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Timely Diagnosis and Successful Treatment of Intravascular Large B-Cell Lymphoma in an Elderly Patient with Poor Performance Status

Patient: Male, 82 Final Diagnosis: Intravascular large B cell lymphoma Symptoms: Altered mental state Medication: — Clinical Procedure: Random skin biopsy Specialty: Hematology OBJECTIVE: Management of emergency care BACKGROUND: Intravascular large B-cell lymphoma (IVLBCL) is a rare type of extranod...

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Autores principales: Kaito, Satoshi, Muto, Hideharu, Miyawaki, Shuichi, Ohashi, Kazuteru, Tomiyama, Junji
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International Scientific Literature, Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561137/
https://www.ncbi.nlm.nih.gov/pubmed/31155607
http://dx.doi.org/10.12659/AJCR.915189
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author Kaito, Satoshi
Muto, Hideharu
Miyawaki, Shuichi
Ohashi, Kazuteru
Tomiyama, Junji
author_facet Kaito, Satoshi
Muto, Hideharu
Miyawaki, Shuichi
Ohashi, Kazuteru
Tomiyama, Junji
author_sort Kaito, Satoshi
collection PubMed
description Patient: Male, 82 Final Diagnosis: Intravascular large B cell lymphoma Symptoms: Altered mental state Medication: — Clinical Procedure: Random skin biopsy Specialty: Hematology OBJECTIVE: Management of emergency care BACKGROUND: Intravascular large B-cell lymphoma (IVLBCL) is a rare type of extranodal large B-cell lymphoma characterized by involvement of lymphoma cells in the lumina of small blood vessels in various organs. Although many studies have claimed that timely diagnosis and early initiation of chemotherapy are important, the literature on the successful treatment of IVLBCL in elderly patients over the age of 80 years is scarce. CASE REPORT: An 82-year-old man presented with abnormal elevation of lactate dehydrogenase at 1605 IU/L and altered mental status, which manifested as forgetfulness, abnormal behavior, and worsening performance status for 2 days. There was no evidence of lymphadenopathy or skin lesions, but a computed tomography scan of the chest showed bilateral diffuse ground-glass opacities. With a primary consideration of IVLBCL, random skin biopsy and transbronchial lung biopsy were performed. Immediately after the pathologic findings on hematoxylineosin staining alone revealed abnormal large cells in the small vessels, chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) at half the usual dose was started; later on, immunostaining revealed CD20 expression in the abnormal lymphoid cells. Immediately after CHOP administration, his mental and physical symptoms rapidly resolved. After 8 cycles of dose-reduced CHOP with rituximab, he remained free from disease progression 2 years after the diagnosis. CONCLUSIONS: We presented a case of successful early chemotherapy for IVLBCL in an elderly patient with poor performance status. Early chemotherapy with CHOP, even before obtaining a definitive diagnosis based on immunostaining, may contribute to good outcomes.
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spelling pubmed-65611372019-06-26 Timely Diagnosis and Successful Treatment of Intravascular Large B-Cell Lymphoma in an Elderly Patient with Poor Performance Status Kaito, Satoshi Muto, Hideharu Miyawaki, Shuichi Ohashi, Kazuteru Tomiyama, Junji Am J Case Rep Articles Patient: Male, 82 Final Diagnosis: Intravascular large B cell lymphoma Symptoms: Altered mental state Medication: — Clinical Procedure: Random skin biopsy Specialty: Hematology OBJECTIVE: Management of emergency care BACKGROUND: Intravascular large B-cell lymphoma (IVLBCL) is a rare type of extranodal large B-cell lymphoma characterized by involvement of lymphoma cells in the lumina of small blood vessels in various organs. Although many studies have claimed that timely diagnosis and early initiation of chemotherapy are important, the literature on the successful treatment of IVLBCL in elderly patients over the age of 80 years is scarce. CASE REPORT: An 82-year-old man presented with abnormal elevation of lactate dehydrogenase at 1605 IU/L and altered mental status, which manifested as forgetfulness, abnormal behavior, and worsening performance status for 2 days. There was no evidence of lymphadenopathy or skin lesions, but a computed tomography scan of the chest showed bilateral diffuse ground-glass opacities. With a primary consideration of IVLBCL, random skin biopsy and transbronchial lung biopsy were performed. Immediately after the pathologic findings on hematoxylineosin staining alone revealed abnormal large cells in the small vessels, chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) at half the usual dose was started; later on, immunostaining revealed CD20 expression in the abnormal lymphoid cells. Immediately after CHOP administration, his mental and physical symptoms rapidly resolved. After 8 cycles of dose-reduced CHOP with rituximab, he remained free from disease progression 2 years after the diagnosis. CONCLUSIONS: We presented a case of successful early chemotherapy for IVLBCL in an elderly patient with poor performance status. Early chemotherapy with CHOP, even before obtaining a definitive diagnosis based on immunostaining, may contribute to good outcomes. International Scientific Literature, Inc. 2019-06-03 /pmc/articles/PMC6561137/ /pubmed/31155607 http://dx.doi.org/10.12659/AJCR.915189 Text en © Am J Case Rep, 2019 This work is licensed under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) )
spellingShingle Articles
Kaito, Satoshi
Muto, Hideharu
Miyawaki, Shuichi
Ohashi, Kazuteru
Tomiyama, Junji
Timely Diagnosis and Successful Treatment of Intravascular Large B-Cell Lymphoma in an Elderly Patient with Poor Performance Status
title Timely Diagnosis and Successful Treatment of Intravascular Large B-Cell Lymphoma in an Elderly Patient with Poor Performance Status
title_full Timely Diagnosis and Successful Treatment of Intravascular Large B-Cell Lymphoma in an Elderly Patient with Poor Performance Status
title_fullStr Timely Diagnosis and Successful Treatment of Intravascular Large B-Cell Lymphoma in an Elderly Patient with Poor Performance Status
title_full_unstemmed Timely Diagnosis and Successful Treatment of Intravascular Large B-Cell Lymphoma in an Elderly Patient with Poor Performance Status
title_short Timely Diagnosis and Successful Treatment of Intravascular Large B-Cell Lymphoma in an Elderly Patient with Poor Performance Status
title_sort timely diagnosis and successful treatment of intravascular large b-cell lymphoma in an elderly patient with poor performance status
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6561137/
https://www.ncbi.nlm.nih.gov/pubmed/31155607
http://dx.doi.org/10.12659/AJCR.915189
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