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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2021; 42(05): 501-505
DOI: 10.1055/s-0041-1735518
Case Report with Review of Literature

The Rare Face of an Infrequent Lymphoma Diagnosed by an Exquisite Method: Case Report with Review of Literature

Bhagat S. Lali
1   Department of Oncopathology, Phase II, Tata Medical Center, Kolkata, West Bengal, India
,
Debdeep Dey
1   Department of Oncopathology, Phase II, Tata Medical Center, Kolkata, West Bengal, India
,
Saurabh J. Bhave
2   Department of Clinical Haematology, Tata Medical Center, Kolkata, West Bengal, India
,
Mayur Parihar
3   Department of Cytogenetics, Tata Medical Center, Kolkata, West Bengal, India
,
Dayanand Lingegowda 
4   Department of Radiology, Tata Medical Center, Kolkata, West Bengal, India
,
Jayanta Das 
5   Department of Nuclear Medicine, Tata Medical Center, Kolkata, West Bengal, India
,
Suvadip Chatterjee
6   Department of Gastroenterology, Tata Medical Center, Kolkata, West Bengal, India
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Abstract

Large B-cell lymphomas include both the commonly encountered, as well as not so frequent entities. We report a rare case of hepatic intravascular large B-cell lymphoma (IVLBCL). These cases usually pose a major challenge to timely diagnosis due to the limited clinical exposure and nonspecific symptoms; however, timely diagnosis is possible with awareness of this entity and close coordination between radiology and pathology. The patient presented with pain abdomen, fever, edema, hepatomegaly but no lymphadenopathy or cutaneous lesions were identified. Blood investigations revealed pancytopenia, high lactate dehydrogenase (LDH) levels and bone marrow investigations were not helpful. Left-sided portal hypertension, coagulopathy, and hypoalbuminemia raised a clinical suspicion of chronic liver disease with high LDH levels and liver biopsy was challenging in view of very low platelet counts. The uniquely explored transjugular biopsy helped in obtaining liver tissue which showed sinusoidal large atypical lymphoid cells positive for CD20 rendering a diagnosis of IVLBCL. After administration of the R-miniCHOP chemotherapy, there was evident clinical and radiological response. This case highlights the importance of considering transjugular liver biopsy in scenarios where the clinical presentation is unusual. At the same time, a meticulous histological examination is needed to diagnose a rare yet potentially treatable large B cell lymphoma.

Keywords

lymphoma - intravascular - transjugular liver biopsy - challenging - rituximab

Ethical Consideration

Informed consent was obtained from the patient to use the material and case details for academic purposes.


Author Contributions

D.D. diagnosed the histology case. M.P. interpreted the cytogenetics report. M.P., DD, and B.S.L. prepared the manuscripts. S.J.B. and S.C. were responsible for treating the patient. D.L. did the transjugular liver biopsy, while J.D interpreted the pre and postchemotherapy positron emission tomography -computed tomography (PET-CT) scans. All authors read and approved the manuscripts.


Supplementary Material



Publication History

Article published online:
24 December 2021

© 2021. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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