Primary pulmonary intravascular large B‑cell lymphoma misdiagnosed as pneumonia: Four case reports and a literature review

Zhu,Mengxia; Chang,Ying; Fan,Haijian; Shi,Jiong; Zhu,Bin; Mai,Xiaoli

doi:10.3892/ol.2023.13820

Primary pulmonary intravascular large B‑cell lymphoma misdiagnosed as pneumonia: Four case reports and a literature review

Authors:
- Mengxia Zhu
- Ying Chang
- Haijian Fan
- Jiong Shi
- Bin Zhu
- Xiaoli Mai
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Affiliations: Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210008, P.R. China, Department of Pathology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu 210008, P.R. China
Published online on: April 18, 2023 https://doi.org/10.3892/ol.2023.13820
Article Number: 234
Copyright: © Zhu et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Primary pulmonary intravascular large B‑cell lymphoma (IVLBCL) is a rare, malignant extranodal lymphoma. It is difficult to diagnose clinically as it requires a combination of clinical and computed tomography (CT) evaluations, as well as laboratory and pathological examinations. In the present study, 4 cases of primary pulmonary IVLBCL were reviewed. The patients' ages ranged from 60 to 69 years old. Of the 4 patients, 3 developed progressive dyspnea on exertion and intermittent fever. Other symptoms included coughing, chest tightness and weight loss. Laboratory data indicated that all patients had anemia, thrombocytopenia, hypoxemia, a markedly high serum lactate dehydrogenase level, elevated erythrocyte sedimentation rate and increased C‑reactive protein. CT demonstrated increased attenuation in bilateral lung parenchyma, especially in the upper lobes, with multiple ground‑glass opacities associated with small nodules in these patients. Initially, all 4 patients were misdiagnosed with pneumonia. However, none of them responded to anti‑inflammatory treatments. The pathologies of all patients were confirmed using lung biopsy. Only 1 patient received regular combination chemotherapy. Based on the observations of the present study, a standard regimen for lymphoma treatment may result in a notable clinical response.

