Intravascular Large B-Cell Lymphoma: A Difficult Diagnostic Challenge.

Area of Science:

• Hematology
• Oncology
• Pathology

Background:

• Intravascular large cell B-cell lymphoma (IVLBCL) is a rare subtype of diffuse large B-cell lymphoma.
• It characteristically proliferates within small blood vessels, with an unknown predilection for the vascular lumen.
• IVLBCL has been associated with viral infections, including HIV, HHV8, and Epstein-Barr virus (EBV).

Purpose of the Study:

• To present a case of IVLBCL in a patient with confirmed EBV infection.
• To discuss the diagnostic challenges and clinical presentation of IVLBCL.
• To highlight the potential association between IVLBCL and viral illnesses.

Main Methods:

• Case report of a 69-year-old male with fever, diarrhea, and confusion.
• Diagnostic workup including laboratory tests, imaging, and autopsy.
• Immunohistochemical analysis of tumor cells for specific markers (CD20, CD79a, Mum-1, Pax-5, Ki-67).

Main Results:

• The patient presented with B symptoms, cytopenias, and elevated LDH, initially negative for malignancy.
• Autopsy revealed intravascular diffuse large B-cell lymphoma involving multiple organs.
• Malignant cells were positive for CD20, CD79a, Mum-1, Pax-5, and Ki-67, confirming IVLBCL.
• The patient had a positive DNA test for Epstein-Barr virus (EBV) infection.

Conclusions:

• IVLBCL is a rare and challenging diagnosis due to its confinement within the vascular lumen.
• The association with EBV infection in this case supports a potential link between IVLBCL and viral illnesses.
• Early consideration of IVLBCL in appropriate clinical settings is crucial for timely treatment and potential for durable remission.