‘A diagnostic test was completed’ – a case of intravascular large B cell lymphoma

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 94; no. Suppl 1; p. A76
• Main Authors: Robinson, Rebecca, Herron, Brian, Moore, Michelle, Lawless, Sarah, Harley, Martin, Kennedy, Fiona
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.11.2023
• Subjects: Biopsy; Lymphoma
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/JNNP-2023-ABN.234

IntroductionIntravascular large B-cell lymphoma (IVLBCL) is a rare, devastating disease affecting the nervous system, diagnosed mostly on post-mortem.CasePatient A is a 58-year-old man who presented with confusion, hallucinations and paraesthesia of the left arm. Brain imaging was strikingly abnormal, offering a wide differential diagnosis. MRI brain with contrast showed leptomeningeal and parenchymal enhancement. Multiple confluent abnormalities were present in both hemispheres, cortical and subcortical, with associated microhaemorrhages. Cerebral angiography was normal. Cerebrospinal fluid showed normal constituents.He progressed both clinically and radiologically. His level of consciousness fluctuated. Corticosteroids were trialled, with some clinical improvement but then held to facilitate a brain biopsy. He required intubation and ventilation to facilitate transfer for biopsy.Biopsy was completed of a right parietal, contrast enhancing, lesion. Histological examination showed large neoplastic lymphoid cells lodged within the lumina of small to medium sized vessels. The morpho- logical features and immunophenotyping was in keeping with IVLBCL. Surrounding brain tissue showed ischaemic changes and thrombi within the blood vessels.DiscussionThe lack of specific radiological findings in IVLBCL can make ante-mortem diagnosis challen- ging. Differential diagnosis can often be wide and consideration for biopsy should be taken especially when lymphoma is suspected, to guide treatment avenues.