title: Early diagnosis of intravascular large B-cell lymphoma: clues from routine blood smear morphologic findings.
abstract: Intravascular large B-cell lymphoma (IVLBCL) is a mature B-cell neoplasm characterized by malignant lymphoid cells within the lumina of blood vessels and capillaries. Given its varied and nonspecific clinical manifestation, this aggressive disease is often not diagnosed until an advanced clinical stage or even at autopsy. This case highlights a patient presenting with autoimmune hemolytic anemia (AIHA) and fevers. Atypical circulating cells on a screening peripheral smear lead to flow cytometric studies highlighting an increase in large, light chain restricted CD20 positive cells. A diagnostic bone marrow biopsy was performed and trephine cores demonstrated predominantly intrasinusoidal lymphoma cells. In conjunction with additional immunophenotypic data, these studies strongly supported a diagnosis of IVLBCL. Judicious use of flow cytometry and morphology resulted in an early-stage diagnosis and likely contributed to the patient's current complete remission status following anti-CD20 therapy. Differential diagnoses for this presentation are discussed in light of serologic, immunophenotypic, histologic, and cytogenetic findings.
authors: Department of Medicine, sspatel@outlook.com.
authors: Sagar S
authors: SS
authors: Patel
authors: Divisions of Hematopathology and.
authors: Garth A
authors: GA
authors: Aasen
authors: Cytogenetics, Department of Laboratory Medicine and Pathology.
authors: Michelle M
authors: MM
authors: Dolan
authors: Divisions of Hematopathology and.
authors: Michael A
authors: MA
authors: Linden
authors: Divisions of Hematopathology and.
authors: Robert W
authors: RW
authors: McKenna
authors: Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis.
authors: Venkatesh K
authors: VK
authors: Rudrapatna
authors: Division of Hematology-Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis.
authors: Bryan J
authors: BJ
authors: Trottier
authors: Divisions of Hematopathology and.
authors: Sarah M
authors: SM
authors: Drawz
mesh_terms: D042241:Early Diagnosis; D004496:Education, Continuing; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000097:blood / Q000175:diagnosis*
keywords: autoimmune hemolytic anemia; bone marrow transplant; flow cytometry; high risk hematologic malignancy; intravascular large B-cell lymphoma; peripheral smear