CPC #5 Pathology. CD3 CD20 Ki-67 Diagnosis Intravascular Large B-Cell Lymphoma.
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Transcript of CPC #5 Pathology. CD3 CD20 Ki-67 Diagnosis Intravascular Large B-Cell Lymphoma.
CPC #5
Pathology
CD3
CD3
CD20
CD20
Ki-67
Ki-67
Diagnosis
Intravascular Large B-Cell Lymphoma
Intravascular Large B Cell Lymphoma
• Extranodal Diffuse Large B Cell Lymphoma characterized by lymphoma cells confined to lumen of small vessels
• Affects adults• Symptoms arise from occlusion of capillaries• Absence of homing recptors on neoplastic cells
– CD29 (B1-integrin)– CD54 (ICAM-1)
Intravascular Lymphoma: Presentation
• Skin-plaques and nodules
• CNS-dementia, focal neurologic deficits– DDX: Vasculitis
• Fever of Unknown Origin
Intravascular Lymphoma: Prognosis
• Thought to have poor prognosis– Delay in diagnosis– Poor response to chemotherapy– Cutaneous-only cases (almost always females) may
be a better prognosis
• DiGiuseppe JA, Nelson WG, Seifter E, Boitnott JK, Mann RB. J Clin Oncol 1994;12: 2573-9.– Aggressive combination chemotherapy can yield
long term survival
Follow-Up on This Case• On 12/29/2008 the patient was transferred to begin
chemotherapy for intravascular lymphoma. CHOP therapy was initiated and her altered mental status resolved rather quickly.
• As of 10/20/2009 the patient is status post 6 cycles of R-CHOP, the last being in 05/09. Her course has been complicated by a sacral decubitus ulcer with associated osteomyelitis for which she was treated with 6 course of vancomycin and cefepime which was completed on 09/10/09. She also has indwelling foley catheter with chronic contamination of C-candida glabrata.