with no mass forming lesion as compared to other lymphomas, makes it unique and difficult to diagnose early. It is extremely heterogeneous in its clinical presentation depending on the organ involved. Primary intravascular large B cell lymphoma of the prostate is extremely rare and only 8 cases have been reported in English literature till date, limited to single case reports. This is a rare case of a 76 year old male patient, who came with complaints of urinary obstruction and fever of unknown origin since 15 days. Routine investigations were within normal limits including the complete urine examination, complete blood picture and PSA levels. Mild prostatomegaly was noted on radiology. Patient was catheterized and transurethral resection was done. On histopathological examination, prostatic acini and stroma were normal but the vessels in the stroma which were dilated and thin walled lacking a muscular coat, showed sheets of loosely cohesive cells with moderate eosinophilic to clear cytoplasm, vesicular nuclei, with 1 to 3 prominent nucleoli and mitoses, averaging 4-6/hpf. On immunohistochemistry, the tumor cells were positive for CD 20 and MUM 1 with high MIB1 index of about 90% and were negative for CD3, CD10, Bcl6, PSA, P63, CK7, CK20, HMWCK, and Pancytokeratin. CD31 stained and highlighted the endothelial cells of the vessels. Final diagnosis made after correlating light microscopy and immunohistochemistry was a Primary Intravascular large B-cell lymphoma of the prostate.
10.4103/IJPM.IJPM_324_20
Prostate primary intravascular large B-cell lymphoma: A case report.
Urology case reports
Intravascular large B-cell lymphoma (IVLBCL) is a distinct subtype of extranodal diffuse large B-cell lymphoma (DLBCL) and mainly affects elderly population characterized by selective infiltration of neoplastic cells within the lumina of small vessels. Prostate primary IVLBCL is extremely rare. Herein we present a case of a 76-year-old male patient who was admitted with symptoms of severe lower urinary tract obstruction. IVLBCL was diagnosed based on histopathological and immunohistochemical examination of the precious tissue specimens though transurethral prostate resection. Awareness and accurate diagnosis are very important to guide the clinicals in formulation of diagnosis and treatment plan.
10.1016/j.eucr.2022.102276