[A case of intravascular lymphoma with diffuse centrilobular opacities]

Area of Science:

• Hematology
• Oncology
• Pulmonology

Background:

• Intravascular lymphoma (IVL) is a rare extranodal non-Hodgkin lymphoma characterized by the proliferation of malignant lymphocytes within small blood vessels.
• Diagnosis can be challenging due to nonspecific symptoms and the absence of a distinct tumor mass.

Observation:

• A 54-year-old woman presented with fatigue and dyspnea, exhibiting markedly elevated serum lactate dehydrogenase (LDH) and diffuse centrilobular opacities on chest CT.
• Bronchoalveolar lavage fluid showed elevated cell counts with 98% lymphocytes.
• Transbronchial lung biopsy revealed CD20-positive atypical cells within alveolar capillaries, leading to an IVL diagnosis.

Findings:

• The patient was diagnosed with intravascular lymphoma based on lung biopsy findings.
• Bone marrow examination confirmed lymphoma cells in sinusoids without hemophagocytosis.
• Combined chemotherapy with cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab (CHOP-R) achieved complete remission.

Implications:

• This case highlights the importance of considering IVL in the differential diagnosis of patients presenting with diffuse centrilobular opacities on chest CT and elevated serum LDH.
• Transbronchial lung biopsy (TBLB) is a key diagnostic tool for identifying intravascular lymphoma in such cases.
• Successful treatment with CHOP-R demonstrates the efficacy of combined chemotherapy in achieving long-term remission for IVL.