[Intravascular lymphomatosis: a case report].
We report a case of a 64-year-old man with intravascular lymphomatosis. He had dementia and generalized seizure. Computed tomogram scan and magnetic resonance imaging showed multiple infarctions in the right frontal lobe, right cerebellar hemisphere and left occipital lobe. A month after admission he had a daily high fever and frequent convulsions. The level of serum LDH was progressively getting higher and the level of beta 2-microglobulin in both serum and CSF was high. One and a half months after admission we performed an open biopsy for making a definite diagnosis by pathological examination. Histological diagnosis was intravascular lymphomatosis (angiotrophic lymphoma) of large B cell type. He was treated with regimens of combined chemotherapy with M-CHOP (methotrexate, cyclophosphamide, adriamycin, vincristine, prednisolone). After chemotherapy his consciousness was gradually improving better and the level of serum LDH and beta 2-microglobulin was reduced to a low level. Three months after admission he died of respiratory failure. After a review of the literature and experience with this case, it is obrious that early diagnosis of this disease is difficult. However, we think that multiple cerebral infarctions on neuroradiological examinations and high levels of serum LDH (especially LDH2 and LDH3) and beta 2-microglobulin in CSF and serum should lead to a presumptive diagnosis of this disease, and biopsy should be used to make a difinite diagnosis.
Adachi
H
H
Department of Neurosurgery, Bizen Municipal Hospital, 2245 Ibe, Bizen-city, Okayama 705-0001, Japan.
Tsuboi
M
M
Hayashi
K
K
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D006801:Humans; D016393:Lymphoma, B-Cell / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D019043:Vascular Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D014750:Vincristine / Q000008:administration & dosage
D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone; D008727:Methotrexate