一例经随机经支气管肺活检诊断为血管内大B细胞淋巴瘤（IVLBCL）且胸部计算机断层扫描无异常发现的病例。

A case of intravascular large B-cell lymphoma (IVLBCL) with no abnormal findings on chest computed tomography diagnosed by random transbronchial lung biopsy.

作者信息

Kaku Norihito, Seki Masafumi, Doi Seiji, Hayashi Tomayoshi, Imanishi Daisuke, Imamura Yoshifumi, Kurihara Shintaro, Miyazaki Taiga, Izumikawa Koichi, Kakeya Hiroshi, Yamamoto Yoshihiro, Yanagihara Katsunori, Tashiro Takayoshi, Kohno Shigeru

机构信息

The Second Department of Internal Medicine, Nagasaki University Hospital, and Department of Hematology, Molecular Medicine Unit, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki.

出版信息

Intern Med. 2010;49(24):2697-701. doi: 10.2169/internalmedicine.49.3986. Epub 2010 Dec 15.

DOI:10.2169/internalmedicine.49.3986

PMID:21173545

Abstract

A 58-year-old woman was admitted with refractory fever despite receiving broad-spectrum antibiotics. She had hypoxemia, severe anemia, elevated levels of serum lactic dehydrogenase and soluble interleukin-2 receptor, and a positive direct Coombs test, which suggested an underlying autoimmune hemolytic anemia (AIHA). Chest computed tomography (CT) showed no abnormal findings, but she had hypoxia, and her alveolar-arterial oxygen difference (A-aDO2) was increased. A random transbronchial lung biopsy (TBLB) was performed, and pathological analysis showed massive proliferation of tumor cells in the lumina of the small vessels. Intravascular large B-cell lymphoma (IVLBCL) was diagnosed, and her general status improved after chemotherapy.

摘要

一名58岁女性在接受广谱抗生素治疗后仍持续发热，遂入院治疗。她存在低氧血症、严重贫血、血清乳酸脱氢酶和可溶性白细胞介素-2受体水平升高，以及直接抗人球蛋白试验阳性，提示潜在的自身免疫性溶血性贫血（AIHA）。胸部计算机断层扫描（CT）未发现异常，但她有缺氧情况，且肺泡-动脉血氧分压差（A-aDO2）增大。进行了一次随机经支气管肺活检（TBLB），病理分析显示小血管腔内肿瘤细胞大量增殖。诊断为血管内大B细胞淋巴瘤（IVLBCL），化疗后她的一般状况有所改善。