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[A case of pulmonary intravascular lymphoma treated with CHOP chemotherapy plus rituximab]
Hirotsugu Ohkubo1, Tsuyoshi Yoshida, Kaori Ohta
1First Dept of Internal Medicine, Tokyo Medical University.
Insights
Pulmonary intravascular lymphoma (PIL) is a rare cancer. This case study shows that a combination of CHOP chemotherapy and rituximab effectively treated a patient with this condition, improving symptoms and imaging results.
Area of Science:
- Oncology
- Hematology
- Pulmonary Medicine
Background:
- Pulmonary intravascular lymphoma (PIL) is a rare, aggressive non-Hodgkin lymphoma characterized by neoplastic lymphoid cells within the pulmonary vasculature.
- Diagnosis can be challenging due to nonspecific symptoms and radiographic findings, often requiring invasive procedures like lung biopsy.
Observation:
- A 72-year-old woman presented with a month-long history of fever and dry cough.
- Chest imaging revealed bilateral ground-glass opacities with a centrilobular distribution.
- Transbronchial lung biopsy identified large lymphoid cells in alveolar septal capillaries, with positive CD20 immunohistochemistry.
Findings:
- The patient was diagnosed with pulmonary intravascular lymphoma of large B cell type.
- Combined treatment with cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) chemotherapy and rituximab led to significant improvement in clinical, laboratory, and radiological parameters.
Implications:
- This case suggests that the standard regimen for diffuse large B cell lymphoma, CHOP chemotherapy plus rituximab, may be an effective treatment for pulmonary intravascular lymphoma.
- Further research is warranted to establish optimal therapeutic strategies for this rare entity.
Abstract:
We report a case of pulmonary intravascular lymphoma of large B cell type in a 72-year-old woman. She had a one-month history of fever and dry cough before admission. Chest X-ray revealed ground glass shadow in both lung fields, and the high-resolution CT disclosed centrilobular distribution of ground glass opacities. Transbronchial lung biopsy demonstrated large lymphoid cells in the capillaries of alveolar septa. The tumor cells showed strong immunohistochemical reactivity to CD 20. After combined treatment with CHOP and rituximab, clinical symptoms, laboratory and radiological findings were improved. As with diffuse large B cell lymphoma, CHOP chemotherapy plus rituximab may prove useful as a standard regimen for pulmonary intravascular lymphoma.