Letter to the Editor
Ictus cerebellopontine as first manifestation of an intravascular diffuse large B cell lymphoma involving at the kidney
Ictus pontocerebeloso como primera manifestación de un linfoma B difuso de células grandes intravascular de localización renal
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=> array:1 [ 0 => array:4 [ "autoresLista" => "Miguel Sagüés, Viviana Paredes, Jordi Altés, Alberto Fernández de Sevilla" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Miguel" "apellidos" => "Sagüés" "email" => array:1 [ 0 => "miguel.sagues.serrano@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Viviana" "apellidos" => "Paredes" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Jordi" "apellidos" => "Altés" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Alberto" "apellidos" => "Fernández de Sevilla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servei d’Hematologia Clínica, Institut Català d’Oncologia-Hospital Duran i Reynals, Universitat de Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servei de Medicina Interna, Consorci Sanitari Integral-Hospital Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ictus pontocerebeloso como primera manifestación de un linfoma B difuso de células grandes intravascular de localización renal" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Intravascular diffuse large B-cell lymphoma (IVDLBCL) is a rare variant of the extranodal diffuse large B-cell lymphoma characterized by a selective growth of lymphomatous cells at the blood vessels lumen area, especially in capillaries, avoiding large vessels.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> This type of lymphoma is mainly diagnosed in adults of approximately 67 years, on average, and is not predominant between genders.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> There are 2 main clinical cases: Western cases, where damages are predominantly neurological and cutaneous, and Asian cases, which present multiple organ failure, pancytopenia, and hemophagocytic syndrome.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> This type of lymphoma has a limited response to chemotherapy, and its prognosis is poor.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a woman, 66 years, with no allergy to medications and no toxic habits, who was admitted to the Neurology Department of the Hospital Sant Joan Despí Moisès Broggi hospital (HSJDMB) in October, 2012, with an acute cerebellopontine ischemic infarction, diagnosed by MRI, and who recovered from it <span class="elsevierStyleItalic">ad integrum</span>. During her hospitalisation, she had episodes of fever, not predominantly in the evening, with a series of negative hemocultures. The presence of bicytopenia stood out in the analysis, with Hb 100<span class="elsevierStyleHsp" style=""></span>g/l, a platelet count of 70<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>10<span class="elsevierStyleSup">9</span>/I, an ESR of 120<span class="elsevierStyleHsp" style=""></span>mm/first hour, LDH 480 UI/I, and Beta-2 microglobulin 4.25<span class="elsevierStyleHsp" style=""></span>mg/dl; kidney and liver functions were preserved, and the 24-hour urinalysis was strictly normal. The patient underwent a CT scan, showing homogeneous hepatosplenomegaly and a bilateral renal mass. She was transferred to the HSJMB Internal Medicine Unit for the study of the mass, and an ultrasound-guided renal biopsy was performed. The anatomopathological results obtained were indicative of a diagnosis of an IVDLBCL, affecting glomerular blood vessels lumen. The immunohistochemistry was positive for CD20 and for negative for BCL2 and BCL6; Ki67 was >70% and showed a clonal ordering of immunoglobulin heavy chain. A PET was done for additional testing, showing pathological spreading affecting hepatosplenic structures, kidneys, both suprarenal glands, uterus and bone structures (left iliac crest, and vertebrae C7, T10–T12 and L2–L5). The biopsy of the bone marrow showed a sinusoidal infiltration caused by lymphoma, with preservation of the haematopoiesis. A lumbar puncture was performed, indicating infiltration by lymphoma. The definitive diagnosis was stage ivE B IVDLBCL by infiltration of bone marrow, CNS, hepatosplenic, renal, suprarenal, uterine and multiple-bone structures, IPI 5/5. The patient received a first-line treatment following the R-CHOP (rituximab, cyclophosphamide, adriamycin, vincristine and prednisone) protocol, as well as a triple intrathecal chemotherapy treatment consisting of methotrexate cytarabine and hydrocortisone, for a total of 8 cycles, obtaining complete remission (CR). In May 2013, consolidation therapy was given to the patient through peripheral blood hematopoietic progenitors autologous transplant, with a preparation according to the scheme BEAM (BCNU, Etoposide, Ara-C and Melphalan). The patient, who was re-evaluated by PET, general analysis, and medullar biopsy, has remained in CR 5 months after the transplant.</p><p id="par0015" class="elsevierStylePara elsevierViewall">IVDLBCL is a rare variant of the diffuse large B-cell lymphoma in Western clinical cases, most frequently affecting the CNS and cutaneous structures, and presenting fever without a focus.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,4–6</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The first case of IVDLBCL diagnosed by means of a renal biopsy was described in 1981,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> and has been reviewed 21 times since then.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">6,8,9</span></a> This lymphoma is most commonly located in the renal glomerular capillary lumen area.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> Some of the most frequent clinical findings in cases of IVDLBCL affecting kidneys are acute renal failure with urine protein in nephrotic range,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> as opposed to the case we described above.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Since there is no standard treatment for IVDLBCL, chemotherapy treatment schemes for aggressive types of lymphomas are administered, preserving the CNS, since it is frequently damaged. Response to chemotherapy is poor,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> despite the fact that adding rituximab to standard treatment schemes has significantly improved the management of this type of lymphoma, with an increase in progression-free survival rates and global survival rates<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a>.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Lastly, neurological disturbances, as well as the presence of pancytopenia, elevated levels of LDH and Beta-2 microglobulin, with or without multiple organ failure, should lead to suspect the presence of an underlying lymphoproliferative disorder similar to the one presented by the abovementioned female patient.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Sagüés M, Paredes V, Altés J, Fernández de Sevilla A. Ictus pontocerebeloso como primera manifestación de un linfoma B difuso de células grandes intravascular de localización renal. Med Clin (Barc). 2015;144:48–49.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "WHO classification of tumors of haematopoietic and lymphoid tissues" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.H. Swerdlow" 1 => "E. Campo" 2 => "N.L. Harris" 3 => "E.S. Jaffe" 4 => "S.A. Pileri" 5 => "H. Stein" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "4th ed." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 0 | 1 |
| 2017 October | 5 | 2 | 7 |
| 2017 September | 10 | 3 | 13 |
| 2017 August | 5 | 1 | 6 |
| 2017 July | 10 | 1 | 11 |
| 2017 June | 6 | 2 | 8 |
| 2017 May | 3 | 5 | 8 |
| 2017 April | 5 | 4 | 9 |
| 2017 March | 12 | 2 | 14 |
| 2017 February | 6 | 0 | 6 |
| 2017 January | 3 | 0 | 3 |
| 2015 November | 1 | 1 | 2 |
