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

Tae-Hwan Lee; Eun Kee Song

doi:10.5045/kjh.2006.41.4.306

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

Case Report

Korean J Hematol 2006;41(4):306-310.

Published online: 19 January 2006

DOI: https://doi.org/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

Tae-Hwan Lee, M.D., Eun Kee Song, M.D.

Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Korea

Correspondence to：Eun Kee Song, M.D. Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Medical School San 2-20, Geumam-dong, Deokjin-gu, Jeonju 561-180, Korea Tel: +82-63-250-1245, Fax: +82-63-254-1609 E-mail: eksong@chonbuk.ac.kr

Received 24 July 2006 Revised 16 October 2006 Accepted 1 November 2006

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Intravascular large B-cell lymphoma, Bone marrow, Rituximab

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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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