Moore Ty M, Tun Aung M, Mullangi Sanjana, Farrell Daniel, Bennett Joseph G
Internal Medicine, University of Kansas Medical Center, Kansas City, USA.
Hematologic Malignancies and Cellular Therapeutics, University of Kansas Health System, Westwood, USA.
Cureus. 2024 Nov 14;16(11):e73704. doi: 10.7759/cureus.73704. eCollection 2024 Nov.
A 66-year-old female presented to the hospital for evaluation of multiple strokes over a three-month period. The patient underwent extensive testing to evaluate for autoimmune vasculitis and other hypercoagulable entities that were negative. Bone marrow and lymph node biopsies showed no evidence of lymphoma. An excisional muscle biopsy was then performed, which demonstrated occasional small blood vessels containing atypical CD20+ lymphoid cells, and a diagnosis of intravascular large B-cell lymphoma (IVLBCL) was rendered. The patient underwent systemic chemotherapy along with CNS-directed therapy, followed by a consolidative autologous stem cell transplant. Here, we will discuss an unusual case of IVLBCL, some of the complications that can arise when diagnosis is delayed, and some of the key principles of diagnostic workup and management.
一名66岁女性因在三个月内发生多次中风而入院接受评估。患者接受了广泛检查以评估自身免疫性血管炎和其他高凝状态相关疾病，结果均为阴性。骨髓和淋巴结活检未发现淋巴瘤证据。随后进行了切除性肌肉活检，结果显示偶尔有小血管内含有非典型CD20+淋巴细胞，最终诊断为血管内大B细胞淋巴瘤（IVLBCL）。该患者接受了全身化疗及中枢神经系统定向治疗，随后进行了巩固性自体干细胞移植。在此，我们将讨论一例不寻常的IVLBCL病例、诊断延迟可能出现的一些并发症以及诊断检查和管理的一些关键原则。
