title: Intravascular Large B Cell Lymphoma as a Rare Cause of Reversed Halo Sign: A Case Report.
abstract: Intravascular large B cell lymphoma (IVLBCL) is a rare type of extranodal diffused large B-cell lymphoma. IVLBCL with primary lung lesion is very rare and it is very difficult to diagnose. Radiographic findings of pulmonary IVLBCL are nonspecific and resembling interstitial lung diseases. Reversed halo sign (RHS) was initially reported in patients diagnosed with cryptogenic organizing pneumonia and then described in a variety of diseases with inflammatory, infectious, autoimmune, and malignant causes. This is the first case of IVLBCL that has presented with RHSs on CT scan.A 59-year-old Chinese man presented with a 4-month history of a nonproductive cough and a weight loss of 5 kg. Physical examination was unremarkable. High-resolution computed tomography scan of the chest showed bilateral patchy ground glass opacities (GGOs) and RHSs. Laboratory tests were unremarkable except elevated serum lactate dehydrogenase (LDH). Surgical lung biopsy was performed. Light microscopic examination of the specimen disclosed diffuse alveolar septal widening caused by neoplastic lymphocytes, which were positive for CD20 and infiltrated in the alveolar capillaries. The patient was diagnosed with IVLBCL and underwent chemotherapy and autologous blood stem cell transplantation. The patient is still alive 5 years after diagnosis.IVLBCL is a rare cause of RHS and should be considered in differential diagnosis of RHS. An increased serum LDH concentration is another important clue.
authors.affiliation: From the Department of Respiratory Medicine (MP, JS); Department of Pathology (HL), Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; and Department of Medicine, Division of Integrative Medicine, Mayo Clinic, Rochester, MN (GL).
authors.forename: Min
authors.initials: M
authors.lastname: Peng
authors.forename: Juhong
authors.initials: J
authors.lastname: Shi
authors.forename: Hongrui
authors.initials: H
authors.lastname: Liu
authors.forename: Guangxi
authors.initials: G
authors.lastname: Li
mesh_terms: D001706:Biopsy; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D018450:Disease Progression; D006801:Humans; D007089:Image Enhancement; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D016403:Lymphoma, Large B-Cell, Diffuse / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011650:Pulmonary Alveoli / Q000000981:diagnostic imaging / Q000473:pathology; D014057:Tomography, X-Ray Computed; D019043:Vascular Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy