Shinoda Hiromi, Maejima Arafumi, Shimizu Kumi, Onaka Akio, Boku Taigen, Oyamada Yoshitaka
Department of Respiratory Medicine, Tokyo Medical Center.
Nihon Kokyuki Gakkai Zasshi. 2010 Jan;48(1):76-80.
A 54-year-old woman was admitted with general fatigue and dyspnea on exertion. Her serum LDH level was markedly elevated to 2145 IU/L, and chest CT revealed diffuse centrilobular opacities. Total cell counts in bronchoalveolar lavage fluid were elevated, and lymphocytes accounted for 98% of the cells. A transbronchial lung biopsy demonstrated numerous CD20-positive atypical cells in the alveolar capillaries, so intravascular lymphoma (IVL) was diagnosed as having. Lymphoma cells were also present in the bone marrow sinusoids, while there was no sign of hemophagocytosis. Combined chemotherapy (CHOP with rituximab) successfully induced complete remission, and she has been free of recurrence for 40 months. In cases with diffuse centrilobular opacities on chest CT, accompanied by elevated serum LDH, it is important to rule out IVL by performing TBLB.
一名54岁女性因全身乏力和劳力性呼吸困难入院。她的血清乳酸脱氢酶（LDH）水平显著升高至2145 IU/L，胸部CT显示弥漫性小叶中心性混浊。支气管肺泡灌洗液中的总细胞计数升高，淋巴细胞占细胞总数的98%。经支气管肺活检显示肺泡毛细血管中有大量CD20阳性非典型细胞，因此诊断为血管内淋巴瘤（IVL）。淋巴瘤细胞也存在于骨髓血窦中，但无噬血细胞现象。联合化疗（CHOP方案联合利妥昔单抗）成功诱导完全缓解，她已无复发40个月。对于胸部CT显示弥漫性小叶中心性混浊且血清LDH升高的病例，通过进行经支气管肺活检排除IVL很重要。
