CPC #5

Pathology

CD3

CD3

CD20

CD20

Ki-67

Ki-67

Diagnosis

Intravascular Large B-Cell Lymphoma

Intravascular Large B Cell Lymphoma

• Extranodal Diffuse Large B Cell Lymphoma characterized by lymphoma cells confined to lumen of small vessels

• Affects adults• Symptoms arise from occlusion of capillaries• Absence of homing recptors on neoplastic cells

– CD29 (B1-integrin)– CD54 (ICAM-1)

Intravascular Lymphoma: Presentation

• Skin-plaques and nodules

• CNS-dementia, focal neurologic deficits– DDX: Vasculitis

• Fever of Unknown Origin

Intravascular Lymphoma: Prognosis

• Thought to have poor prognosis– Delay in diagnosis– Poor response to chemotherapy– Cutaneous-only cases (almost always females) may

be a better prognosis

• DiGiuseppe JA, Nelson WG, Seifter E, Boitnott JK, Mann RB. J Clin Oncol 1994;12: 2573-9.– Aggressive combination chemotherapy can yield

long term survival

Follow-Up on This Case• On 12/29/2008 the patient was transferred to begin

chemotherapy for intravascular lymphoma. CHOP therapy was initiated and her altered mental status resolved rather quickly.

• As of 10/20/2009 the patient is status post 6 cycles of R-CHOP, the last being in 05/09.  Her course has been complicated by a sacral decubitus ulcer with associated osteomyelitis for which she was treated with 6 course of vancomycin and cefepime which was completed on 09/10/09.  She also has indwelling foley catheter with chronic contamination of C-candida glabrata.