A Case of Intravascular Lymphoma

Hiroyuki Sugihara 1, Etsuko Nakamura 1, Keizo Nishiyama 2, Masahiro Yamamoto 3, Toshiyuki Tsujioka 3

1 Department of Pathology, Shiga University of Medical Science
2 Department of Internal Medicine, Kohka Public Hospital
3 Department of Central Clinical Laboratory, Kohka Public Hospital

  We report a CPC record on the autopsy case of a 75-year-old male who suffered from intravascular lymphoma. She was followed up due to diabetes mellitus and angina pectoris and was admitted to our hospital due to aggravated chest pain. She had lasting fever, elevated CRP and LOH levels, renal failure, pancytopenia and faint chest shadows. High-level soluble IL-2 receptor was detected, whereas no abnormal uptake was noted in Garium scintigram. Brain CT disclosed a cerebellar infarct. On the 20th day of admission, she died of cardiopulmonary arrest. At autopsy, intravascular large neoplastic B cells were detected in lung, heart, pancreas, urinary bladder and prostate, in addition to diabetic nephropathy and hemophagocytosis. The heart had multiple small infarcts, and the lung had scattered collapse with hyaline membranes. The CNS may be also involved in this lymphoma and the aggravation of the involvement may be the cause of death, though brain could not be examined at autopsy. We discussed how we could deal with this disease, which is often presented as a diagnostic enigma.

Key words: CPC, intravascular lymphoma, soluble IL-2 receptor