Intravascular lymphoma with hypopituitarism: A case report

Area of Science:

• Hematology
• Oncology
• Endocrinology

Background:

• Intravascular lymphoma (IVL) is a rare hematologic malignancy characterized by lymphoma cell growth within blood vessels, often presenting without lymphadenopathy.
• The varied clinical manifestations and rarity of IVL frequently lead to delayed diagnosis, with many cases identified only postmortem.

Observation:

• An 80-year-old woman presented with a 7-month history of lower limb paresthesia, pancytopenia, daily fevers, hypoglycemia, and unconsciousness.
• Initial evaluation suggested hypopituitarism as the cause of hypoglycemia, but other symptoms remained unexplained.
• Bone marrow aspiration revealed hemophagocytic lymphohistiocytosis (HLH), and a skin biopsy confirmed intravascular B-cell lymphoma (IVL) as the underlying cause.

Findings:

• The patient was diagnosed with intravascular B-cell lymphoma, with secondary hemophagocytic lymphohistiocytosis and hypopituitarism.
• Treatment with chemotherapy resulted in a complete response.
• The patient remained relapse-free two years post-treatment.

Implications:

• Intravascular B-cell lymphoma should be considered in the differential diagnosis of hypopituitarism.
• Prompt diagnosis and chemotherapy are crucial for treating IVL and its associated complications, offering a potentially life-saving intervention.