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

Intravascular large B-cell lymphoma (IVLBCL) is a rare variant of extranodal malignant large B-cell lymphoma characterized by the selective growth of lymphoma cells within the vessels. It is well known that the diagnosis of IVLBCL is sometimes difficult because of heterogeneity of clinical symptoms and the lack of lymphadenopathy and mass formation. Recently, the usefulness of performing random skin biopsy on healthy-appearing skin in patients with suspected of IVLBCL has been reported. Herein, we review the clinicopathological features of consecutive four cases of IVLBCL and discuss the possible diagnostic strategy, including the usefulness of analyzing biopsy specimen from senile hemangioma, in patients with suspected of IVLBCL. One of 4 cases of IVLBCL was diagnosed by random skin biopsies, which were performed in three cases; however, the random skin biopsy specimens showed no atypical lymphocytes in two cases. Biopsy from senile hemangioma clearly revealed accumulation of atypical lymphoid cells within the dilated vessels of senile hemangioma in the remaining three cases, which led to an ultimate diagnosis of IVLBCL. The results of this study demonstrated that performance and analysis of skin biopsy on senile hemangioma in combination with random skin biopsy is useful for the diagnosis of IVLBCL. The performance of combination skin biopsies on cutaneous hemangioma and normal-appearing skin could facilitate and verify early detection of lymphoma cells in patients suspected of IVLBCL, leading to appropriate therapy and good prognosis.