Random skin biopsy for diagnosis of intravascular large B-cell lymphoma in a patient with hypoxemia and normal lung imaging.
Random skin biopsy for diagnosis of intravascular large B-cell lymphoma in a patient with hypoxemia and normal lung imaging.
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DOI：
10.1016/j.jdcr.2017.11.013
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发表时间：
2018-03
影响因子：
--
通讯作者：
Kayasut K
中科院分区：
文献类型：
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作者：
Banjongjit A;Chiratikarnwong K;Saelue P;Sangmala S;Auepemkiate S;Kayasut K
IVLBCL是一种具有挑战性的诊断。患者通常表现为不明原因的发热，并在诊断之前进行广泛的调查，超过一半的IVLBCL病例直到尸检才被诊断出来。7在39%的IVLBCL患者中描述了皮肤病变，最常见于大腿（41%），其次是腿部（35%）、躯干（31%）、手臂（15%）和臀部（7.5%）。IVLBCL最常见的皮肤表现是形状不规则的皮下结节和大小不等的硬化斑块。9大多数亚洲患者没有皮肤病变。即使没有皮肤病变，随机皮肤活检也是诊断IVLBCL的有用工具，因为它可以检测皮内和皮下血管内的肿瘤细胞。在此，我们提出一个IVLBCL的情况下，提出了低氧血症没有明显的肺部病变。迄今为止，只有少数此类病例报告，其中患者表现为发热和低氧血症，肺部成像正常，最终通过肺微血管细胞学、开放性肺活检或随机经支气管肺活检诊断为IVLBCL。3，4，5，6在我们的病例中，我们使用随机皮肤活检来诊断IVLBCL。尽管有贫血和血小板减少症，但骨髓活检正常。
DiscussionIVLBCL is a challenging diagnosis. Patients commonly present with fever of unknown origin and are investigated extensively before a diagnosis can be made, and more than half of IVLBCL cases are not diagnosed until autopsy. 7 Cutaneous lesions have been described in 39% of patients with IVLBCL and are most often found on the thighs (41%), followed by the legs (35%), trunk (31%), arms (15%), and buttocks (7.5%). The most common skin manifestations of IVLBCL are irregularly shaped subcutaneous nodules and indurated plaques of variable size. 9 Most Asian patients have no cutaneous lesions. 10 Even if no skin lesions are present, a random skin biopsy is a useful tool for the diagnosis of IVLBCL because it can detect tumor cells within intradermal and subcutaneous vessels. Herein, we present a case of IVLBCL that presented with hypoxemia without obvious lung lesions. To date, only a few such cases have been reported in which the patients presented with fever and hypoxemia with normal lung imaging, with IVLBCL eventually diagnosed by pulmonary microvascular cytology, open lung biopsy, or random transbronchial lung biopsy. 3, 4, 5, 6 In our case, we used random skin biopsies to diagnose IVLBCL. A bone marrow biopsy was normal despite anemia and thrombocytopenia.