PULMONARY INVOLVEMENT IN INTRAVASCULAR LARGE B-CELL LYMPHOMA

Abstract

PURPOSE: To describe the clinical and radiologic correlates of pulmonary involvement with intravascular large B Cell Lymphoma (IVLBCL). METHODS: We retrospectively identified 26 patients with IVLBCL encountered between 1998-2017 at Mayo Clinic, Rochester, Minnesota. We analyzed five of these patients (19%) who had pulmonary involvement confirmed histopathologically (3 surgical lung biopsy, 2 autopsy). RESULTS: Median age was 68 years (range 44-73) and included 1 woman. On presentation, 4 (80%) patients had respiratory complaints including dyspnea, hypoxia, cough, and tachypnea. Chest radiography failed to demonstrate parenchymal infiltrates in all patients. Chest computed-tomography (CT) was obtained in 4 patients revealing intrathoracic adenopathy in all 4 patients and diffuse ground glass opacities in 1 (25%) patient. Two patients underwent positron emission tomography (PET) scanning before treatment and fluorodeoxyglucose (FDG) avidity was noted in intrathoracic adenopathy in one patient; neither manifested parenchymal FDG avidity. Pulmonary function test obtained in 3 patients demonstrated reduced diffusing capacity of the lungs for carbon monoxide (DLCO) in all. Two patients were diagnosed to have IVLBLC only at autopsy. Remaining 3 patients were initiated on chemotherapy; two died within a few months after initiating treatment, one remains in remission at four year follow-up. CONCLUSIONS: IVLBCL is a rare form of non-Hodgkin lymphoma that is difficult to diagnose and pulmonary involvement may be radiologically occult including on CT and PET scanning. CLINICAL IMPLICATIONS: Absence of radiologic abnormalities on CT or PET scanning does not exclude the diagnosis of IVLBCL in patients presenting with respiratory symptoms, decreased diffusing capacity, and intrathoracic adenopathy.