title: Recurrence of nodal diffuse large B-cell lymphoma as intravascular large B-cell lymphoma: is an intravascular component at initial diagnosis predictive?
abstract: We report a case of a 59-year-old man who first presented with a nodal diffuse large B-cell lymphoma that later relapsed as an intravascular large B-cell lymphoma. In the initial biopsy specimen, a few intranodal small vessels that contained large lymphoma cells were noted. After 8 months of multiagent chemotherapy, clinical remission was attained. Two years after the initial diagnosis of nodal diffuse large B-cell lymphoma, the patient presented with a rapid onset of multiorgan failure, which at autopsy was shown to be due to intravascular large B-cell lymphoma. Molecular genetic studies showed that these 2 lymphomas had immunoglobulin heavy-chain gene rearrangements that were of identical size, suggesting that they were derived from the same clone. To our knowledge, this is the first report of a nodal large B-cell lymphoma that relapsed as an intravascular large B-cell lymphoma. Although this report is of only a single case, the presence of a relatively inconspicuous intravascular component in an otherwise typical nodal large B-cell lymphoma may be predictive and could affect clinical decisions regarding diagnosis, monitoring, and prognosis of such lymphomas.
authors.affiliation: Department of Pathology and Laboratory Medicine, SUNY at Buffalo School of Medicine, Buffalo, NY, USA. xzhao@path.wustl.edu
authors.forename: Xian-Feng
authors.initials: XF
authors.lastname: Zhao
authors.forename: Amy M
authors.initials: AM
authors.lastname: Sands
authors.forename: Peter T
authors.initials: PT
authors.lastname: Ostrow
authors.forename: Regina
authors.initials: R
authors.lastname: Halbiger
authors.forename: James T
authors.initials: JT
authors.lastname: Conway
authors.forename: Adam
authors.initials: A
authors.lastname: Bagg
mesh_terms: D017809:Fatal Outcome; D006801:Humans; D016393:Lymphoma, B-Cell / Q000175:diagnosis*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D019043:Vascular Neoplasms / Q000175:diagnosis*