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Open Access Case Report

Diffuse large B-cell lymphoma presenting with neurolymphomatosis and intravascular lymphoma: a unique autopsy case with diverse neurological symptoms

Sohsuke Yamada1*, Akihide Tanimoto12, Atsunori Nabeshima1, Takashi Tasaki1, Ke-Yong Wang1, Shohei Kitada13, Hirotsugu Noguchi1 and Yasuyuki Sasaguri1

Author Affiliations

1 Department of Pathology and Cell Biology, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, 807-8555, Japan

2 Department of Molecular and Cellular Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, 890-8544, Japan

3 Department of Urology, School of Medicine, University of Occupational and Environmental Health, 1,3. Kitakyushu City, Japan. 2, Kagoshima City, Japan

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Diagnostic Pathology 2012, 7:94  doi:10.1186/1746-1596-7-94

Published: 13 August 2012

Abstract

A 78-year-old Japanese male noticed a difficulty in the beginning of standing up, followed by 7a progressive numbness of extremities with pain, Bell’s palsy, dysarthria, and difficulty in swallowing. A clinician had suspected cancer of unknown primary origin, accompanied by the diverse and elusive neurological symptoms, likely presenting as painful mononeuropathy simplex and cranial neuropathy. He developed dysbasia over weeks and died 1 month after the symptom onset. At autopsy, an ill-defined large and soft tumor mass in the right lobe of the liver with direct invasion into the right adrenal gland was observed. The left adrenal gland or right iliopsoas muscle was also involved. Microscopic findings showed a monotonous proliferation of medium-sized to large atypical lymphoid cells, which were diffusely positive for CD20 in immunohistochemistry, consistent with diffuse large B-cell lymphoma (DLBL). Furthermore, the lymphoma cells aggressively infiltrated endoneurial and subperineurial spaces not only in the peripheral nerves and plexuses, but partly in the spinal nerve roots, and intravascular spaces in various tissues. Therefore, systemic lymphoma (DLBL) complicated with neurolymphomatosis (NL) and intravascular lymphoma (IVL) was diagnosed. Very early diagnosis and treatment are necessary for the NL patients with poor prognosis.

Virtual slides

The virtual slides for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/5862472377020448 webcite.

Keywords:
Neurolymphomatosis (NL); Peripheral nerve; Intravascular lymphoma (IVL); Diffuse large B-cell lymphoma (DLBL)