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Pathology of Intravascular Large B-cell Lymphoma  

Distinctive B-cell lymphoma with Atypical Lymphoid cells inside the Blood Vessels

  Dr Sampurna Roy MD                

 

Dermatopathology Quiz Case 175

Diagnosis:  Intravascular Large B-cell Lymphoma

 

                                                                                                                      

 

 

Intravascular Large B-Cell lymphoma is the preferred term for a distinctive of lymphoma previously described under a variety of names including malignant angioendothelimatosis, angiotropic lymphoma and intravascular lymphomatosis.

Intravascular Large B-Cell lymphoma is considered to consist of 2 types: a conventional European type and an Asian variant.

The Asian variant of intravascular large B-cell lymphoma is characterized by hemophagocytic syndrome, i.e. the clinical features include pancytopenia, hepatosplenomegaly, and rarely mass formation.

It usually lacks any neurological abnormality or skin lesions, which are typical features of classical intravascular large B-cell lymphoma.

The tumour usually affects elderly patients and is characterized by general fatigue, disorders of various organs, and elevated serum lactate dehydrogenase (LDH) and soluble interleukin-2 receptor (sIL-2R) levels.

Common symptoms include skin eruptions, neurological abnormalities, and gastrointestinal abnormalities.

Intravascular large B-cell lymphoma is an important cause of fever of unknown origin and multiple organ failure.

The skin changes and neurological symptoms are more frequent in the conventional type of Intravascular Large B-Cell lymphoma but are not rare in the Asian variant.

Neurological manifestations are primarily caused by varying degrees of ischemia due to intravascular tumour cells.

Rare cases reported include hemangiomas, angiolipoma and Kaposi's sarcoma in association with AIDS/HIV.

The tumour almost invariably affects only extranodal sites.

Any organ or system may be involved but most commonly it is central nervous system and skin. 

Trunk, extremities and face are favoured sites.

Cutaneous manifestations usually take the form of erythematous or violaceous nodular subcutaneous masses which may ulcerate.

Microscopic features: The lesion is characterised by an accumulation of large atypical lymphocytes within the lumens of small to intermediate-sized blood vessls of the affected tissue.

The tumor cells primarily grow within the blood vessel lumina but may cause minimal extravascular infiltration around the involved vessels in some patients.

Some rare cases contain extravascular infiltrates as well.

In the skin the blood vessels in the dermis and the subcutis are almost completely occluded by atypical lymphoid cells.

These cells are larger than the endothelial cells and have high nuclear:cytoplasmic ratio.

The cell nuclei are round to oval with prominent nucleoli.

Multiple atypical mitotic figures are present. 

Dermatopathology Quiz Case 175

Immunohistochemistry:

The intravascular cells are positive for CD19, CD20, CD22 and CD79A.

The bcl2 protein is positive in these lesions.

(1) Hematoxylin and eosin  

(2) Hematoxylin and eosin

CD20 positive

Note: Random skin biopsy is an extreme useful tool for the diagnosis of Intravascular Large B-Cell lymphoma.

The rate of positive diagnoses is high, since sufficient specimens can be obtained easily with little invasion.

To yield positive results, the biopsy should:

(i) target a visible skin lesion, if possible;

(ii) include not only the dermis but also deeper layers, including the hypodermic adipose tissue;

(iii) be relatively large; and

(iv) should be performed at, at least, 3 different locations such as the upper arm, thigh, and abdomen


Visit: Pathology of Subcutaneous Panniculitis-Like T-Cell Lymphoma

Visit: Pathology of Lymphomatoid Papulosis - Cells resembling 'chunks of coal'

Visit: Pathology of Primary Cutaneous Anaplastic Large Cell Lymphoma

Visit: Pathology of Pagetoid reticulosis (Woringer-Kolopp disease)

Visit: Pathology of Cutaneous B-Lymphoblastic Lymphoma

Visit: Pathology of Primary Cutaneous Marginal Zone B-Cell Lymphoma

Visit: Pathology of Primary Cutaneous Diffuse Large B-Cell Lymphoma

 

Further reading:

[Proposal of possible diagnostic strategy for intravascular large B-cell lymphoma--usefulness of biopsy from senile hemangioma].

Intravascular B-cell lymphoma: the role of skin biopsy.

Intravascular large B-cell lymphoma with involvement of the abdominal subcutis: a case report and literature review.

Intravascular large B-cell lymphoma.

Intravascular large B-cell lymphoma presenting as cholecystitis and pancytopenia: case report with literature review.

Intravascular B-cell lymphoma with hypercalcemia as the initial presentation.

[Intravascular large B-cell lymphoma: report of two autopsy cases with literature review].

[Intravascular lymphoma: report of two autopsic cases, literature review].

[Pathology of intravascular lymphoma].

[Diagnosis of intravascular lymphoma: usefulness of random skin biopsies].

[Intravascular large B-cell lymphoma: an important cause of fever of unknown origin].

An Asian variant of intravascular lymphomatosis: an updated review of malignant histiocytosis-like B-cell lymphoma.

 

 

 

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


 

 

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