Intravascular large B-cell lymphoma: The Great Imitator

Area of Science:

• Hematology
• Oncology
• Pathology

Background:

• Intravascular large B-cell lymphoma (IVLBCL) is a rare hematologic malignancy with a poor prognosis.
• IVLBCL is characterized by neoplastic lymphocytes confined to the lumen of blood vessels.
• Clinical presentation is often nonspecific, posing a diagnostic challenge.

Observation:

• A case of IVLBCL was discovered incidentally at autopsy in an 80-year-old male.
• The patient initially presented with symptoms suggestive of ehrlichiosis, a tick-borne illness.
• Key diagnostic features of IVLBCL, such as lymphadenopathy and hepatosplenomegaly, were absent.

Findings:

• The autopsy revealed intravascular neoplastic B-cells, confirming the diagnosis of IVLBCL.
• The patient's initial symptoms mimicked other conditions, delaying definitive diagnosis.
• The broad differential diagnosis for IVLBCL complicates early identification.

Implications:

• This case underscores the importance of considering rare diagnoses like IVLBCL in patients with nonspecific symptoms.
• Awareness of IVLBCL's varied presentation is crucial for timely diagnosis and improved patient outcomes.
• Autopsy findings can be critical in identifying missed diagnoses and understanding disease progression.