Intravascular large B-cell lymphoma diagnosed at autopsy

Abstract

Background: Intravascular large B-cell lymphoma is a rare, extranodal lymphoma characterised by intravascular growth of a malignant mature B-cell population, primarily affecting capillaries. Pre-mortem diagnosis can be challenging as patients often present with non-specific clinical findings including fever of unknown origin, decreased general condition and neurological abnormalities. Radiological findings may be non-specific or falsely negative. Aims: We present the case of an 87-year-old lady who presented to hospital with cognitive and functional decline, headache and presumed transient ischaemic attacks. Despite extensive investigations a definitive cause for her symptoms was unable to be established prior to her death. Autopsy revealed multiorgan involvement by intravascular large B-cell lymphoma. Methods: The patient underwent a full non-coronial hospital autopsy. With consent, the patient’s brain was retained for extended fixation and neuropathological assessment which also revealed widespread lymphomatous infiltration. Results and conclusions: This case demonstrates a rare case of intravascular large B-cell lymphoma diagnosed at autopsy and highlights the difficulties in pre-mortem diagnosis due to the non-specific clinical presentation and lack of diagnostic radiological features.