Journal List > Korean J Hematol > v.43(2) > 1032771

Hong, Choi, Kim, Joo, Jang, Lee, Ko, and Kim: Relapsed Intravascular Large B-cell Lymphoma in the Lungs

Abstract

Intravascular lymphoma (IVL) is a rare form of non-Hodgkin's lymphoma that is characterized by the preferential growth of malignant lymphocytes within blood vessels. Pulmonary presentation of IVL is uncommon, and only a few cases have been reported in Korea. Here, we report on a 59-year-old woman with relapsed intravascular large B-cell lymphoma in the lungs. She had been treated with 6 cycles of rituximab, cyclophosphamide, adriamycin, vincristine, and prednisolone (R-CHOP) combination chemotherapy for intravascular large B-cell lymphoma in the nasal cavity, and was followed up regularly with no evidence of disease recurrence. About 1 year later, her chest computed tomography showed extensive ground-glass opacity, suggesting interstitial lung disease and, interestingly, diffuse pulmonary fluorodeox-yglucose (FDG) uptake was observed in positron emission tomography (PET). We performed bronchoscopy, bronchoalveolar lavage, and transbronchial lung biopsy. Pathology revealed relapsed intravascular large B-cell lymphoma in the lungs, and she commenced ifosfamide, methotrexate, etoposide, prednisolone (IMVP-16/PD) salvage chemotherapy. After 3 cycles of chemotherapy, PET showed no abnormal FDG uptake. We suggest that a primary or relapsed pulmonary IVL should be considered in the differential diagnosis of unexplained interstitial lung disease and that PET appears be useful in evaluating pulmonary IVL.

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Fig. 1
Linear atelectasis in the right lower lung zone.
kjh-43-113f1.tif
Fig. 2
Lung window of a coronal reformatted CT scan shows extensive ground-glass opacity in both lungs except for some areas (arrows). Ground-glass opacity lesions suggest the presence of interstitial disease process.
kjh-43-113f2.tif
Fig. 3
Maximum intensity projection image of PET demonstrates diffuse FDG uptake in both lungs (arrows). Abbreviation: L, liver.
kjh-43-113f3.tif
Fig. 4
Small and medium-sized blood vessels of the lung filled with intravascular lymphoma cells. Hematoxylin and eosin staining, ×400.
kjh-43-113f4.tif
Fig. 5
Immunohistochemical staining for CD20 in neoplastic cells, ×400.
kjh-43-113f5.tif
Fig. 6
Follow-up PET scan shows reduced lung lesions with nearly complete disappearance of FDG.
kjh-43-113f6.tif
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