Intravascular lymphoma

Case contributed by Dr Jini P Abraham

Presentation

Presented with right lower limb swelling and Doppler revealed deep venous thrombosis

Patient Data

Age: 70 years
Gender: Male
CT

Bulky right adductor and pectineus muscles of thigh with heterogeneously enhancing lesion within, with associated inguinal lymphadenopathy; filling defects in right common femoral vein extending into inferior vena cava – likely neoplastic etiology with tumor thrombus formation.

Multiple retroperitoneal, mesenteric and peritoneal nodular deposits noted.

Multiple nodular opacities in bilateral lung fields – likely metastases.

Filling defects in visualized branches of pulmonary artery in right lower lobe and posterobasal segment of left lower lobe – suggestive of thromboembolism.

Few small cysts noted in liver.

Case Discussion

Ultrasound guided biopsy of deep inguinal lymph node on right side and external iliac vein thrombus was performed.

Microscopy: Sections shows multiple linear cores of tumor tissue composed of sheets of cohesive large lymphoma cells with hyperchromatic nuclei and indistinct nucleoli. Extensive areas of fibrin, hemorrhage and necrosis seen. Sections from external iliac vein thrombus shows tumor tissue of above mentioned morphology.

Features are in favor of intravascular large B cell lymphoma.

Tumor thrombus from either a primary nodal mass or primary extranodal mass is an unusual manifestation of lymphoma. The mechanism of tumor thrombus formation in lymphoma is unclear and poses a diagnostic dilemma.

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