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Clinical utility of positron emission tomography leading to rapid and accurate diagnosis of intravascular large B-cell lymphoma presenting with the central nervous system symptoms alone: A case report and review of the literature.
Inagaki, Ryo; Inoue, Akihiro; Miyazaki, Yukihiro; Kanehisa, Kota; Kunihiro, Joji; Kondo, Takuya; Katayama, Eiji; Taniwaki, Mashio; Shigekawa, Seiji; Watanabe, Hideaki; Kitazawa, Riko; Kunieda, Takeharu.
Afiliação
  • Inagaki R; Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan.
  • Inoue A; Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan.
  • Miyazaki Y; Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University School of Medicine, Toon, Japan.
  • Kanehisa K; Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan.
  • Kunihiro J; Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan.
  • Kondo T; Division of Diagnostic Pathology, Ehime University Hospital, Toon, Japan.
  • Katayama E; Division of Diagnostic Pathology, Ehime University Hospital, Toon, Japan.
  • Taniwaki M; Division of Diagnostic Pathology, Ehime University Hospital, Toon, Japan.
  • Shigekawa S; Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan.
  • Watanabe H; Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan.
  • Kitazawa R; Division of Diagnostic Pathology, Ehime University Hospital, Toon, Japan.
  • Kunieda T; Department of Neurosurgery, Ehime University School of Medicine, Toon, Japan.
Surg Neurol Int ; 14: 89, 2023.
Article em En | MEDLINE | ID: mdl-37025518
ABSTRACT

Background:

Intravascular large B-cell lymphoma (IVLBCL) is a rare entity among large B-cell non-Hodgkin lymphomas and is often difficult to diagnose. We report the case of a patient with IVLBCL who presented with central nervous system (CNS) symptoms alone, in which positron emission tomography (PET) enabled a rapid and accurate diagnosis. Case Description An 81-year-old woman was admitted to our hospital with a 3-month history of gradually progressive dementia and declining spontaneity. Magnetic resonance imaging revealed multiple hyperintense lesions bilaterally on diffusion-weighted imaging without enhancement on gadolinium-enhanced T1-weighted imaging. Laboratory findings showed elevated serum lactate dehydrogenase (626 U/L) and soluble interleukin-2 receptor (sIL-2R) (4692 U/mL). Cerebrospinal fluid (CSF) analysis showed slightly elevated levels of protein (166 mg/dL) and lymphocytic cells (29/µL), and ß2-microglobulin (ß2-MG) (4.6 mg/L) was highly elevated. Whole-body computed tomography revealed faint ground-glass opacities in the upper and middle lung fields and diffuse enlargement of both kidneys without lymph node swelling. 18F-fluorodeoxyglucose (FDG)-PET showed diffuse and remarkably high FDG uptake in both upper lungs and kidneys without uptake by lymph nodes, suggesting a malignant hematological disease. IVLBCL was confirmed histologically by incisional random skin biopsy from the abdomen. Chemotherapy using R-CHOP regimen in combination with intrathecal methotrexate injection was started on day 5 after admission and follow-up neuroimaging showed no signs of recurrence.

Conclusion:

IVLBCL presenting with CNS symptoms alone is rare and often has a poor prognosis associated with delayed diagnosis, and various evaluations (including systemic analysis) are therefore necessary for early diagnosis. FDG-PET, in addition to identification of clinical symptoms and evaluation of serum sIL-2R and CSF ß2-MG, enables rapid therapeutic intervention in IVLBCL presenting with CNS symptoms.
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Texto completo: 1 Base de dados: MEDLINE Tipo de estudo: Diagnostic_studies / Prognostic_studies / Screening_studies Idioma: En Ano de publicação: 2023 Tipo de documento: Article

Texto completo: 1 Base de dados: MEDLINE Tipo de estudo: Diagnostic_studies / Prognostic_studies / Screening_studies Idioma: En Ano de publicação: 2023 Tipo de documento: Article