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Intravascular large B-cell lymphoma: representative cases and approach to diagnosis
  1. James Llewellyn Barker1,2,3,
  2. Oshi Swarup1,2 and
  3. Anish Puliyayil3
  1. 1Department of Medicine, The Royal Melbourne Hospital, Melbourne, VIC, Australia
  2. 2Department of Medicine, Albury Wodonga Health, Albury, NSW, Australia
  3. 3Border Medical Oncology and Haematology, Albury Wodonga Regional Cancer Centre, Albury, NSW, Australia
  1. Correspondence to Dr James Llewellyn Barker; jameslbarker90{at}gmail.com

Abstract

Intravascular large B-cell lymphoma (ILBCL) is a subtype of non-Hodgkin’s large B-cell lymphoma that is characterised by neoplastic lymphocyte proliferation within the lumen of small blood vessels, which may occur without an extracellular tumour mass or peripheral blood involvement. This report highlights some of the diagnostic issues for ILBCL, and how it can be approached. The two cases described below highlight two significantly different presentations, one with predominately neurological phenomena, and the other with fever of unknown origin for investigation. Both patients were managed with chemotherapy and intercalated intrathecal chemotherapy, with good clinical outcomes, without further evidence of clinical relapse. These cases along with a review of the literature highlight the key learning points in the difficulties in the diagnosis of this condition, and the appropriate use of random skin biopsy in patient suspected of having ILBCL, such as those with constitutional symptoms with otherwise negative malignancy screening, and unexplained neurological phenomena, especially if recurrent in nature.

  • haematology (incl blood transfusion)
  • medical education

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Footnotes

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  • Contributors JLB: primary author of article. OS: editing of work, took part in literature review and writing of discussion. AP: supervisor, haematologist primarily caring after the two included patients, editor of work and assistance with creation of discussion.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.