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Intravascular Large B Cell Lymphoma as a Rare Cause of Reversed Halo Sign

View Article: PubMed Central - PubMed

ABSTRACT

Intravascular large B cell lymphoma (IVLBCL) is a rare type of extranodal diffused large B-cell lymphoma. IVLBCL with primary lung lesion is very rare and it is very difficult to diagnose. Radiographic findings of pulmonary IVLBCL are nonspecific and resembling interstitial lung diseases. Reversed halo sign (RHS) was initially reported in patients diagnosed with cryptogenic organizing pneumonia and then described in a variety of diseases with inflammatory, infectious, autoimmune, and malignant causes. This is the first case of IVLBCL that has presented with RHSs on CT scan.

A 59-year-old Chinese man presented with a 4-month history of a nonproductive cough and a weight loss of 5 kg. Physical examination was unremarkable. High-resolution computed tomography scan of the chest showed bilateral patchy ground glass opacities (GGOs) and RHSs. Laboratory tests were unremarkable except elevated serum lactate dehydrogenase (LDH). Surgical lung biopsy was performed. Light microscopic examination of the specimen disclosed diffuse alveolar septal widening caused by neoplastic lymphocytes, which were positive for CD20 and infiltrated in the alveolar capillaries. The patient was diagnosed with IVLBCL and underwent chemotherapy and autologous blood stem cell transplantation. The patient is still alive 5 years after diagnosis.

IVLBCL is a rare cause of RHS and should be considered in differential diagnosis of RHS. An increased serum LDH concentration is another important clue.

No MeSH data available.


Related in: MedlinePlus

Imaging of the lung. (A) High-resolution computed tomography scans demonstrate multiple ground-glass opacities bilaterally in the uppers lung and a small nodule (arrow) in the right upper lung. (B–F) High-resolution computed tomography scans demonstrate bilateral patchy ground-glass opacities, multiple lesions of the reversed halo sign (arrowhead).
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Figure 1: Imaging of the lung. (A) High-resolution computed tomography scans demonstrate multiple ground-glass opacities bilaterally in the uppers lung and a small nodule (arrow) in the right upper lung. (B–F) High-resolution computed tomography scans demonstrate bilateral patchy ground-glass opacities, multiple lesions of the reversed halo sign (arrowhead).

Mentions: The chest radiograph revealed patchy high-attenuation opacities predominantly in the upper lungs. A high-resolution computed tomography (HRCT) scan of the chest showed bilateral patchy ground-glass opacities (GGOs) and RHSs predominantly in the upper lungs (Figure 1A-F). There was a small nodule in the right upper lung (Figure 1A). No enlarged lymph nodes or pleural effusions were identified. In the nonenhanced CT scan of the abdomen that was performed simultaneously, there was no evidence of lymphadenopathy or splenomegaly.


Intravascular Large B Cell Lymphoma as a Rare Cause of Reversed Halo Sign
Imaging of the lung. (A) High-resolution computed tomography scans demonstrate multiple ground-glass opacities bilaterally in the uppers lung and a small nodule (arrow) in the right upper lung. (B–F) High-resolution computed tomography scans demonstrate bilateral patchy ground-glass opacities, multiple lesions of the reversed halo sign (arrowhead).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998387&req=5

Figure 1: Imaging of the lung. (A) High-resolution computed tomography scans demonstrate multiple ground-glass opacities bilaterally in the uppers lung and a small nodule (arrow) in the right upper lung. (B–F) High-resolution computed tomography scans demonstrate bilateral patchy ground-glass opacities, multiple lesions of the reversed halo sign (arrowhead).
Mentions: The chest radiograph revealed patchy high-attenuation opacities predominantly in the upper lungs. A high-resolution computed tomography (HRCT) scan of the chest showed bilateral patchy ground-glass opacities (GGOs) and RHSs predominantly in the upper lungs (Figure 1A-F). There was a small nodule in the right upper lung (Figure 1A). No enlarged lymph nodes or pleural effusions were identified. In the nonenhanced CT scan of the abdomen that was performed simultaneously, there was no evidence of lymphadenopathy or splenomegaly.

View Article: PubMed Central - PubMed

ABSTRACT

Intravascular large B cell lymphoma (IVLBCL) is a rare type of extranodal diffused large B-cell lymphoma. IVLBCL with primary lung lesion is very rare and it is very difficult to diagnose. Radiographic findings of pulmonary IVLBCL are nonspecific and resembling interstitial lung diseases. Reversed halo sign (RHS) was initially reported in patients diagnosed with cryptogenic organizing pneumonia and then described in a variety of diseases with inflammatory, infectious, autoimmune, and malignant causes. This is the first case of IVLBCL that has presented with RHSs on CT scan.

A 59-year-old Chinese man presented with a 4-month history of a nonproductive cough and a weight loss of 5 kg. Physical examination was unremarkable. High-resolution computed tomography scan of the chest showed bilateral patchy ground glass opacities (GGOs) and RHSs. Laboratory tests were unremarkable except elevated serum lactate dehydrogenase (LDH). Surgical lung biopsy was performed. Light microscopic examination of the specimen disclosed diffuse alveolar septal widening caused by neoplastic lymphocytes, which were positive for CD20 and infiltrated in the alveolar capillaries. The patient was diagnosed with IVLBCL and underwent chemotherapy and autologous blood stem cell transplantation. The patient is still alive 5 years after diagnosis.

IVLBCL is a rare cause of RHS and should be considered in differential diagnosis of RHS. An increased serum LDH concentration is another important clue.

No MeSH data available.


Related in: MedlinePlus