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1	Shimada K, Kinoshita T, Naoe T and Nakamura S: Presentation and management of intravascular large B-cell lymphoma. Lancet Oncol. 10:895–902. 2009. View Article : Google Scholar : PubMed/NCBI
2	Pfleger L and Tappeiner J: On the recognition of systematized endotheliomatosis of the cutaneous blood vessels (reticuloendotheliosis? Hautarzt. 10:359–363. 1959.(In German). PubMed/NCBI
3	Sanguedolce F, Zanelli M, Zizzo M, Bisagni A, Soriano A, Cocco G, Palicelli A, Santandrea G, Caprera C, Corsi M, et al: Primary pulmonary B-Cell lymphoma: A review and update. Cancers (Basel). 13:4152021. View Article : Google Scholar : PubMed/NCBI
4	Brunet V, Marouan S, Routy JP, Hashem MA, Bernier V, Simard R, Petrella T, Lamarre L, Théorêt G, Carrier C, et al: Retrospective study of intravascular large B-cell lymphoma cases diagnosed in Quebec: A retrospective study of 29 case reports. Medicine (Baltimore). 96:e59852017. View Article : Google Scholar : PubMed/NCBI
5	Satoh T, Arai E, Kayano H, Sakaguchi H, Takahashi N, Tsukasaki K and Yasuda M: Pulmonary intravascular large B-cell lymphoma accompanying synchronous primary pulmonary adenocarcinoma and benign interstitial lesions. J Clin Exp Hematop. 59:140–144. 2019. View Article : Google Scholar : PubMed/NCBI
6	Masood S, Vijayan K and Wheeler YY: Primary lung intravascular large B-cell lymphoma clinically mimicking sarcoidosis: A rare case report and review of literature. Respir Med Case Rep. 29:1009892019.PubMed/NCBI
7	Geer M, Roberts E, Shango M, Till BG, Smith SD, Abbas H, Hill BT, Kaplan J, Barr PM, Caimi P, et al: Multicentre retrospective study of intravascular large B-cell lymphoma treated at academic institutions within the United States. Br J Haematol. 186:255–262. 2019.PubMed/NCBI
8	Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R, Advani R, Ghielmini M, Salles GA, Zelenetz AD and Jaffe ES: The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 127:2375–2390. 2016. View Article : Google Scholar : PubMed/NCBI
9	Orwat DE and Batalis NI: Intravascular large B-cell lymphoma. Arch Pathol Lab Med. 136:333–338. 2012. View Article : Google Scholar : PubMed/NCBI
10	Ponzoni M, Campo E and Nakamura S: Intravascular large B-cell lymphoma: A chameleon with multiple faces and many masks. Blood. 132:1561–1567. 2018. View Article : Google Scholar : PubMed/NCBI
11	Wu F, Wang Z, Xing X, Yu M and Shi B: The value of ¹⁸F-FDG PET/CT in diagnostic procedure of intravascular large B-cell lymphoma presenting fever of unknown origin and pulmonary hypertension as an initial manifestation. Clin Nucl Med. 41:506–507. 2016. View Article : Google Scholar : PubMed/NCBI
12	Wang H, Huang Y, Xu CW and Lin L: Clinical analysis of tumor and non-tumor patients complicated with pulmonary embolism. Int J Clin Exp Med. 8:18729–18736. 2015.PubMed/NCBI
13	Matea F, Alowami S, Bonert M, Sur M, Shargall Y and Naqvi AH: Pulmonary intravascular B-cell lymphoma with angiotropism/angioinvasion mimicking interstitial lung disease: A clinical dilemma and potential diagnostic challenge. Case Rep Hematol. 2018:38213922018.PubMed/NCBI
14	Nguyen TT, Sekiguchi H, Yi ES and Ryu JH: Occult diffuse neoplasm in the lungs: Intravascular large B-cell lymphoma. Am J Med. 134:926–929. 2021. View Article : Google Scholar : PubMed/NCBI
15	Spencer J, Dusing R, Yap W, Hill J and Walter C: Intravascular large B-cell lymphoma presenting with diffusely increased pulmonary fluorodeoxyglucose uptake without corresponding CT abnormality. Radiol Case Rep. 14:260–264. 2018. View Article : Google Scholar : PubMed/NCBI
16	Hong JY, Kim HJ, Ko YH, Choi JY, Jung CW, Kim SJ and Kim WS: Clinical features and treatment outcomes of intravascular large B-cell lymphoma: A single-center experience in Korea. Acta Haematol. 131:18–27. 2014. View Article : Google Scholar : PubMed/NCBI
17	Sullivan HC, Edgar MA, Cohen C, Kovach CK, HooKim K and Reid MD: The utility of ERG, CD31 and CD34 in the cytological diagnosis of angiosarcoma: An analysis of 25 cases. J Clin Pathol. 68:44–50. 2015. View Article : Google Scholar : PubMed/NCBI
18	Robetorye RS, Ramsower CA, Rosenthal AC, Yip TK, Wendel Spiczka AJ, Glinsmann-Gibson BJ and Rimsza LM: Incorporation of digital gene expression profiling for cell-of-origin determination (Lymph2Cx testing) into the routine work-up of diffuse large B-cell lymphoma. J Hematop. 2:3–10. 2019. View Article : Google Scholar : PubMed/NCBI
19	Scott DW, Mottok A, Ennishi D, Wright GW, Farinha P, Ben-Neriah S, Kridel R, Barry GS, Hother C, Abrisqueta P, et al: Prognostic significance of diffuse large B-cell lymphoma cell of origin determined by digital gene expression in formalin-fixed paraffin-embedded tissue biopsies. J Clin Oncol. 33:2848–2856. 2015. View Article : Google Scholar : PubMed/NCBI
20	He X, Chen Z, Fu T, Jin X, Yu T, Liang Y, Zhao X and Huang L: Ki-67 is a valuable prognostic predictor of lymphoma but its utility varies in lymphoma subtypes: Evidence from a systematic meta-analysis. BMC Cancer. 14:1532014. View Article : Google Scholar : PubMed/NCBI