case_images: PMC11325336_01
case_images: Summary of laboratory findings and clinical course. CT images of IVLBCL cerebral lesion in the left frontal lobe obtained on admission (a), in disease progression (b). (c) The reduced lesion was detected on CT imaging of the patient's brain after three cycles of chemotherapy. (d) Hematophagocytes in bone marrow image (hematoxylin-eosin, x400). (e) Hematoxylin and eosin staining showed lymphoid cells with pleomorphic nuclei and prominent nucleoli selectively accumulated within the small vessel (hematoxylin-eosin, x400). (f) Immunohistochemical staining for CD20, CD5, MUM1, C-Myc, and CD10 revealed that lymphoid cells were positive for CD20, C-Myc, and CD5, negative for MUM1, and CD10 (x400). Samples from deep ham skin biopsy showed small and medium vessels. (g) List of mutated genes detected in the lymphoma cells using next-generation sequencing. (h) The graphical timeline of the diagnostic process and treatment.. CT, computerized tomography; IVLBCL, intravascular large B-cell lymphoma.
case_images: 10.1177_20406207241270788-fig1.jpg
case_images: PMC11325336_01_10.1177_20406207241270788-fig1.jpg
case_images: fig1-20406207241270788
case_images: Brain computerized tomography (CT) scan showed low-density changes in the left frontal lobe (Figure 1(a)). CT imaging indicated that the lesions in the patient's brain continued to progress (Figure 1(b)). CT of his brain showed the small hematoma in the left frontal lobe accompanied by edema with finger size. The bone marrow aspirate showed 1.5% hematophagocytes lacking obvious evidence of neoplastic or infectious disorders (Figure 1(d)). Subsequently a random skin biopsy was performed and found that a B-lymphocyte population with pleomorphic nuclei and prominent nucleoli expanded in dermal blood vessel (Figure 1(e)). Immunohistochemical studies showed the lymphoma cells were positive for CD20, CD5, CD31, BCL2, BCL6, and C-Myc, while negative for CD3, CD30, CD10, MUM1, Cyclin D1, PD-L1, and TDT (Figure 1(f)). The patient was finally diagnosed as hemophagocytic IVLBCL (Figure 1(h)), belonging to germinal center B cell-like subgroups.   Owing to the mini-CHOP was more tolerable for the elderly patient with severe comorbidities, he began to receive chemotherapy with two cycles of mini-R2-CHOP (Rituximab 375 mg/m2 on day 0, Cyclophosphamide 400 mg/m2 on day 1, Vindesine 2 mg on day 1, Doxorubicin hydrochloride liposome 25 mg/m2 on day 1, Prednisone 40 mg day 1-5, Lenalidomide 25 mg for 10 days) with a 14-day interval. Missense or frameshift mutations across KMT2A, IRF8, STAT3, NOTCH2, BCL6, CCND3, BRAF, and CARD11 genes were identified (Figure 1(g)). The brain lesion became smaller and edema reduced (Figure 1(c)).