Open AccessEarly Diagnosis of Intravascular Large B-Cell Lymphoma: Clues From Routine Blood Smear Morphologic Findings
Author(s) -
Sagar S. Patel,
Garth Aasen,
Michelle Dolan,
Michael A. Linden,
Robert W. McKenna,
Venkatesh K. Rudrapatna,
Bryan Trottier,
Sarah M. Drawz
Publication year - 2014
Publication title -
laboratory medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.332
H-Index - 28
eISSN - 1943-7730
pISSN - 0007-5027
DOI - 10.1309/lmsveokln18m5xtv
Subject(s) - intravascular large b cell lymphoma , medicine , pathology , bone marrow , lymphoma , cd20 , lymphoplasmacytic lymphoma , differential diagnosis , stage (stratigraphy) , immunophenotyping , biopsy , flow cytometry , immunology , waldenstrom macroglobulinemia , biology , paleontology
Intravascular large B-cell lymphoma (IVLBCL) is a mature B-cell neoplasm characterized by malignant lymphoid cells within the lumina of blood vessels and capillaries. Given its varied and nonspecific clinical manifestation, this aggressive disease is often not diagnosed until an advanced clinical stage or even at autopsy. This case highlights a patient presenting with autoimmune hemolytic anemia (AIHA) and fevers. Atypical circulating cells on a screening peripheral smear lead to flow cytometric studies highlighting an increase in large, light chain restricted CD20 positive cells. A diagnostic bone marrow biopsy was performed and trephine cores demonstrated predominantly intrasinusoidal lymphoma cells. In conjunction with additional immunophenotypic data, these studies strongly supported a diagnosis of IVLBCL. Judicious use of flow cytometry and morphology resulted in an early-stage diagnosis and likely contributed to the patient's current complete remission status following anti-CD20 therapy. Differential diagnoses for this presentation are discussed in light of serologic, immunophenotypic, histologic, and cytogenetic findings.