Kanazawa Yuka, Hagiwara Noriko, Matsuo Ryu, Arakawa Shuji, Ago Tetsuro, Kitazono Takanari
Division of Cerebrovascular Medicine, Kyushu Rosai Hospital.
Rinsho Shinkeigaku. 2014;54(6):484-8. doi: 10.5692/clinicalneurol.54.484.
A 60-year-old man was admitted to our hospital complaining of fever, headache and vertigo. Neurological examination on admission showed mild ataxic gait. Brain magnetic resonance imaging showed linear high intensity in the left parietal lobe on diffusion-weighted imaging (DWI) and laboratory data revealed elevated serum lactate dehydrogenase and soluble interleukin-2 receptor. Although intravascular lymphoma was suspected from these findings, bone marrow and skin biopsies were negative. Two months later, he presented with sensory disturbance of the left upper limb, and new lesions in the right frontal and bilateral parietal lobes were detected on DWI. A systemic evaluation showed multiple low-density lesions in the bilateral kidneys on computed tomography. Based on the results of a renal biopsy, we made a histological diagnosis of intravascular large B-cell lymphoma (IVLBCL). As IVLBCL is quite rare and often has a poor prognosis, a systemic evaluation to determine the proper biopsy site is needed for early diagnosis.
一名60岁男性因发热、头痛和眩晕入院。入院时神经系统检查显示轻度共济失调步态。脑部磁共振成像在弥散加权成像（DWI）上显示左顶叶呈线状高信号，实验室检查数据显示血清乳酸脱氢酶和可溶性白细胞介素-2受体升高。尽管根据这些发现怀疑为血管内淋巴瘤，但骨髓和皮肤活检结果为阴性。两个月后，他出现左上肢感觉障碍，DWI检查发现右额叶和双侧顶叶有新病灶。计算机断层扫描显示双侧肾脏有多个低密度病灶。根据肾活检结果，我们做出了血管内大B细胞淋巴瘤（IVLBCL）的组织学诊断。由于IVLBCL非常罕见且预后通常较差，因此需要进行全面评估以确定合适的活检部位以便早期诊断。
